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Renae Rossow
Renae Rossow
Chronic Care Management for Rural Health Centers

Chronic Care Management for Rural Health Centers

Let's start this conversation by taking a quick look at what Chronic Care Management is in general and some truly startling statistics about how our population is affected by chronic disease. Chronic Care Management itself is the term used for services provided per calendar month for patients with two or more chronic conditions that are expected to last more than 12 months or until the death of the patient. These conditions must also place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. Something important to note is that only one practitioner can bill for Chronic Care Management services per month. That is more than likely going to be the Primary Care Physician but it can be a specialist if the PCP is not already providing these services. 

So why did Medicare start paying attention to chronic conditions and begin reimbursing for these services? Let’s take a look at a few of the statistics. There are some interesting numbers when it comes to the how much our population is affected by Chronic Disease. These are just a few:

  1. Over 133 million Americans suffer from at least one chronic condition.
  2. 1.7 million Americans die every year due to a chronic condition. That means 7 out of every 10 deaths in the U.S. are attributable to Chronic Disease. 
  3. 81% of costly hospital admissions are attributable to a chronic disease. 
  4. And 91% of prescription are filled to treat a chronic disease. 

Now if we look even further into the population that Medicare serves here’s a couple more statistics:

  1. The CDC did a study that showed approximately two-thirds of Medicare beneficiaries had 2 or more chronic conditions which established a prevalence amongst that segment; and
  2. Remember that statistic on the previous slide that said 1 of every 4 Americans has a chronic condition?  Well that number triples for Americans age 65 and older which is means that chronic medical conditions are the single most problematic health issue facing the Medicare population and by treating those conditions appropriately, we can have the biggest, most effective impact on not only the health outcomes of our senior population but the rising costs of their care.  So, what does that mean for rural health centers?

With all the research coming forth about how much our entire population, let alone our seniors are being affected by Chronic Conditions, CMS decided to start reimbursing. Fortunately, on January 1st of 2016, just last year, CMS added rural health centers to the list of providers that could be reimbursed for chronic care management using CPT code 99490. Now, normally, each state determines the reimbursement amount for CCM services. However, Rural Health Centers are reimbursed at the national average which in a lot of cases is more than your specific state’s reimbursement rate. Additionally, as of January 1st of this year, 2017, CMS has stated that services furnished by auxiliary personnel incident to a CCM visit may be furnished under general supervision which means it no longer must be face-to-face.

Now, one thing that’s different for Rural Health Centers is that you must initiate Chronic Care Management Services at either a comprehensive evaluation and management visit, an Annual Wellness visit, or an initial preventive physical examination visit and initiate the CCM service as part of that visit prior to billing for CCM.  For regular PCPs that requirement was changed if the patient had been seen in the last year and was not a new patient.  They have not, however, changed that for rural health centers.  So, you must initiate CCM at one of those types of visit. 

Also, in 2017 there were new codes added for more complex chronic care management cases. Those additional codes have not been added for Rural Health Centers so the only code that applies for reimbursement at this point in time is CPT Code 99490. Our guess is that they will eventually approve the additional codes for rural health centers, they simply haven’t done that at this time.  

So how does Chronic Care Management benefit rural health centers? This is probably information that most of you are aware of but I wanted to go over a CDC study that was published in January of this year because of its findings with regards to rural health. The CDC found that the percentage of excess deaths also called preventable deaths, among persons less than 80 years old, from the five leading causes, was higher in rural areas versus urban areas – and by the way, the two main reasons were the lack of quick access to care and poor management of care. From their findings, the number one recommendation made by the CDC was that increased care coordination be implemented to ensure rural residents have that timely access to care and of course, that’s what chronic care management services are all about. Now let’s look at some actual numbers.

In a recent study published in the Journal of American Medicine that was conducted to specifically show to what extent chronic care management services could improve the management of chronic conditions here are just a few of their findings:

  • Within a 90-day period, the overall cost of care was $460 less per patient in the treatment group.
  • They saw a 56% reduction in hospital readmissions and a significant improvement in the quality of life scores when compared with controls. By the way, these two statistics are regarding patients with congestive heart failure. 
  • They also studied patients with asthma and found when receiving CCM services there were 73% fewer emergency department visits.
  • And they found an astounding 84% fewer hospitalizations. The overall savings greatly exceeded any costs associated with the program. In fact, the improved health outcomes overall were significant as were the reduction in overall costs.  So those are some clear benefits that CCM services can have.  
Stay tuned for our next article where we will discuss what factors you must consider before adding CCM services. Additionally, we'll walk you through the process of easily implementing that service to your practice in be up and running in just a matter of days.  

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