Chronic Care Management in the Real World


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Physicians share their actual experiences, successes, and stumbles as they implement CCM in their practices.

Fam Pract Manag. 2015 Sep-Oct;22(5):35-41.

Author disclosure: no relevant financial affiliation disclosed.

The Centers for Medicare & Medicaid Services began paying physicians for providing chronic care management (CCM) services in January, but more than halfway through the year, questions remain: Are patients embracing this new benefit? Are physicians billing for it? Is Medicare actually paying for it? Are private payers getting on board?

To get a better feel for how CCM is affecting physicians and to help readers learn from others' experiences, Family Practice Management spoke to physicians in situations ranging from solo practices to large health care groups. We asked how successful they have been at getting patients to opt in, how much staff time it is taking to provide the services according to Medicare requirements, how the additional documentation requirements are handled, whether they have encountered any difficulties in getting paid, and whether they feel the extra work has been or soon would be worth it.

The physicians' responses, although not necessarily representative of all practices, were mixed. Some physicians said they saw a significant, almost immediate, increase in revenue with relatively little additional work, while others reported having stopped billing for CCM, at least temporarily, bogged down in compliance issues or combatting patient skepticism.

CCM is still evolving. But in the meantime, physicians wanting to incorporate the new payments and requirements into their practice can learn from these physicians' experiences to make their own way easier.

Getting started

Most practices interviewed said they began recruiting patients and billing for CCM as soon as it became available in January 2015. For these early adopters, it required extensive preparation, including studying and understanding the long list of program rules and determining which of their eligible patients were most likely to benefit from more focused management of their chronic conditions.

Leisa Bailey, MD, a solo family physician in Bonifay, Fla., said she was looking forward to finally getting paid for work she was already doing for her patients.

“Every time something comes up that gives you an opportunity to be rewarded for what you do, you have to grab it because you're having so many things taken away in other areas,” Bailey said, referring to reductions in Medicaid reimbursements and increased staff time dedicated to prior authorization and similar tasks.

Several physicians, including Bailey, said they initially performed financial analyses

About the Authors

David Twiddy is associate editor of Family Practice Management.

Author disclosure: no relevant financial affiliation disclosed.



Copyright © 2015 by the American Academy of Family Physicians.
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