CCM resources
TMA Chronic Care Management Resource Center
www.texmed.org/ ChronicCareManage ment
TMA upcoming Chronic Care Management webinar series
www.texmed.org/ education or call TMA Practice Consulting at (800) 523-8776
ers caution the program may require heavy lifting for some practices. Still, physicians generally cheer the move as a long-overdue recognition of all that doctors do to care for patients with complex needs. And they hold hope the new code can deliver a two- for-one deal that can boost physicians’ bottom line now and better position practices for the future payment par- adigm that places a greater emphasis on quality improvement. “It is rigorous. It is lengthy and de-
tailed, and I would not do it this way. But among all the things CMS throws at us — meaningful use, PQRS [Physi- cian Quality Reporting System], and other regulations — this is a breath of fresh air and an acknowledgment of all the hard work most primary care physicians do. And that’s a lot of work,” says Austin internist Ghassan Salman, MD, a member of TMA’s Council on Health Care Quality and chief execu- tive officer of Austin Diagnostic Clinic (ADC). The primary care group is in the process of restructuring to take advantage of the new CCM program. Practices must do their own math
to decide whether the program is vi- able. But Dr. Salman says it’s about more than just money. “This is something that is in the
best interest of our patients. With the time we spend doing these things, patients will get better, physicians will get better reimbursement, and if done correctly, it will cost the sys- tem less money,” he said. As Medicare and commercial insurers increasingly turn to alternative payment models that emphasize care management and coordination to keep costs down, Dr. Salman adds: “This may become the way we practice, and the [CCM program] is a step that can help move physicians in the direction of value- based care delivery.”
BILLING THE 99490 CCM CODE Under the CCM program, physician practices can earn an average $42 per month per eligible patient for non- face-to-face care coordination ser-
46 TEXAS MEDICINE September 2015
vices. Patients must have at least two chronic conditions that are expected to last at least a year or until the death of the patient, or that create signifi- cant health risks, such as hospitaliza- tion or a decline in quality of life. “If you look at Medicare research,
that’s when costs start to go up sig- nificantly, and CMS is hoping that as groups engage this population more proactively, they will be able to ad- dress these issues before they become exceedingly acute and benefit the pa- tient, as well as Medicare, in terms of cost,” said David McCormick of In- novista Health Solutions, a partner of TMA’s physician services organiza- tion, TMA PracticeEdge. (See “Cut- ting Edge,” May 2015 Texas Medicine, pages 26–31, or
www.texmed.org/ CuttingEdge.) He is chief information officer and president for the Central Texas market. With two-thirds of Medicare pa-
tients diagnosed with two or more chronic conditions, federal officials say the program “is only one part of a multifaceted CMS initiative to im- prove Medicare beneficiaries’ access to primary care” and help reduce costs. The move builds on CMS’ 2013 codes to pay for transitional care manage- ment and dovetails with other incen- tive programs to test and encourage participation in medical homes, ac- countable care organizations (ACOs), and other alternative payment models. To bill the 99490 CCM code, prac-
tices must first get patients’ consent to participate and develop a comprehen- sive, patient-centered care plan that is electronically available at all times to all members of the practice team involved in chronic care activities. Experts say physicians can create the care plan during separate office visits or via online questionnaires. The program does not require
practices to attest to meaningful use, although many elements entail use of a certified electronic health record (EHR) system and a formal care man- agement program to capture, docu- ment, track, and share patient infor-
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