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Chronic Care Management Services

April 20, 2017

Iowa Medical Group Management Association

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2

Introduction

Population Health Solutions

David Beam-

Director of

Emerging Solutions


Agenda & Objectives

• Review Chronic Care Management (CCM)

• Detail CMS changes to the 2017 final rule

• CCM Program Discussion and Keys to Success


Population Health Management

CARE

COORDINATION

CONNECTIVITY &

DATA AGGREGATION

PATIENT

ENGAGEMENT

ANALYTICS

CareInMotion

PLATFORM

Catalyzing the shift from fee-for-service to fee-for-value by empowering healthcare to improve care

quality and performance while optimizing revenue and managing costs

POPULATION HEALTH

MANAGEMENT


Why Are These Areas Important?

5%=50% 66%5% of patients create

50% of the cost

Medicare beneficiaries

with 2+ chronic diseases

1. The Concentration of Health Care Spending, NIHCM. http://www.nihcm.org/pdf/DataBrief3%20Final.pdf

2. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/

3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3244301/

http://www.nihcm.org/pdf/DataBrief3 Final.pdf

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/


Alignment with The Institute for Healthcare Improvement Triple Aim

Lower Costs

Enhanced Patient

Experience

Improved Outcomes


Reimbursement for CPT code 99490 for chronic care management services began

January 2015.

Average reimbursement per patient per month is $42.60 (RHC/FQHC $40).


Requirements

20 Minutes Contact-Based Care

• Patient-Doctor, Doctor-Doctor, Pharmacy-Doctor, Lab-Doctor

• General planning time does not count

Certified EHR and Care Plan

• Physical, Mental, Cognitive, Psychosocial, Functional, Environmental, Preventative Care Services, Medication Reconciliation, Review of Adherence, Inventory of Clinicians


Comprehensive Care Plan

Medication Reconciliation

Transition of Care

Care Coordination between Providers

Chronic Care ManagementProvide a minimum of 20 minutes of Non face-to-face services including the following

program components to Medicare Patients with two or more chronic conditions :


Allscripts Chronic Care Management ServicesA team of clinical resources performing as an extension of the

provider organization, engaging with patients monthly to support

outcome driven initiatives and support billing of code 99490.


Detailed Scope of CCM ServicesCCM Services must be initiated as part of a face-to-face visit by

the provider with the patient. This visit includes:

• Comprehensive wellness exam (e.g. Initial Preventive Physical Exam (IPPE))

• G0402

• Annual Wellness Visit (AWV)

• G0438

• G0439

• Evaluation & Management visit of moderate to high medical complexity

• 99212

• 99213

• 99214

• 99215

Reference: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf


Coding

99490

Exceptions

• Only 1 provider can bill for a patient per month

• Copayments DO apply

• Dual Eligible Co-Insurance & Secondary Insurance

• Certain services cannot be billed in the same month


Overlapping Services• There are some CPT codes whose services overlap with those delivered through CCM

• CMS does not allow providers to bill for these codes in the same 30 day time period

as CCM

TCM

• Transitional Care Management, 94945

• Transitional Care Management, 94946

CPO

• Home Health Care Supervision, G0181

• Hospice Care Supervision, G0182

ESRD

• End Stage Renal Disease Services

• 90951-90970

Remote

• Analysis of Clinical Data, Computers, 99090

• Collection & Interpretation of Physiologic Data, 99091


CCM is the bridge to help providers

make the leap from fee for services

(FFS) to

value-based payment models

such as the ACO model.


CCM’s ProgressionPrior to 2015 January 2015

2017

Copyright © 2014 Population Health | Powered by Allscripts 18

Why the change?• In its 2017 final rule, CMS commented that to date, only 513,000 Medicare

beneficiaries have had a CCM claim since the program started in January of 2015.

• With tens of millions of Medicare beneficiaries expected to be eligible for CCM

services, CMS acknowledged that the uptake of the program by practices has likely

been slowed by the significant administrative burden practices face under current CCM

service elements and billing requirements.

• Over the past nearly two years, the positive intent of CMS and value of CCM

programs has been largely overshadowed by the arduous service and billing

requirements and misinformation that has surrounded the field.


Why the change?• A significant portion of the 2017 final rule discusses how Medicare is effectively

"doubling down" on its investment in care management services, which can keep

people healthier and out of hospitals and emergency rooms - while rewarding medical

providers who perform this valuable work with new revenue.

• As CMS works under mandate by MACRA to increase beneficiary access to CCM

services, it announced payment for new CCM codes that are expected to better

support complex patients and the providers who care for them, as well as new

payment mechanisms for providers who discuss CCM services with eligible patients

during regular visits.


Changes to Physician Payment Models

As such, in 2017, Medicare has made several changes expected to

reduce the administrative burden of CCM, most notably

• Removing the requirement for a written consent for patient

enrollment, and

• Removing the initiating visit requirement for patients who have

been seen within the past year by the CCM practice.


2017 Changes• Enrolling patients in CCM no longer requires a face to face visit for existing patients

that have been seen in the last year. New patients or those not been seen in the last

year still require an initiating visit.

• Separate consent forms are no longer required. However, documentation of acceptance

must exist and include: cost sharing, that only one physician can bill for CCM, patient

may stop the service at any time and whether they accepted or declined services.

• 24 x 7 Care CMS changed the 24/7 access language to be for ‘urgent’ needs rather

than ‘urgent chronic care needs.’

• CMS has finalized their change to the supervision requirement for CCM (Chronic Care

Management) services furnished by FQHCs & RHCs.

• Effective January 1, 2017 FQHCs & RHCs may provide CCM and TCM services under the

general supervision of a RHC practitioner.

• Reimbursements?


2017 Changes (Relevant?)• Additional reimbursements are provided for CCM patients of moderate and high

complexity that involve additional time. See below. (Note: CCM 99490 did not

require moderate or high complexity)

• Additional reimbursement of $68 under G code G0506 is now available upon creation

of the patient’s care plan. See below


The Keys to CCM Program Success

Enrollment

Engagement

Alignment

Measurement

Patient

Provider

Patient Engagement

Center (PEC)

Care Teams


PREPARE

BUILD

UNDERSTAND

EXCEL

SUPPORT

POSITION


Preparing for CCM Program Success

• Client Information

- Contacting the Office

- Hours of Operation

• Annual Wellness Visits

• Office Procedures

• Messaging/Tasking


IDENTIFY

PATIENTS

ENROLL

PATIENTS

ENCOUNTER/

DOCUMENT

20 MIN

Allscripts

BILL FOR

ENCOUNTER

MAKE AVAILABLE

REQUIRED CARE

PLAN

Allscripts

CCM 2016Workflow Steps

1 2 3 4 5


Care Plan Send to EHR

• Sent as a Base64 encoded PDF inside a HL7 messages

• The Care Plan is a PDF and not text

• Message can be formatted to be an ORU or MDM


Integration Points

BILL FOR ENCOUNTER5


CCM Reporting - Billing

Allscripts

Care Director


Patient Care Plan• PEC attach care plan to

patient EHR, Available to

providers 24/7 in patient EHR.

• PEC communicate key

awareness items to provider.

• PEC will send to patients on

request (choice of mail, secure

email, or secure fax)


CCM Reporting - Enrollment


CCM Reporting - Billing


CCM Services Value• Enhance patient experience & improve outcomes

– 20 Minutes of non-face-to-face care each month

– Medication reconciliation

– Create and maintain patient care plan

– Care coordination

– Transition of care from hospital

• Care Director

• Create new revenue streams

– Ability to bill 99490

– Drive new appointments with proactive outreach

– Transition of care, annual wellness exams, other E/M


Colquitt Regional Medical Center • Serving the Moultrie, GA community for more

than 70 years going back to 1893. The Medical

Center of Moultrie delivers comprehensive

medical care and services to thousands of

patients.

• More than 20 physicians at 14 different

physician offices delivering professional service

across a wide range of specialties, including

Internal Medicine, Women’s Health, Pulmonology,

Cardiology, Orthopedic Surgery, Oncology, and

many more.

• Colquitt Regional Physicians Group has

Greenway, Allscripts Pro and Aprima EHRs.


CCM Case Study: Colquitt Regional Medical Center • CRMC has been a loyal and successful ACM

client since 2013.

• The CCM opportunity was initiated at the

CNO level at CRMC.

• Doug Strange, Chief Finical Officer has been

champion of CCM project.

• Projecting 2,000 participants in the program

due to large Medicare patient population.

• High levels of patients with two Chronic Care

conditions.

• CRMC is taking out full page ad in local

newspaper advertising CCM program; to

provide better patient satisfaction.

• On July 28, 2016 Allscripts and CRMC

had the CCM project kick-off call.

• Doug Strange commented Allscripts

CCM ROI was just 50K off his internal

projections.

• Projecting over 1M in new revenue

stream for Colquitt Regional Medical

Center over the next 3 years.

TCV: $1.3M


Benefits of a Formal CCM Program in 2017

• Anticipate that more organizations will begin CCM programs

based on these changes

• Land Grab – Only 1 provider can bill for a patient per month

(Physicians & Advanced Practice Providers)

• Implementation Queue & Training Timeline

• Phased Rollout Approach


Contacts

• David Beam – Director of Emerging Solutions

–[email protected] • 317-691-9460

mailto:[email protected]

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