With New Chronic Care CPT Code 99490 is CMS Getting Serious About Chronic Care?
I was recently trying to explain the term “null set” to my middle-schooler for her math class. I suggested to her that could be illustrated as the (lack of) intersection between things she wanted to do on a school night and things she was allowed to do on a school night. Unfortunately, the same null set could describe the lack of intersection between “What Clinicians Can Bill For” and “Things That Help Manage Chronic Disease.”
It has seemed very odd to me that, in a country where 80% of all health-care costs are driven by chronic-disease(s) largely attributable to six or seven key conditions, we continue to pay for time spent in a physician’s office. As someone who has spent most of the past five years trying to make chronic-disease management accessible to a broad range of people, I know first-hand that discussing nutrition, exercise, tracking biometrics, and educating family members on the disease state may help make people better, but doesn’t pay the bills for the clinical community.
Happily, I now have revised my algebraic diagram. As of January 1st, the Center for Medicare has created its first CPT code - 99490 for chronic care management outside the physician office. A health care provider is eligible for $42.60 per patient per month. This is a significant step in the right direction.
The Centers for Medicare & Medicaid Services (CMS) recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as reduced spending. Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, with the following required elements:
- Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, `
- Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, `
- Comprehensive care plan established, implemented, revised, or monitored.
How important is this?
Remote Patient Management
Practically speaking, how does a health system move to remote management of patients? This is a fundamental shift in the care model, and one that takes advantage of the investments in technology that health systems have made through Meaningful Use.
- Identification of eligible patients
- Education and enrolling of patients
- Scheduling and training clinical staff on effective methods for remote patient communication
- Consistent care plans for disease state
- Secure mobile technology for collecting and disseminating patient information
Importantly, this also bridges the gap between the fee-for-service model and bundled payments and ACOs. A health system can afford to make the investments to move to remote care monitoring before they move to an ACO. Remote chronic care management should lead to better outcomes and increased affinity, which should help aspiring ACOs attract patients and physicians. Can one CPT code change the landscape of chronic care management? Probably not, but this is a significant step in the right direction.
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