Examining Medicare’s Chronic Care Management Payments
Starting in 2015, CMS has a new incentive for physicians that focuses on patients with chrinic conditions.
- The shift away from fee-for-service payments to a value-based approach is going to create some challenges. No major industry shift happens without going over some speedbumps. Each addition needs to be vetted and analyzed to ensure it is benefiting the right parties.
A recent article published by the New England Journal of Medicine examines Medicare’s chronic care management (CCM) payment, which is scheduled to start next year. Authors Samuel Edwards, MD, MPH, from the Veterans Affairs Boston Healthcare System and Harvard Medical School, and Bruce Landon, MD, MBA, from Beth Israel Medical Center and Harvard Medical School, raise the question of what provider and patients will benefit and which will not when CCM payments take effect.
Currently, the fee-for-service approach restricts payments for primary care to office-based visits. The article calls this “poorly designed to support the core activities of primary care,” which can include a number of tasks outside the office, including patient communication, medication refills and electronic/telephone payments.
The 2015 change will see the Centers for Medicare and Medicaid Services (CMS) introduce a non-visit-based payment for CCM, which the article calls the “most important broadly applicable change” that has been made to date when it comes to primary care payments. Practices that care for beneficiaries that have two or more chronic condition that are expected to last at least 12 months and confer a significant risk of death, decompensation or functional decline can receive a monthly fee of an estimated $40 per beneficiary. So a physician caring for 200 qualifying patients would receive a really revenue of $100,000.
To bill for the fee, practices are required to use EHR systems, offer round-the-clock access to staff who have access to the EHR, maintain a designated practitioner for each patient and coordinate care through transitions to and from the hospital, specialist and other providers.
There are going to be challenges for this process to be successful. These include:
• Beneficiaries will face a 20 percent coinsurance for CCM under Medicare Part B. Those without supplemental insurance will be required to pay the charge out of pocket.
• Smaller practices with limit resources may have trouble meeting the substantial requirements for receiving the extra payments and could therefore be rendered ineligible.
• How care plans will be implemented is still unclear as current guidelines lack crucial details regarding required features.
• The new policy is not restricted to primary care specialties, thought specialties may not want to take on the requisite coordination responsibilities.
• While the payments will provide additional resources to a desperate primary care system, it may not achieve the practice transformation envisioned in patient-centered medical home initiatives.
“The CCM payment will probably evolve over time. Future iterations could provide incentives for adopting additional PCMH capabilities, incorporate incentives for cost reduction, or target practices participating in broader payment-reform experiments such as accountable care organization programs,” the article reads. “The policy could also represent a first step toward broader reform whereby an increasing proportion of Medicare’s primary care reimbursement would come in the form of fixed monthly payments.”
