Many providers across the nation are finding that participating in Medicare’s Chronic Care Management Services (CCM) program is a natural parallel to meeting requirements defined in the Merit-based Incentive Payment System (MIPS), which was launched in October, 2017.
As the healthcare industry moves towards a value-based reimbursement model, practitioners across the nation are working to gain an understanding of what this means for their practices.
What changes will be necessary in the way patient care is delivered?
What associated reporting is required?
What are the possible impacts to clinical revenue?
What additional technology or resources are going to be needed?
On the heels of meaningful use, PQRS and value-based modifier reporting, congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which consolidated and replaced these former programs. (View our comprehensive 2020 MACRA white paper here) MACRA incentivizes medical providers to deliver high-quality care through two Quality Payment Programs (QPPs), known as MIPS and Advanced APMs. MIPS, specifically, focuses on 4 categories including:
- Improvement Activities
- Promoting Interoperability
MACRA as bi-partisan legislation, has continued to expand over the last five years. Providers are faced with the challenge of avoiding up to a -5% Medicare penalty, and alternatively explore the opportunity to successfully participate in MIPS, potentially earning a positive Medicare payment incentive. Offering DocsInk Chronic Care Management Services (CCM) is a viable option which offers both monetary and health outcome benefits.
According to U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), 5% of the population accounts for 49% of total health care expenses across the nation. AHRQ further reports that patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition. Understanding that many chronic conditions, such as heart disease, can be prevented through healthier living, care delivery continues to shift from acute episodic-based medicine to prevention and wellness.
To address this initiative, CMS introduced the CCM program in 2015, to improve patient engagement and outcomes at a lower cost for their 35 million beneficiaries being treated for multiple chronic conditions. Medicare initially reimbursed approximately $42+ per month for a minimum of 20 minutes of non-complex, non-face-to-face services, rendered to patients suffering from two or more chronic conditions. During the first 2 years of the program, Medicare concluded that CCM services were severely under-utilized, receiving claims for only 2% of their eligible beneficiaries. In an effort to encourage medical providers to incorporate CCM services into their practices, CMS has continued to release new and less stringent guidelines which are designed to increase access and reimbursement for these services. (View our 2020 CCM summary here).
There are several benefits for eligible providers to offer CCM services. Beyond the opportunity to substantially increase clinical revenue, CCM also closely mirrors the goals and activities outlined by MIPS, setting the stage for successful participation in value-based care models. We can draw these parallels as they relate to each of the MIPS categories. As evidenced below, providers who offer CCM services to their chronically-ill patient population, are well positioned to successfully report in the MIPS program.
It is important to note that to be eligible for participation in MIPS and be considered an eligible clinician (EC), you must meet the necessary criteria during two available determination periods. In 2020, all EC’s are subject to a possible -5% to +5% payment adjustment. The EC’s Medicare penalty or incentive payment percentage is determined by their performance in the four MIPS domains listed below, which are then used to generate a composite score that is compared to national benchmarks.
The MIPS Quality category specifies 270+ individual quality measures from which providers must select to report metrics. A CCM program fully supports the Quality metrics necessary to maximize both minimize penalties and maximize incentive payments. Two of the optional measures are:
- Develop and follow a comprehensive care plan (Quality ID #47; NQF 0326)
- Perform a medication reconciliation (Quality ID# 130; NQF 0419)
Each of these tasks are required components of the CCM guidelines.
In addition, CCM programs facilitate the successful reporting on health improvements of patients with chronic conditions such as hypertension and diabetes, also included in the Quality category.
Improvement Activities (IA)
The MIPS IA category outlines 9 categories and 112 activities that are designed to improve patient outcomes. Four of the available activities are also components and/or requirements of providing CCM services including:
- Chronic Care and Preventive Care Management for Empaneled Patients;
- Engagement of Patients, Family, and Caregivers in Developing a Plan of Care;
- Implementation of Medication Management Practice Improvements; and
- Integration of Patient Coaching Practices Between Visits.
Promoting Interoperability (PI)
The MIPS PI category promotes the adoption and use of certified electronic health record (EHR) systems, by meeting specific objectives and measures. Although, CCM doesn’t directly share any measures with Promoting Interoperability, the CCM guidelines require providers to create their patient’s care plans using structured data from their certified EHR systems, which must be able to be shared with CCM patients and their respective care teams. Therefore, by meeting the CCM electronic care plan requirements, you are also complying with the applicable PI measure.
The MIPS Cost category concentrates on reducing medical expenses and over-utilization of emergency and inpatient services. Providers participating in the CCM program are shown to achieve these same goals by offering cost-effective, non-face-to-face services for their chronically ill patient population. Medical adherence is improved, transitions are streamlined, and avoidable readmissions are reduced.
Understanding how closely the initiatives of the MACRA payment reform legislation aligns with the CCM program, CCM becomes an obvious parallel to successful MIPS reporting for many providers. The added revenue generated from the CCM offering, also may help offset associated expenses that clinicians and medical groups are likely to incur while implementing a successful value-based care model.
HOW DOCSINK’S CCM SOLUTION CAN HELP YOU
DocsInk easily identify chronic care management (CCM) patients, to promote improved health outcomes and maximized reimbursement for non-face-to-face patient services, performed by providers and their support staff. As required by Medicare, electronic patient care plans may be created and securely shared in real-time with patients, between care team members, and across multiple organizations. All eligible CCM clinical tasks and associated time units are quickly logged and tasks are generated to ensure no patient is lost to follow-up, promoting seamless workflows. Our unique “audit-lock” feature aggregates all data input throughout the month, calculating the level of complexity based on The Center for Medicare and Medicaid Services’ (CMS) national medical decision making (MDM) guidelines, to automatically generate the highest and most accurate billing codes for CCM services performed.
DocsInk differentiates its software from the competition by simultaneously addressing the fiscal, communication, and connectivity needs of medical professionals. Delivered as Software-as-a-Service (“SaaS”), DocsInk is improving the way technology integrates with the various workflows of the healthcare industry. We provide simple, effective solutions that improve the speed, efficiency, accuracy, and options in the delivery of patient care. Beyond our technology, that is native to Mac, PC, iOS, and Android, our team is dedicated to providing customer support and a user experience that is second to none.