Posted by: notdeaddinosaur | October 14, 2015

Few are Submitting for Medicare Chronic Care Management Payments; Gee, I Wonder Why?

Who’d a thunk it? Doctors leaving money on the table? Not billing for services we apparently are already providing? Surely not us greedy doctors.

But yes:

The CMS says doctors tending to tens of millions of chronically ill Medicare patients aren’t taking advantage of federal dollars aimed at improving care and reducing hospital readmissions and overall costs.

This year, Medicare began paying an average of $42 per patient per month for non-face-to-face chronic-care management services, such as consulting with other doctors caring for the same patient who might be dealing with dementia, heart disease or arthritis.

The CMS estimates 70% of Medicare beneficiaries—roughly 35 million—would be eligible, but CMS has only received reimbursement requests for 100,000 beneficiaries thus far, Kathy Bryant, a senior technical adviser in the Center for Medicare, said last week at an Advisory Panel on Outreach and Education meeting. She added that even that number may be too high as some could be duplicate claims.

Now why wouldn’t I want to collect an extra $500 or so a year per Medicare patient? I mean, I’m already coordinating their care, calling specialists, keeping track of their tests, refilling meds and so forth without seeing a penny. Why not bill for it?

What would I have to do? (Following info from this CMS Fact Sheet)

First, I have to get the patient’s consent. No biggie. I’m sure most of my patients would be okay with it. Turns out that there’s a little bit more to it than that, though:

Patient consent requirements include:

  • Inform the patient of the availability of the CCM service and obtain written agreement to have the services provided, including authorization for the electronic communication of medical information with other treating practitioners and providers.
  • Explain and offer the CCM service to the patient. In the patient’s medical record, document this discussion and note the patient’s decision to accept or decline the service.
  • Explain how to revoke the service.
  • Inform the patient that only one practitioner can furnish and be paid for the service during a calendar month.
  • How to access the elements of the service;
  • How the patient’s information will be shared among practitioners and providers;
  • How cost-sharing (co-insurance and deductibles) applies to these services

Sure, no problem. I can probably manage to squeeze that discussion in between going over their latest admission for CHF, refilling their COPD meds, reviewing their home glucose readings, updating their pneumococcal vaccine, making sure they got a flu shot, and discussing their wishes for end of life care.

Okay, say I get their consent, what exactly do I have to do? It boils down to creating, implementing, and monitoring a “Comprehensive Care Plan”.

What the hell is that?

You asked:

A comprehensive care plan for all health issues typically includes, but is not limited to [italics mine], the following elements:

  • Problem list;
  • Expected outcome and prognosis;
  • Measurable treatment goals;
  • Symptom management;
  • Planned interventions and identification of the individuals responsible for each intervention;
  • Medication management;
  • Community/social services ordered;
  • A description of how services of agencies and specialists outside the practice will be directed/coordinated
  • Schedule for periodic review and, when applicable, revision of the care plan.

Not only this, but it turns out that Medicare only pays 80% for this “service”, leaving patients footing the bill for things they basically never had to pay for previously.

As my eyes glaze over, I can’t help but wonder: Why is anyone surprised that doctors aren’t rushing to bill for this albatross of a “service”?

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Responses

  1. The bureaucratic burden doesn’t surprise me. My mother’s primary care doc is trained in geriatric medicine, and he recently had to do a referral for home health care for a fall injury. He had to write an explanation to Medicare justifying every home health care professional that Mother needed — PT, OT, nurse. He had to specify that home health was needed because my mother doesn’t drive and her children work, plus her condition was precarious at the time, so it would be an extreme burden for her to travel to obtain these services in a clinical setting. Then he had to write the exact same info on the referral being sent to the home health agency that we chose — and if the info didn’t match between the two forms, it could lead to Medicare refusing to pay. (Then he printed out the referral that he sent to the home health agency and gave it to us because the home health agencies often don’t give that crucial clinical information to the health care professionals who show up at the house!)

  2. Oh dear, where to begin?

    It’s important to realize that you only get paid for chronic care management if you document 20 minutes or more of such during the month. And by document, CMS means BY THE MINUTE. If we’re being honest, there are actually very few patients in a practice who require that month in and month out – calling them up to chat about the weather or last night’s ball game does not count. And, in the case of those truly sick patients where you spend 10 hours in one week coordinating care, you’re still only going to get paid for 20 minutes.

    Practices are finding this impossible to do without hiring a whole new employee just for this purpose. If the practice is lucky, they might break even (assuming that the doctor’s work is always counted as a freebie). That’s cost-effective medical care in action.

    And of course those brain-dead morons at the AAFP think that this is the way to save family medicine. I include in that group your BFF Wanda Filer, who is quoted as saying “I’ve heard unbelievable success stories from practices that have deployed chronic care management codes.”

    Are these people truly as cluelessly, terminally stupid as they appear, or are they merely completely corrupt? Discuss.

  3. Bottom line: it’s a PITA and costs more to do that you get. As to the last post, my vote would be cluelessly, terminally stupid.

  4. Yeah, R Wat; I’m afraid Wanda’s been sipping at the corporate KoolAid just a bit. Stupidity is more likely than out and out corruption. That’s the ABIM’s gig.

  5. […] with multiple chronic conditions. Again, something that sounds like a good idea in practice didn’t quite turn out that way. Gee, I wonder why? Because of the micromanagement of required documentation, in […]


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