Medicare Patients Become More Active with Chronic Care Management (CPT 99490)

Patients involved in Chronic Care Management through CPT 99490 should notice health improvements from increased routine exercise. Despite the proven benefits of regular physical activity on the health of older adults, over half of the older population is sedentary (47% of older adults 65 to 74 years of age and 61% of adults over 75 do not engage in physical activity) (1). Increased physical activity is especially important for the older population, as increased activity levels can prevent or slow down the gradual decline in physical function with increasing age(1) . With their treatment plan instructions and activity preference in mind, Chronic Care Management patients should benefit from receiving education on the benefits of exercise, gaining access to exercise resources, and creating a schedule for physical activity.

Why Exercise?

When a patient receives Chronic Care Management, he/she should always be provided education to follow his/her treatment plan, especially when it includes routine exercise. Regular physical activity can help control weight, reduce the risk of chronic diseases, strengthen bones and muscles and improve mental health (1). Physical activity reduces the risk of developing cardiovascular disease, hypertension, type 2 diabetes, osteoporosis, obesity, colon cancer, breast cancer and cognitive impairment, and can relieve anxiety and depression (1). Being that some of the aforementioned chronic diagnoses are common and often poorly managed amongst CCM patients at home, ample amounts of physical activity related information should be given to enable awareness and proactivity of implementing exercise regimes.

When to Exercise?

Through Chronic Care Management services, patients may be assisted with developing a system for planning exercise, organizing weekly schedules, and accomplishing tasks. CCM care coordinators should provide information to ensure that patients enrolled will set regular exercise as a priority. The Centers for Disease Control and Prevention says that older adults need at least, 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (e.g., brisk walking) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) (2). Patients can base activities on things they enjoy as well as schedule times to participate in those activities with friends or family. A CCM coordinator can collaborate with the patient to create an individualized plan of activities for reference in between appointments with providers. When Chronic Care Management assistance with scheduling physical exercise is done effectively, patients are able to do the following:

  • Understand what he/she can realistically achieve with his/her time
  • Achieve his/her health goals and priorities in the time he/she has available
  • Make sure he/she has enough time for essential tasks
  • Set aside enough time for family and friends
  • Achieve a good work-life balance(3)

Where to Exercise?

Chronic Care Management enrolled patients should receive access to resources necessary to improve their lives. An enthusiastic CCM coordinator can discuss with patients, physical activity tolerance and instructions from their providers, while assessing the type of activities these patients would find of interest. Patients may be presented with different options from their CCM coordinator for remaining active such as:

  • Local group activity classes
  • Home exercises
  • Exercise program coverage
  • Online or DVD videos for specific activities

Consider the subsequent, disguised case example of a Chronic Care Management program providing a patient resources to increase physical activity.

Mrs. C, a 79 year old, has osteoarthritis and anxiety. During an initial assessment, Mrs. C reports joint stiffness from her osteoarthritis. The CCM coordinator should confirm activity instructions from Mrs. C’s provider. The patient has been encouraged to incorporate 20 to 30 minutes of physical activity with walking and swimming as suggestions. Mrs. C voices that she had not initiated any activity because she does not feel she can walk for 30 minutes straight, nor does she have a pool. The CCM care coordinator provides Mrs. C with contact information for the local recreational center which has a track for indoor walking and an instructed senior water aerobics class once a week. After motivation and education from her CCM care manager, a short-term goal is created to implement walking for 10 minutes at least twice a day, as tolerated. When Mrs. C completes her next appointment with her provider, she notes less stiffness and says her friends at the recreational center say she is less anxious. Here, the key aspect of receiving passionate Chronic Care Management, shines light on how simple guidance with physical activity impacts the patient’s wellbeing in multiple ways.

  1. Agency for Healthcare Research and Quality . National Quality Measures Clearinghouse. [Online] [Cited: 22 2016, August.]
  2. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. [Online] Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. [Cited: August 22, 2016.]
  3. Mind Tools. [Online] Mind Tools Ltd, 1996-2016. [Cited: August 23, 2016.]

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