What is the CMS Chronic Care Management Program?

In January, the Centers for Medicare and Medicaid Services (CMS) launched a new way for Medicare patients to receive more frequent personalized care outside of the doctor’s office. The new program is called Chronic Care Management (CCM). Under this program, Medicare can reimburse primary care physicians $43.12 per patient/per month for spending at least 20 minutes in non-face-to-face consultations. Find out what CCM is, who is eligible, and what this change means for primary care physicians.

What is Chronic Care Management?

CCM is the continuous care of a patient that has chronic conditions (i.e. dementia, diabetes, etc.) from dedicated health care professionals through constant communication, increased access to care outside the doctor’s office, system-based approaches for patient assessments, coordination of care and the general ability to access expert care. The CCM program, which is provided by CMS, offers financial incentives for primary care practices to provide the much-needed support for those with chronic conditions.

Who is Eligible to Receive CCM?

Medicare patients (see if you qualify for Medicare here) are eligible if he/she has multiple chronic conditions (two or more) that are expected to last at least 12-months or until death. These requirements open this program up to approximately 33 million Medicare beneficiaries since two-thirds of all Medicare beneficiaries have two or more chronic conditions, such as:

  • Alzheimer’s Disease
  • Asthma
  • Cancer
  • Chronic Obstructive Pulmonary Disease
  • Diabetes
  • Heart Failure
  • Hypertension
  • And many others

Who is Eligible to Provide CCM?

Those eligible to provide the CCM through Medicare are physicians and non-physician practitioners including:

  • Certified nurse midwives
  • Clinical nurse specialists
  • Nurse Practitioners
  • Physician Assistants

What Is the Impact for Primary Care Physicians?

The program is still in its infancy but based on a survey of 45,000 American primary care physicians who treat Medicare patients, 67.33% of respondents are unaware or not familiar with the program (Smartlink Mobile). More than 50% of respondents are planning to launch a CCM program in their practice within a year. The program does offer great financial incentive for care but some challenges include:

  • Enrolling eligible patients
  • Lack of staff/expertise to meet the 20 minutes monthly minimum for enrolled patients
  • Maintaining an auditable record of time and tasks performed
  • Meeting the electronic requirements

Physicians need to continue to enroll CCM patients into the program. Moving forward, it is clear that educating both the eligible patient population and the health care professionals on what is available will lead to increased enrollment and use of this program.

If you are an eligible Medicare patient that has two or more chronic conditions, speak with your physician today to explore the option of Chronic Care Management.

 

.