Chronic Care Management
White Paper: Chronic Care Management Offers Enhanced Quality Care and Additional Revenue
Better management of chronic illness can help improve patient quality of life; reduce complications, emergency room visits and hospitalizations; and strengthen patient engagement, according to McKesson Business Performance Services. As value-based reimbursement (VBR) gradually supersedes the fee-for-service care model, a new CMS chronic care code provides incentives for preventive care, early intervention and care continuity. This code creates an opportunity to generate revenue for services already being performed. With a reimbursement rate of approximately $40 per enrollee per month, the new code could produce an additional $100,000 annually for a physician practice caring for 200 qualified patients.1
The new reimbursement code reflects an acknowledgment by CMS that compensation for the chronic care management (CCM) duties central to new delivery models like accountable care are not included in traditional fee-for-service payments.
Equally important from a business perspective, CCM offers a low-risk opportunity for practices to prepare for the future. Gaining experience and proficiency with population management and value-based reimbursement will become essential as Medicare shifts an ever-greater portion of its payments to these emerging methodologies.
"Embracing chronic care management is the right thing to do because it can improve quality of care and patient quality of life, and it can also help rein in the enormous cost of chronic illness," said Jeb Dunkelberger, executive director of accountable care services and corporate partnerships for McKesson Business Performance Services.
Physicians who pursue Medicare CCM reimbursement must decide whether to rely on internal staff to execute the many clinical support duties associated with the code or turn these over to a qualified outsource vendor. Each approach has benefits. However, the decision may ultimately depend on whether the practice has the internal capability to perform the code's reimbursement requirements consistently.
Download the white paper, "Chronic Care Management Offers Enhanced Quality Care and Additional Revenue," to learn more about the code and options available to practices. This white paper explores opportunities to improve care for Medicare patients with chronic conditions, as healthcare transforms from a costly fee-for-service care model to quality-driven value-based reimbursement.
1: Samuel T. Edwards, Bruce E. Landon, "Medicare's Chronic Care Management Payment - Physician Reform for Primary Care," New England Journal of Medicine, Nov. 27, 2014, http://www.nejm.org/doi/full/10.1056/NEJMp1410790