(Last Updated On: December 2, 2016)
Introduced by the Centers for Medicare and Medicaid Services (CMS) in January 1st of 2015, Chronic Care Management (CCM) allows practices to bill for non-face-to-face coordination services monthly through use of billing code CPT 99490. CMS introduced this code to serve chronically ill patients, specifically those with 2+ chronic conditions, whose healthcare costs make up the vast majority of annual Medicare spending. Numerous studies show reduced costs via decreased hospital admissions, increased patient self-management, and improved coordination of care through use of services similar to those provided in Chronic Care Management programs.
CCM’s Impact on Hospital Admissions
In one case study, which tested the impact of nurse-delivered care calls on hospital admission rates, found that the hospital admission rate in the called group (similar to CCM participants) decreased by 6.2% compared with a 14.9% increase in the not called control group. Additionally, the called group admissions decreased as the number of calls increased. These findings indicate that proactive Chronic Care Management calls can help reduce hospital admissions.
CCM plays a large part in not only proactively preventing hospital admissions, but also preventing readmissions after an acute event by allowing practices to provide patients additional education and arrange for critical clinical/non-clinical resources. According to a study, published in the Annals of Internal Medicine and commissioned by the Agency for Healthcare Research and Quality (AHRQ), patients who have a clear understanding of their after-hospital care instructions, including how to take their medications and when to make follow-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information. Chronic Care Management can provide patients additional support during the most vulnerable periods of their care.
CCM’s Impact on Patient Self-Management
In addition to reducing hospital admissions/readmissions, Chronic Care Management can reduce healthcare costs by assisting patients with certain lifestyle changes resulting in improved control of their chronic conditions. Unfortunately, time is limited during office visits for physicians to address and actively reinforce non-compliant behaviors. Often CCM patients may not be taking medications as directed, are not up-to-date with preventative screening exams, or have not disclosed other social barriers putting them at risk for a further decline in health. From not having the education regarding disease processes to lacking support required to implement the self-care best practices, behaviors leading to noncompliance can be significantly improved and impacted by providing coordinated care through Chronic Care Management and subsequent usage of CPT 99490.
CCM’s Impact on Coordination of Care
What are the effects of not providing coordinated care through CCM? In their publication on care coordination, the American Nurses Association (ANA) discusses a study commissioned by the Institute of Medicine that performed analysis of over nine million Medicaid and dual Medicare/Medicaid patient claims records for five populous states to determine patterns and costs associated with uncoordinated care. About 10% of patients demonstrated extreme patterns of uncoordinated care and accounted for 30% of program costs. On average, patient costs of those with uncoordinated care were 75% higher than matched patients whose care was coordinated.
Chronic Care Management can coordinate care by providing a patient-centric, collaborative service, emphasizing input from the patient and effective interprofessional collaboration between specialists/other social providers, under the primary care provider’s general direction. Each month CPT 99490 initiates with a care coordinator’s telephonic communication directly with the patient to maintain an individualized care plan catering specifically to the patients’ chronic conditions, but holistically addressing the patient’s needs and encouraging collaboration between the patient’s multiple providers. These monthly calls, included as part of Chronic Care Management, allow for patient accountability of implementing goals and initiating action, serving as a catalyst for patients to take more of an active role in their care. Through these mechanisms, Chronic Care Management can achieve better outcomes and quality of care, cutting recurring healthcare costs associated with ER visits, inpatient charges, lab/diagnostic testing, and more.
SOURCES: The Value of Nursing Care Coordination, American Nurses Association. June 2012. http://www.nursingworld.org/carecoordinationwhitepaper; Hamar et al. The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society. Population Health Management. 13(6): 339–345. December 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128444; Brian W. Jack, MD, Veerappa K. Chetty, PhD, David Anthony, MD, MSc, et al, “A Reengineered Hospital Discharge Program to Decrease Rehospitalization,” Annals of Internal Medicine 150(3), Feb. 3, 2009, pp.178-187. http://www.annals.org/content/150/3/178.abstract