Medicare's year-old chronic care management services program pays physicians separately for “virtually” coordinating the care of patients with multiple chronic medical conditions like asthma, diabetes and hypertension. Despite the promise of clinical benefits for patients and financial benefits for physicians from proactively managing care without costly office visits, most doctors and medical practices have yet to sign up for the program.
We spoke with McKesson reimbursement expert Jeb Dunkelberger about real and perceived barriers to participation, ways to overcome those barriers and strategies physicians and their practices can deploy to realize the benefits of the program for their patients and their own bottom lines.
Dunkelberger, who is executive director for accountable care services and corporate partnerships at McKesson, recently hosted a webinar, “Chronic Care Management under CPT Code 99490: How to Improve Patient Engagement and Increase Reimbursement,” which is available for replay.
What are the major non-operational reasons most physicians are not participating in Medicare's chronic care management services program?
Dunkelberger: There are three primary non-operational reasons or misperceptions. First, it's a new program with a new CPT code, and many physicians don't even know about it. We as an industry need to do a better job educating them to eliminate that knowledge gap. Second, doctors who know about it are wary of a new CPT code that comes with a lot in terms of the documentation that's required to get reimbursed. And third, they're unable to see or calculate the potential return on investment.
What are the major operational barriers physicians face when considering whether to participate?
Dunkelberger: The three issues I hear most about from physicians are care plans, resources and clinical data. The program requires practices to develop a comprehensive care plan for each patient. Care plans are not treatment plans. Care plans are more holistic in the sense that you're helping the patient change behaviors, change lifestyles, change diets. You assume the responsibility for improving the overall health of the patient, not just treating an illness or injury. In terms of resources, any medical practice will tell you they're at max capacity. They may be holding back because they don't have any extra staff to perform the 20 minutes per month per patient of patient outreach required by the program. Vetting through clinical data to identify which of your patients in your entire panel have two or more chronic medical conditions can be cumbersome and time consuming.
How can physician practices overcome those major operational barriers?
Dunkelberger: Doctors don't have to build care plans themselves. There are a lot of care plan templates on the market. They can acquire one that fits their needs or customize one for their chronic care patient population. They also can hire outside vendors that just do care plans. To deal with the resources issue, practices must fundamentally change the job descriptions of their staff. Much of what front office staff does at a medical practice – taking messages, making referrals, scheduling, prescriptions – can be automated at least in part. That would free up time to make outbound calls as directed by a physician. Another way is allowing a practice's nurse practitioners or physician assistants to have their own patient panels, taking some of the chronic care oversight responsibilities off physicians' plates. Most physicians could figure out who their high-cost, high-utilizer, high-risk patients are. One way is to go through your charts and identify patients with two or more chronic medical conditions using a simple spread sheet. There are also population health software tools available that integrate into EHR systems.
What return on investment can physicians expect from participating in the program?
Dunkelberger: We use a typical primary care practice with 300 Medicare lives as our model, but the numbers work out pretty consistently no matter what size practice you have or the number of qualified patients you could enroll and care for under the program. We calculate the ROI at 56 percent, meaning for every dollar a practice spends operating a chronic care program it would get back $1.56. Related: Calculate chronic care management program costs.
How does participating in the program prepare physicians for other value-based care initiatives?
Dunkelberger: What practice wouldn't want to have a 56 percent return on patient care? But, they shouldn't be doing this for the money. Practices should be doing this to develop the competencies to succeed in a value-based reimbursement environment. I call the chronic care management services program a VBR petri dish. You're learning the clinical, business and technical skills needed to succeed in the future and getting paid to do it. You'll learn things like risk stratification, prevention and wellness, medication adherence and how to improve margins through cost avoidance. Medicare is subsidizing your VBR education. Those practices that take advantage of the opportunity will put themselves in a much stronger competitive position both clinically and financially in the future.
Related: Learn about McKesson's chronic care management services