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Renae Rossow
Renae Rossow
Chronic Care Management for Rural Health Centers Part 2

Chronic Care Management for Rural Health Centers Part 2

Last week we discussed some clear benefits that Chronic Care Management services can have for patients living in rural areas. Today we want to talk a little about implementing CCM services and what that looks like for direct hire or outsourcing and then we’ll move on to discuss telehealth for rural health centers. So the first couple of steps you need to take in regards to implementing CCM are these two steps.

  1. First, you need to assess how many patients you have that are eligible for CCM services. The Medical Group Management Association, also known as MGMA, found that the average primary care physician had approximately 500 patients that would be eligible for CCM.  Now we already know that patients in rural areas often have a higher incidence of chronic disease so those numbers may be higher but nevertheless, significant. So you need to identify how many patients you have that are eligible. 
  2. Once you have that number, then you’ll have a better understanding of the staff that would be required to serve those patients and this is where outsourcing begins to make more sense for rural health centers because adding additional staff is problematic when you’re already suffering shortages to start with. By the time you make room for additional staff, someone to manage the staff that is well-versed in what Medicare requires in order to reimburse for CCM services, then phone lines and computer systems it can get pretty expensive. But don't stop there or get overwhelmed by it all because this is where another option comes in and that's outsourcing.

When you outsource chronic care management, you really should think of it as an extension of your practice. Your patients will still consider it as part of the rural health center. They usually don’t realize that the call is coming from another company, it’s just part of the services the center offers. So because of this, you’ll want to be comfortable enough with the vendor that they will represent your center the way you want them to because they will, in essence, be acting on your behalf. And when you find the right vendor, you’ll also find that your patients will have a positive experience. In fact, studies show that those patients participating in outsourced CCM services not only rated the experience more positively but they also demonstrated better clinical outcomes. One of the reasons we suspect this is true is because that’s what the CCM vendor specializes in and what they’re clinicians do all day every day instead of combining their work with other tasks that can be distracting or cloud some of the focus. 

A few other points we want to make about Outsourcing CCM Services as sort of a checklist you can go by are:

  • Make sure the vendor uses a certified EHR to ensure reimbursement. Though they’ve lightened up on a few of these regulations it’s still necessary to document in a certified EHR and so that’s the first thing you’ll want to confirm.  
  • Next, it’s important to know the actual revenue sharing you can expect. In other words, what percentage of the reimbursement will they keep and how much do you get to keep. Vendors can range from 10-20% so make sure you find a quality vendor with an average price that you’re happy with. 
  • Additionally, you’ll want to ask that vendor what they will require of your staff after the initiating visit. CMS requires Rural Health Centers to initiate CCM during certain types of visits like we discussed earlier, and so after that occurs, make sure you understand what is expected of your staff and if the vendor will be giving you pamphlets and information to hand out during that initiating visit. Whatever they will do to save your staff time and money should be identified. 

And then lastly, you’ll want to ask these three questions;

  • How often will we communicate? More specifically, how will the vendor share information with you. That’s important to this relationship and applies to things like patient records, billing, and other matters that may come up. Ask things like how often will I receive Escalation Reports, Reimbursement and Billing reports, etc.
  • You’ll also want to ask about HIPAA Compliance and Anti-Kickback Statutes. Everyone knows they need to be HIPAA compliant, but abiding by the anti-kickback statutes is important too. You absolutely should make sure they are aware and proactively compliant. 
  • And then, like any other healthcare service, it’s up to the patient if they want to continue receiving them or not. At some point, some patients may choose to discontinue receiving CCM services. If this happens, you can only bill for CCM if the service was already provided during the month the patient withdraws. How will the vendor handle these cancellations?

At the end of the day, it’s these three steps that will help you make the right decision about adding Chronic Care Management services to your Rural Health Center. 

  • Start by assessing the Center to identify how many patients you have and what that means in terms of effort and reimbursement related to providing CCM services. 
  • Then you’ll have to have an understanding about whether or not you can realistically afford to add the staff and provide the space, equipment, and management to implement a CCM program.
And, like most rural health centers, you will probably lean towards outsourcing to a vendor that specializes in providing CCM services and you’ll find the right vendor by asking the questions we just reviewed. We hope you found this information helpful. Next week we will be discussing the benefits Rural Health Centers will get from implementing Telehealth Services.  

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