Healthcare News & Insights

3 chronic care hurdles hospitals should plan for

Providers can finally get paid for coordinating care for patients with chronic illnesses, but it won’t be all smooth sailing when it come to getting reimbursement for chronic care management (CCM).

504564037In an attempt to cut costs and reduce adverse patient outcomes associated with these conditions, providers now can be reimbursed for services they likely already perform for chronically-ill patients.

There are many reasons why hospitals will want to take advantage of the new CCM code from the Center for Medicare & Medicaid Services (CMS).

For one, CMS pays providers a monthly rate of $42.60 for each 20-minute period of CCM with patients who have two or more chronic diseases. That means CCM gives hospitals an opportunity to add a small boost to their bottom lines since so many people are afflicted with chronic diseases.

In a 2013 study by the Department of Health and Human Services, about a quarter of all Americans are living with multiple chronic conditions. And about two-thirds of Medicare beneficiaries with multiple chronic conditions made up over 90% of the programs spending.

Reimbursement barriers

However, CMS indicated that providers have to meet other criteria in order to qualify for CCM payments. And some of the criteria can trip up hospitals trying to qualify for CCM reimbursement, according to a recent Medical Economics article.

In particular, hospitals may run into issues with three specific requirements:

  1. Using certified electronic health record (EHR) systems and interoperability. CCM-related services have to be performed using either a 2011 or 2014 certified EHR, and  all members of a health team must be able to access patients’ records. Many hospitals have already encountered problems establishing interoperability between different EHRs. As a result, facilities will have to plan ahead and establish ways for facilities and their care partners to work around any potential interoperability issues.
  2. Tracking time spent on CCM. Providers may also encounter issues with keeping thorough records of how much time was spent with each patient on CCM over each month. This can be difficult since not all services involve face-to-face care. Many EHR systems aren’t able to track time spent on each of the patient’s required CCM services, though some can be customized to do so. However, this can be costly. As an alternative, some coding experts recommend creating a paper-based “flow sheet” system to track and document CCM.
  3. Acquiring patient approval. In order to be reimbursed by CMS, your patients must first agree to pay an $8 monthly copay. CCM is still a relatively new, and some patients may not understand why they should have to pay for something they were previously getting for “free.” George Ellis, Jr., an internist in Youngstown, OH, and adviser for Medical Economics has received patient buy-in by explaining that CCM is “an attempt to control your disease process, and enable you to connect with your care team 24/7, 365 days a year to reduce or eliminate emergency department visits and hospitalizations.”

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