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Medicare Proposes Chronic Care Management (CCM)

Medicare continues to emphasize primary care management services by beginning to make separate payment for chronic care management (CCM) services beginning in 2015.

On July 3, 2014, Medicare published a proposed rule that would pay physicians and other practitioners for managing the care of Medicare patients with two or more chronic conditions beginning in 2015.  For a summary description of the program, click here >>

In last year’s final rule, the Centers for Medicare and Medicaid Services (CMS) established a policy to make separate payments for non-face-to-face chronic care management services for beneficiaries who have multiple, significant chronic conditions (two or more). Chronic care management services include regular development and revision of a plan of care, communication with other treating health professionals, and medication management.

The proposed rule addresses three aspects of CCM services including:

• A payment rate of $41.92 billed once per month per qualified patient

• Greater flexibility in the supervision of clinical staff providing CCM services

• No additional standards for CCM, however CMS is seeking comments for additional standards for electronic health records.

CMS has indicated that payments for CCM are only one part of a multi-faceted approach to improve Medicare beneficiaries’ access to primary care. Additional models are being tested through the Innovation Center to explore other primary care innovations.

For a primary practice doctor or practitioner, the additional resources could be substantial. For an average chronic care practice, approximately 490 patients with 2 or more chronic conditions could yield over $246,000 annually per year according to the Medical Group Management Association Cost Survey for Single Specialty Practices: 2013 Report Based on 2012 Data. With other rates being trimmed, the new CCM reimbursement will provide incentives to have providers create and manage plans for chronic patients. It will be interesting to follow this innovation to determine if there will be clear medical and financial benefits in the future.

For more about Medicare’s Chronic Care Management Program, click here >>

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