Posts Tagged ‘Medicare Chronic Care Management’

8 Findings from CMS Medicare Chronic Care Management Assessment

January 26th, 2018 by Patricia Donovan

YNHHS embedded care coordination

Medicare Chronic Care Management services reduced healthcare utilization and likelihood of hospital admissions for CCM recipients, according to a new CMS report.

Beneficiaries who received Chronic Care Management (CCM) services experienced a lower growth rate in healthcare expenditures compared to those who did not receive CCM services, according to a new evaluation report from the Centers for Medicare and Medicaid Services (CMS).

The lower rate of growth in total Medicare per beneficiary per month (PBPM) expenditures ranged from $28 to $74, after removing the average monthly CCM fee of $29.

The Medicare and Medicaid payor released the report on the diffusion and impact of CCM payment during the program’s first two years of implementation.

In January 2015, CMS introduced a separately billable non-face-to-face Chronic Care Management service (CPT code 99490). The goal of CCM is to improve Medicare beneficiaries’ access to chronic care management in primary care.

Here are seven more findings from the evaluation report:

  • Over 684,000 beneficiaries received CCM services from January 2015 to December 2016, the first two years of the new payment policy.
  • The decreased rate of growth was driven by decreases in expenditures for inpatient hospital services, skilled nursing facility services, and outpatient services; the decreased expenditures were partially offset by increased expenditures of home health and professional services. Researchers similarly found a lower rate of growth among CCM beneficiaries in hospitalizations and all-cause emergency department visits.
  • Receipt of CCM services was also associated with a reduced likelihood of an admission for the ambulatory care sensitive conditions of diabetes, congestive heart failure, urinary tract infection, and pneumonia among CCM beneficiaries, relative to the comparison beneficiaries.
  • A total of 16,549 individual healthcare providers billed for a total of $105.8 million in CCM fees in the first two years of the new payment policy.
  • Chronic Care Management beneficiaries were generally concentrated in the South and had poorer health status than the general Medicare fee-for-service (FFS) population.
  • About 19 percent of beneficiaries only received one month of CCM services; however the majority of beneficiaries received between four and ten months of CCM services, on average.
  • Primary care physicians (PCPs) billed for 68 percent of CCM claims and 42 percent of CCM billers were solo practitioners. Individual providers billed for $105.8 million in CCM fees during the first 24 months of the program and, on average, managed about 47 patients per month. However, the median number of patients was 10, indicating that the average was skewed by a small number of providers delivering CCM services to many beneficiaries. This translates to about $300 in CCM fees per month for providers furnishing CCM services to 10 beneficiaries.

The report did not examine the impact of 2017 CCM policy revisions that significantly increased payment for providing CCM to more medically complex patients.

Read the complete CMS Chronic Care Management evaluation report.