Chronic Care Management Services: Advantages for Your Practices

Transcription

1 Chronic Care Management Services: Advantages for Your Practices Rachel S. Eichenbaum, RN, MSN Yvonne La-Garde, M.ED Susan Whittaker, CPC, CPMA This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO), the Medicare Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMSQINB

2 Presenter Rachel S. Eichenbaum, RN, MSN

3 Agenda CMS quality goals and strategies Overview of Chronic Care Management (CCM) Codes Required elements of CCM codes Putting these codes to work for you and your patients Resources Questions

4 Objectives Describe the core attributes of the new Medicare Chronic Care Management (CCM) Codes Give examples of chronic care management activities that count toward the CCM codes

5 New England QIN-QIO Two successful healthcare quality organizations pool expertise and resources to engage beneficiaries and providers in improving care, improving health and reducing costs across New England Led and administered by Healthcentric Advisors in partnership with Qualidigm Healthcentric Advisors: MA, ME, RI Qualidigm : CT, NH, VT

6 Centers for Medicare and Medicaid Triple Aim Population Health Patient experience Per capita cost

7 Chronic Care Model The task of meeting the complex needs of people with chronic illness is the single greatest challenge facing organized medical practice. Edward W. Wagner, MD, MPH

8 What is the Chronic Care Model? Focus on patients with chronic disease Support informed, activated patients Become a proactive healthcare team Move from fee for service to team based care

9 What is the Chronic Care Model? Six elements Health system or organization Staff Values and goals Clinical Information Systems Able to track patient with multiple chronic conditions Information exchange between providers and patient Decision support Evidence-based practice Patient preference

10 What is the chronic care model? Delivery system design Review delivery of Healthcare services Opportunity to improve care delivery Self-Management Support Patient s role in caring for their chronic illness Self-Management education Community Resources Programs in the community to support patient Financial, emotional, educational

11 Why Chronic Care Management Services? Telephonic care management services study Improved patient satisfaction Increased communication with providers Enhanced self-management skills Increasing use of preventative services Decreased hospitalizations Decreased Medical costs (Wenneberg et al., 2010)

12 Why Chronic Care Management Services? Better health outcomes Improved communication between providers and patients Care coordination for multiple health conditions Better care transitions Maximize health through focused management of existing conditions Payment for services you already do

13 Why is Medicare concerned? Percent of Medicare Beneficiaries with Chronic conditions 36.40% 68.40% 2 or more 4 or more

14 Cost of Chronic Conditions Mortality rates associated with common chronic illnesses 2.80% 5.90% 25.70% 21.70% Heart Disease Cancer Stroke Diabetes

15 Cost of Chronic Conditions: Health Services Utilization Highest among Medicare Beneficiaries with multiple chronic conditions More Chronic conditions > more hospitalizations & ED visits

16 Cost of Chronic Conditions: Expenditures $35,000 $30,000 $25,000 Per capita Medicare spending for beneficiaries with chronic conditions $20,000 $15,000 $10,000 CC 0-1 CC2-3 CC 4-5 CC6+ $5,000 $- National New Hampshire Mass Maine

17 Presenter Yvonne La-Garde, M.ED

18 Frenchie s Story: The Case for Chronic Care Management

19 Frenchie s Story: The case for Chronic Care Management

20 Frenchie s Story: The Case for Chronic Care Management

21 Presenter Susan Whittaker, CPC, CPMA

22 Chronic Care Management Services By covering non face-to-face encounters, chronic care management (CCM) services support the shift from a fee-for-service care model to a medical team-based approach for chronically ill patients.

23 Benefits of receiving CCM services Patient benefits Team of health care professionals Personalized care plan Focused support between medical visits Better care transitions Increased self-management

24 Benefits of providing CCM services Provider benefits Billing for services you already provide Capturing additional revenue for the assessment & plan for CCM services Improves care coordination and transitions Supports patient/ family adherence to care plans Increases patient-practice communication Sustains and grows your practice

25 CCM Patient Eligibility Medicare or dual eligible (Medicare & Medicaid) Diagnostic Criteria 2 or more chronic illnesses expected to last at least 12 months, with risk of exacerbation decompensation functional decline death

26 Chronic Condition Examples include but are not limited to: Alzheimer's/ dementia Arthritis (osteoarthritis, rheumatoid) Asthma Atrial Fibrillation Autism disorders Cancer COPD Cardiovascular disease Depression Diabetes Hypertension Infectious disease; i.e., hepatitis, HIV

27 Who Can Provide Services? All Clinical staff and office staff as directed by physicians & non-physician practitioners Physician Nurse practitioner Physician s Assistant Certified Nurse Midwives Clinical Nurse Specialists

28 Initiating Visit Established patients CCM may be initiated with consent, and creation of a care plan at any time for an established patient seen within the past year. New patients, or those not seen within a year An initiating visit (IPPE, AWV or office visit), consent & care plan are required Patients requiring a comprehensive assessment for CCM may be billed a Comprehensive assessment service (G0506) in addition to the initiating visit Consent may be verbal but must be documented in the medical record

29 Codes Demystified G0506 comprehensive assessment (medical, functional, psychosocial) and care planning for patients requiring chronic care management services May be charged in addition to an E&M or AWV Copy of care plan is given to patient/ caregivers Approximate non-facility rate $64.00

30 Codes Demystified CPT Chronic Care Management at least 20 minutes of clinical staff time per calendar month coordinate care for 2 or more chronic conditions Approximately non-facility rate $43

31 Codes Demystified CPT Complex Chronic Care Management At least 60 minutes of clinical staff time per month Moderate or high complexity medical decision making Approximate non-facility rate $94

32 Codes Demystified CPT Complex Chronic Care Management, each additional 30 minutes Used with CPT as add on code Moderate or high medical decision-making Approximate non-facility rate + $47

33 Coding Summary G0506 Comprehensive CCM assessment & plan $ CCM services, 20 minutes $ Complex CCM services, 60 minutes $ each additional 30 minutes +$47

34 Chronic Care Management Care Plan Comprehensive Care Plan (with patient engagement) includes Problems Prognosis Measurable goals Symptom management Interventions Community services plan Review date

35 What actions count as CCM services? Coordination of community based services Connecting patient with needed services Patient/ practice communication Phone, through portal Medical record and lab review Medication management Rx, medication changes Specialty referrals Coordinating care with other providers Disease & Care plan updates

36 CCM Medical Record Documentation Maintain a monthly Chronic Care Management summary of actions, including Date of the action? Who performed the action? Time spent performing the action?

37 CCM Medical Record Documentation Using a Certified Electronic Health Record, maintain a current Problem List Medication reconciliation Health History

38 Chronic Care Management Billing Information Create an encounter each month for tracking the summary of actions for CCM documentation Bill at the end of each calendar month Bill before end of month if CCM services are completed Patient s request to discontinue CCM services would be effective at the end of the calendar month

39 CCM services may not be billed in conjunction with: TCM transitional care management(99495/ 99496) Home health supervision (G0181) Hospice Supervision (G0182) ESRD services ( ) Prolonged E&M services Another provider s CCM

40 CMS CCM Links Connected Care: The Chronic Care Management Resource Code and billing changes Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/ChronicCareManageme ntserviceschanges2017.pdf Document about chronic care management Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/ChronicCareManageme nt.pdf

41 Contact Information Rachel Eichenbaum, RN, MSN Yvonne La-Garde, M.ED Susan Whittaker, CPC, CPMA

42 Your Turn

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