Chronic care management is care coordination services done outside of a regular office visit for Medicare patients with more than one chronic condition. These services, which are typically not face-to-face, allow medical practices to bill for at least 20 minutes or more of care coordination services per month. There are two sets of billing codes for CCM—one for non-complex care, introduced in 2015 and expanded in 2020, and another for complex chronic care management, which came online in 2017. Not only does CCM represent an additional reimbursement stream for providers, it also stands to improve patient care. By taking a proactive approach to managing patients’ chronic conditions, care coordination has been shown to improve patient outcomes. And yet, adoption has been slow.
According to the latest set of data from CMS, published in this final rule from November 2019, only 9% of Medicare fee-for-service beneficiaries currently receive care management services in the ambulatory setting, despite the fact that two-thirds of Medicare beneficiaries have more than one chronic condition and are therefore eligible for these services.
CCM challenges facing rural practices
In rural communities, one of the challenges boils down to simple math. While the best practice for CCM is to have a full-time registered nurse in the care coordinator position, the vast majority of rural practices simply don’t have the volume of patients to make that hiring decision financially viable.
“Typically one care coordinator can manage between 200 and 250 patients,” says Faith Jones, director of care coordination and lean consulting for HealthTechS3. “In a small practice, they might not have more than 50 patients.”
Splitting a nurse’s job between care coordination and the office setting is impractical, too.
“In healthcare, we’re so used to dealing with the urgency in front of us,” Jones says. “Care coordination is about getting rid of that urgency and being proactive—looking two steps down the road and not just what’s in front of you today. But, when it becomes another duty as assigned, before you know it, the urgency of the day takes over, and care coordination get moved to the back burner.”
That, compounded by the fact that many rural communities also have a shortage of qualified RNs, is a lot of the reason that CCM just isn’t happening, she says.
Creative solutions for CCM staffing challenges
On Oct. 29, Jones will be hosting a webinar, “Care Coordination Staffing Strategies,” to talk about the challenges facing rural providers in providing CCM services and also present some outside-of-the-box alternatives to hiring a full-time RN.
One example is utilizing a regional care coordinator model, where unaffiliated practices might join forces to share a single care coordinator. Each practice has a point person who interfaces with the regional coordinator. This person is located close enough to each community to be available for an on-site visit on a bimonthly basis.
Another outside-the-box solution that Jones encourages rural practices to look into is leveraging remote care coordination, like that offered by HealthTechS3.
By definition, care coordination is not delivered face to face. The idea, then, that a full-time RN needs to be sitting in the medical office providing these services is limiting. Remote care coordination can address the problems of volume and scarcity, as well as help practices fill in gaps during long leaves or in times of turnover, Jones says. Other examples include paying care coordinators on a contract, per-patient basis versus hiring full-time or even part-time.
In order for any of these models to be successful, however, practices need to change the way they view the role of care coordinator. “When I first talk to practice managers interested in care coordination, I hear a lot about how many hours their care coordinator needs to work,” she says. “But, it’s really not about that at all. Care coordinators need to have the flexibility and the autonomy to put patients first and make sure they’re taken care of. Care coordination is a time trackable modality, so as long as your coordinator is getting patients qualified to be billed for CCM each month, that’s success.”
Don’t miss Jones’ upcoming webinar on outside-the-box solutions for care coordination staffing challenges. Register today.