September 8, 2016 Ask Owen

Good News On Medicare’s CCM Telehealth Program

Medicare’s Chronic Care Management (CCM) telehealth program is a hit with patients, according to the first reported patient satisfaction survey conducted since the program was put in place at the beginning of 2015.

A survey of more than 100 chronic care patients treated by providers using CPT code 99490 finds that almost 90 percent are satisfied or very satisfied with the clinical engagement services. In addition, 90 percent said they were satisfied or very satisfied with their chronic care providers, almost 80 percent said they’d recommend the telehealth service, and 60 percent said their health improved due to the monthly service.

The survey was conducted by Hello Health, which provides outsourced management and call center services for providers seeking to take advantage of the CCM platform. The New York-based company is one of a handful to have sprung up since Code 99490 was launched on Jan. 1, 2015, offering to help clinics and small practices with the complicated service.

The news might help support a program that has come under fire from telehealth advocates who feel 99490 isn’t helping healthcare providers.

The Centers for Medicare & Medicaid Services launched the CCM program with an eye toward allowing providers to be reimbursed for a certain amount of care management delivered by telehealth each month. The code allows for 20 minutes each month of non-face-to-face communication between a doctor and patient with two or more recognized chronic conditions (CMS currently recognizes 27 chronic conditions), to be reimbursed at the rate of $41.92 per patient per month.

According to a study published in the Annals of Internal Medicine shortly after CPT Code 99490 was instituted, a practice with 2,000 Medicare patients could expect to generate more than $75,000 in net revenue per full-time physician if just half of those patients were enrolled in the CCM program.

While organizations like the American Telemedicine Association said the new program was a step in the right direction, many providers either tried to use the code and failed, or simply ignored it altogether, because it took too much time and effort to implement and run.

“There’s only so much you can do with 20 minutes,” Peter Weigel, MD, a Westfield, N.J.-based physician, told in an interview this past January. “It’s very limiting when you have to do it all yourself. You do all the advance work, prepare for the call, then get on the phone for one thing – and they have four more things that they want to talk about. And then when they’ve gotten off the phone they forget the answers to three of the questions they asked.”

According to CMS officials, $12 million was paid out to qualifying physicians through CPT code 99490 in 2015, averaging out to 275,000 patients receiving CCM services three times a year. That’s well below the estimated 35 million Medicare beneficiaries who would qualify for CCM services.

In February, the American Association of Family Practitioners (AAFP) sent a letter to a Senate Finance Committee workgroup charged with finding new ways to improve chronic care treatment for Medicare beneficiaries. The AAFP offered a broad range of suggestions that included leveraging more telehealth and bolstering accountable care organizations. It also called Code 99490 a good first step, but not enough.

“Unfortunately, the current payment policy related to code 99490 represents a one-size-fits-all approach that ignores the fact that different patients will require different levels or intensities of CCM and thus will consume variable amounts of physician work and practice expenses,” the letter read.

“Under the CCM code, absent supplemental coverage, the beneficiary is responsible for copayment of about $8 a month, whether or not the patient sees the doctor in a separate face-to-face encounter,” the letter added. “This has led to beneficiary confusion and to the administrative difficulty of collecting the beneficiary’s share of the payment. Some beneficiaries also are unable or unwilling to enroll in a recurring monthly service that carries an additional patient charge.”

CMS officials have hinted since then that they hope to refine the CCM program to make is easier for providers.

Nat Findlay, Hello Health’s CEO, says the patient satisfaction survey proves that the CCM program has value – especially to those it’s supposed to serve.

“CCM is based on the idea of extending clinical excellence into the home, and this survey shows we are making measurable progress at replicating the effectiveness of an in-person visit via telehealth,” he said in remarks accompanying the survey. “We appreciate this survey is neither independent nor scientific; however, it speaks to the reception this important program is receiving among patients and their providers. The results show that patients enjoy the one-on-one time spent discussing their care, and that they feel it is beneficial to their overall health.”

This article originally appeared here.

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