How Chronic Care Management Reduces Overall Healthcare Expenses
The CMS initiated Chronic Care Management on January 1st, 2015, and permits a practice to bill for non-face-to-face coordination services monthly using billing code CPT 99490. CMS brought in this code to meet the needs of patients who are chronically ill, more so those with two or more chronic diseases, who consume the overwhelming majority of Medicare funds. The research done on this service reveals lower costs using lowered hospitalization, enhanced patient self-management, and better organization of care through similar services to Chronic Care Management.
Reducing Hospitalizations and Emergency Visits
One of the studies, which investigated the effects of the nurse-delivered care calls on hospitalization, revealed that the hospitalization rate in the called group, as with CCM participants, reduced by 6.2% compared with 14.9% in the not called control group. Also, the called group admissions were affected in a way that they reduced as the calls enhanced. These results suggest that proactive CCM calls can assist in lowering the number of readmissions to the hospital.
CCM also has a great role in anticipating hospital readmissions that occur after an acute event by helping the practices to offer the patients extra information and ensure that the necessary clinical/non-clinical resources are in place. This article in the Annals of Internal Medicine funded by the Agency for Healthcare Research and Quality (AHRQ) found that patients who understand their after-hospital care instructions including how to take their medicine and when to return for follow-up appointments are 30 percent less likely to be readmitted or visit the emergency department. Chronic Care Management can offer patients extra help during the most critical days of their treatment.
Quality of Life and Cost Reduction
Besides the potential to decrease the number of patients readmissions to hospitals, Chronic Care Management can contribute to cost savings because it helps patients with some lifestyle changes when they have chronic diseases. However, during office visits there is often not enough time for physicians to both identify and intervene about non-compliance.
Very often CCM patients may not be adherent to their medications, have not had their preventative health screening exams, or have not reported other social factors that would put them at risk for a further decline in health as instructed. Mistakenly, from not having the education about disease processes to not having the support that is needed to put into practice the self-care best practices, behaviors that contribute to noncompliance can be highly improved and affected by providing Chronic Care Management and the subsequent use of CPT 99490.
The Impact of Chronic Care Management (CCM) on Care Coordination
What are the consequences of not delivering coordinated care through CCM?
ANA’s (American Nurses Association) publication on care coordination also mentions a study that was conducted by the Institute of Medicine that used claims records of Medicaid and dual Medicare / Medicaid patients of the five most populous states to assess the patterns and costs of uncoordinated care. Patients with the highest levels of fragmented care represented 10% of the sample but used 30% of the program’s resources. The patient costs of the latter with uncoordinated care were on average 75% higher than matched patients with coordinated care.
Chronic Care Management can coordinate care by making a patient-oriented, interdisciplinary service, encouraging the patient’s involvement and communication among different specialists/other social providers with the overall supervision of the primary care provider. Every month CPT 99490 starts with a care coordinator making a telephonic contact with the patient for a direct consultation to ensure that a personalized care plan is established for the patients’ chronic illnesses but also for their overall well-being and coordination of care with all the patient’s providers.
These monthly calls included in Chronic Care Management provide a platform to ensure that the goals set are achieved and that action is taken, thus forcing the patients to be more engaged in their care.
In this manner, Chronic Care Management can have improved results and work towards the betterment of the quality of care, reducing the repetitive costs of healthcare that are related to Emergency Room visits, inpatient charges, lab/diagnostic costs, and more.
To get in touch call us right now at (713)715-7997 to learn more about our CCM services or you can also book a 30 min free consultation.
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