Chronic Care Management: Interest Remains High, Implementation Is Slow Going

The results also provide important insights regarding the reasons for CCM's slow adoption rate. It's certainly not due to a lack of interest: Nearly two-thirds of respondents indicated their organizations had analyzed the opportunity.

According to CMS, two-thirds of Medicare beneficiaries have two or more chronic conditions, and thus are eligible to receive Chronic Care Management services (CCM).  That translates to 25.4 million traditional Medicare beneficiaries.

As reported by Modern Healthcare on October 13, CMS officials admit having received CCM claims for only 100,000 Medicare beneficiaries thus far.  That means less than one-half of one percent of eligible beneficiaries now are receiving these critical services

The Modern Healthcare article includes quotes from several industry experts speculating on the reasons for slow adoption of CCM: 

    * Neither CMS nor professional organizations have furnished adequate education to providers regarding CCM billing rules.

    * The work involved in providing and documenting CCM is not justified by the level of reimbursement.

    * CCM rules require written consent from a beneficiary acknowledging responsibility for the 20% co-payment for CCM. Many think patients will be unwilling to pay for these services, and believe they are already receiving them.

    * Most physicians are waiting for early adopters to report success before investing in CCM infrastructure.

To provide more definite answers, PYA now is working on the final report for the National Chronic Care Management Survey 2015.  The survey, developed by PYA and ENLI Health Intelligence, was conducted this past summer.  Respondents included both clinical and non-clinical individuals across many types of healthcare organizations.  The following presents some interesting information from the survey.  (Note: Based on the number of respondents, the survey results reach the 95-percent confidence level.)

    * The survey findings are consistent with CMS’ recent pu blic statements.  Only one-quarter of respondents’ organizations have launched any sort of CCM program for their Medicare patients. And just over half of these early adopters have successfully submitted a claim and received payment from Medicare for CCM.

    * The results also provide important insights regarding the reasons for CCM’s slow adoption rate.  It’s certainly not due to a lack of interest:  nearly two-thirds of respondents indicated their organizations had analyzed the opportunity.  Only 11 percent of respondents stated they did not intend to implement a CCM program in the future.

    * The top three obstacles to providing CCM are:

  1. Insufficient reimbursement for the time and effort required (47 percent).
  2. Lack of awareness regarding the opportunity (43 percent).
  3. Compliance concerns (39 percent).

    * Of note, less than half of the respondents believe they could successfully operate a CCM program with their current staffing levels.

The full report for the National Chronic Care Management Survey 2015 will be released by early November.  And, soon thereafter, CMS should be releasing the 2016 Medicare Physician Fee Schedule Final Rule.  In the proposed rule, the agency requested comments on how to speed adoption of CCM.  Hopefully, CMS will move to eliminate many of the barriers reported in the PYA/ENLI survey, thus pushing adoption rates far beyond current levels.

To be notified when the National Chronic Care Management Survey 2015 is released, please send a request to collaborate@enli.net

Originally posted on PYA’s Healthcare Blog, “Bridging Business & Healthcare”

Martie Ross, Principal with PYA Consulting