Medicare Chronic Care Management. November 8, 2017

Transcription

1 Medicare Chronic Care Management November 8, 2017

2 2 Overview 1) Overview of the Medicare CCM program 2) Chronic Care Management 2018 Service Update 3) Implementing at your Organization 1) Key Questions 2) Action Steps 3) Chronic Care Management Toolkit 4) Story From the Field Coastal Family Health Center

3 3 Medicare CCM Timeline Program 2015 Launches 2016 FQHCs eligible 2017 Rules significantly relaxed No F2F initiating visit, no signed consent, etc CODE CHANGE, enhanced payment, further eligibility

4 4 Overview of 2017 Codes

5 5 Click to edit Master title style Chronic Care Management in 2018 and Beyond

6 Rules for 2018 Establish new General Care Management G code, G0511 Payment set to average of codes 99490, , G0507 Estimated to be ~$61 PMPM for 20 minutes of care management services Requires a visit (E&M encounter, Annual wellness, etc.) within last 12 months of beginning billing of G0511that was billed as an FQHC/RHC visit Covers both traditional CCM services (such as code 99490), but also Behavioral Health Integration Services! All information sourced from CMS.gov 6

7 7 Patient Eligibility for Chronic Care Management Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, and place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline (HIV, HTN, DM, CVD, etc.)

8 8 Required Elements CCM Structured elements of patient health information (demographics, problems, medications, etc.) Patient has 24/7 access to care team or clinical staff Individualized patient care plan recorded inside of the EHR, and available to the patient

9 9 Example Services CCM Care transitions and referrals management (ED followup, hospital discharge, exchange of transitions of care documents with other practices, referral follow-up) Coordination with home and community based services Patient and care giver communication through telephone, secure messaging, internet, etc.

10 10 Patient Eligibility for General BHI Any behavioral health or psychiatric condition being treated by the RHC or FQHC PCP, including substance use disorders, that, in the clinical judgement of the RHC or FQHC practitioner, warrants BHI services

11 11 Required Elements BHI Initial assessments and follow-up monitoring using validated tools Comprehensive care plan, including revisions Care coordination and continuity of care with a designated care team member

12 12 Billing for G0511 Estimate capacity based on current staffing Identify Patients Obtain verbal consent & document in EHR Includes sharing information on cost-sharing, general program info Develop individualized care plan with patient & caregiver Perform 20 minutes of non-face-to-face services per month & document in EHR Performed by FQHC practitioner (NP, PA, MD, DO, CNM) OR by clinical personnel under general supervision Use billing code G0511 (2018) each month for ~$61 PMPM

13 13 Psychiatric Collaborative Care Model Uses code G0512 ~$ PMPM Any mental, behavioral health, or psychiatric condition being treated by the PCP, including substance use disorders, that, in the clinical judgement of the FQHC practitioner, warrants psychiatric CoCM services At least 70 minutes in the first month, and at least 60 minutes in subsequent months Requires 3 main elements FQHC PCP Behavioral Health Care Manager Psychiatric Consultant

14 14 Click to edit Master title style Implementing at your Organization

15 15 Questions to Ask Before Beginning Does my organization already provide some of these services? have a significant Medicare population? have dedicated care coordinator/management staff? Does my EHR have the required information in a documentable fashion? Which provider/care team/location should I pilot this with?

16 16 Piloting the Program Analyze the potential financial impact of this program at your organization LPHI Chronic Care Management Toolkit Determine a care team or site to engage in the planning and design EHR optimization Documentation guidelines Patient Identification/Prioritization Identification of staff to provide services Pilot the program with your selected team How did it go? What needs to change?

17 17 On Cost-Sharing Comment: Some commenters noted that patients are often unwilling to pay the patient share of care management services and requested CMS waive cost-sharing or pursue waivers for these codes. Response: We are aware that the copayment and/or deductible in RHCs and the copayment in FQHCs can be a barrier for some beneficiaries, but we do not have the statutory authority to waive these charges. Because these services are typically furnished non face-to-face, and therefore, are not visible to the patient, it is important that adequate information is provided during the consent process on cost-sharing responsibilities and the benefits of care management services. RHCs and FQHCs should also provide information on the availability of assistance to qualified patients in meeting their cost-sharing obligations, or any other programs to provide financial assistance, if applicable.

18 Utilizing the Chronic Care Management Toolkit 18

19 19 Click to edit Master title style Story From the Field Coastal Family Health Center

20 20 Coastal Family Health Center Why did Coastal choose to take advantage of the CCM program? How does it align with other work at your organization? How has Coastal approached launching their CCM program? What were the greatest challenges in kicking off the program? What advice do you have for other organizations looking into launching CCM?

21 21 References Proposed New Care Coordination Services and Payments for Rural Health Clinics and FQHCs Medicare 2018 PFS Go to page for more info Connected Care The Chronic Care Management Resource Partner Toolkit (for 2017 rules)

22 22 Questions? Jack Millaway, MS, CPHQ Stacey Curry, MPH Alvin Baker, MSW, LMSW