Chronic Care Management — a patient guide

pnonenurseDoctors have long complained they don’t get paid to solve problems over the phone.  Now primary care providers (not specialists) can charge $40 per month for something called “Chronic Care Management.” (CCM)

If you have several long term and serious conditions like diabetes, congestive heart failure and chronic obstructive pulmonary disease then Medicare will pay $32 per month and you or your supplemental insurance will pay the rest for this service.  Many supplemental insurance plans have deductibles and co-payments — so many, if not most patients will be paying an extra $8 per month.

Who actually does all the work?  The office nurse.  The doctor supervises the decision making.

You will have to sign a consent for CCM in order for the doctor to bill you each month, so it is important to know what to expect.  Some doctor’s offices will make the service helpful but in other offices you may never know where the money is going.

If you can’t tell you are getting CCM then simply stop the service — revoke the consent with a letter “Dear Doctor, effective at the end of this month please stop “Chronic Care Management”.  I will continue visits as usual.”

In general, CCM is a good thing.  Here are some of the problems it solves:  Without CCM many doctors just don’t take the time to coordinate services except as part of an office visit — if you go to the emergency room the primary care provider would not act on recommendations until you actually go for an office visit.  If your visiting nurse suggests some course of action then you go for an office visit.  If you want to see a specialist you first go for an office visit.  If you get discharged from the hospital and need physical therapy you go for an office visit before it will be ordered.  With CCM the doctor gets $40 per month to coordinate care without always going for a face-to-face visit.

The minimum requirement for the provider is to spend at least 20 minutes per month working on your case without seeing you in person.  Here is a list of things providers of CCM are required to do (at no extra charge) and thus things you should expect:

  1. Transitional care management:  meaning admission or discharge from some medical service or facility (like giving orders for physical therapy after hospital discharge or providing full medical records to a rehab facility)
  2. Supervision of home healthcare.  The provider gives orders for home care with lists of medications, duration of treatment and goals of treatment.
  3. Hospice care supervision.
  4. Provide a limited number of end-stage renal disease services.

The provider must have 5 capabilities and use those capabilities as needed:

  1. Keep your records in a computer
  2. Create a care-plan — an outline of goals and actions the provider will follow to meet those goals.  Like “keep blood sugars in control — by weekly phone contact”. The provider should give you a copy of the plan — it should be specific to you and not a standard form applicable to anyone.
  3. Provide phone access to talk to a someone associated with the office 24 hours per day (they should be able to look at your computer record).  Provide office visits as needed (presumably same day for urgent problems and within a week for non-urgent problems)
  4. Facilitate transitions in care.  Like provide prescriptions and orders for therapy after discharge from a hospital or providing medical information to specialists for each visit.  Or, keeping orders for home oxygen up to date.  Or, immediately sending outpatient medical records to the hospital where you are admitted.
  5. Coordinate care.  This does not mean providing all care, it is not a wall around you.  If you need to see a specialist the provider makes sure all your medical data is transmitted to that specialist and makes appointments for you.  And, follows the instructions of the specialist (as medically reasonable).  Engages therapy such as home visits by nurses, physical therapy, occupational therapy or social service.  And, makes efforts to meet the care needs outlined by those therapy services (as medically reasonable).

CCM does not eliminate office visits but it makes sure loose ends are dealt with and it obligates the provider charging CCM fees to provide access to someone that can look at your chart 24 hours per day.  It also means the ER can call the primary care provider office and get up-to-date medical information about you in an urgent situation.

—————–

Disclaimer:  the rules and fees for this program are in a state of flux.  What is true today may not be accurate tomorrow.  So, discuss the meaning of CCM with your primary care provider.  Give them a copy of this article as a place to start a discussion.  Here are some additional helpful links:

CMS – Medicare.gov

PBS Newshour

 Pershing Yoakley & Associates

, , , , , , , , , , ,

%d bloggers like this: