chronic care management · 2020. 10. 5. · regulations. one such topic is on reimbursements for...

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AUTOMATEDCHRONIC CARE MANAGEMENT

F O R C A R D I O LO GY

How to protect your independence, achieve the best outcomes, and bring

new comfort to your patients

by Matt Ethington


Introduction 3

Why I Wrote This Book 5

Chapter 1: Protecting Your Independence - To remain independent in the future,

you’ll need additional reliable ancillary practice revenue and a stellar reputation

among patients and peers 6

Chapter 2: MACRA – You don’t really have a choice 11

Chapter 3: Patient Relationships - Maintaining and strengthening patient

relationships in an environment that is increasingly competitive for your time 15

Chapter 4: Knowing That You Are Doing Your Best Work 19

Chapter 5: Net New Revenue in Healthcare 22

Chapter 6: The Future of Healthcare 25

Can We Help You? 27

About The Author 28

Table of Contents


Cardiologists are proven to be the hardest working medical professionals in

healthcare averaging 60 hours in practice per week.

One might think that through the years and with all the advances in technology the practice of medicine had become more simplified or streamlined. What we see happening is actually the opposite: cardiology practices today are far more complex and challenging than they were ten years ago. The latest big change is MACRA which will be transformational to how you get paid. It is already federal law and, for the vast majority of you, unavoidable. We just finished migrating to ICD-10 which came on the heels of at least 2 phases of Meaningful Use and government attesta-tion which followed EHR selection, implementation, and transition. PQRS and VMs were mixed in there somewhere and only a couple years before that HIPAA, UPINs and NPIs, HCFA 1500s and UB04s, faxes and paper charts. Those are just non-clini-cal changes.

Today you’re neck deep in pre-certifications, red tape and documentation. A study released by The Annals of Internal Medicine in 2016, showed that physicians spend twice as much time on the EHR and desk work than with patients,(1) all valuable time once spent with patients. The non-clinical tasks of running a practice take away from valuable time spent focusing on patient care and maintaining patient relationships. You went into practice to provide optimal cardiac care. In this book, I show you exciting technology that enables you again to do just that.

People with chronic conditions account for 99% of Medicare spending(2) and 86% of US healthcare spending.(3) This puts Medicare specifically and healthcare as we know it on an unsustainable course. Nowhere is this more visible than your special-ty. Cardiovascular diseases are not only some of the most expensive conditions in the US but occur in staggering numbers. An adult dies of a cardiovascular condition every 40 seconds in the US.(4) One in three adults has at least one type of cardio-vascular disease and they cause 31% of all mortalities.(5)

Introduction


Introduction

Clearly, there is no shortage of demand for cardiologists. It’s the proliferation of non-clinical activities, changes, and requirements like those listed above that threaten your independent practice. The usual suspects are always worth mention-ing also: overhead costs, dependable staff, being profitable and finding work/life balance. Is that too much to ask?

Here is some better news: there is sun behind the clouds. What is waiting for you is a more enjoyable, more profitable practice that will enable you to protect your income, preserve your independence, deliver better care than you ever thought possible, and lower the stress and strain on administration. And, it’s possible now.

My name is Matt Ethington. Before I switched my career to medical technology nearly two decades ago, I was quite an unexpected patient. At age 30, I showed up in the emergency room, on the verge of a coma and in all-around pretty bad shape. That’s when I was diagnosed with Type I Diabetes. With a desire to remain closer to medicine, I switched my career to Health IT and have had some success in devel-oping solutions and building a business that managed 45 million electronic medical records for doctors on two continents. Today, I am a husband, father, executive, chronic patient, and child of two seniors that struggle with CAD, hypertension, afib, breast cancer, Sjogren’s, and Alzheimer’s. You might say the only person with a better seat than me to all the change in healthcare over the last two decades is you. What is it that Churchill said, “If you’re going through hell, keep going?” I’m happy to tell you there’s smoother sailing ahead.


I wrote this book for two reasons.

First, I see the challenges that cardiologists face daily as well as the lack of support providing cardiologists with information, understanding and implementation of new regulations. One such topic is on reimbursements for chronic care management, CCM. CMS has created specific reimbursements for the non-face-to-face activities your clinical staff are already performing to care for patients with multiple chronic conditions. The reimbursements for CCM come under CPT Codes 99490, 99487, 99489 and G0506. There are initial and recurring monthly reimbursements for the care provided to eligible Medicare and many commercial patients. Cardiologists in particular can easily add thousands of dollars per provider per month while reduc-ing the administrative burdens of these complex patients without additional office visits. Automated chronic care technology and training have been enabling cardiol-ogy practices to do this at scale and without significant burden for over two years. Secondly, as a patient, I learned that dealing with a chronic diagnosis is a very lonely process. When my parents began to deal with their own chronic conditions, this lesson was vividly reinforced. Patients have many concerns, insecurities, and ques-tions but they do not want to be a bother to you, your staff or worry their loved ones. As a result, they’re not always keeping your practice informed of the care they need, and you find out too late about disease progression that could have been halted or hospitalizations that could have been avoided. At other times, they may not even know when or which signs or symptoms are serious. While patients may have emotional support at home, few have medically trained help at home. For a chronic patient, knowing that their clinician has eyes on their status and trends is not only a significant comfort, it’s better medicine. There is a method of care for chronic patients that delivers better outcomes, generates greater reimbursement, reduces overall costs, and delivers higher patient satisfaction with a lower administrative burden. Cardiology is ground zero for chronic disease with the most patients and the most acute conditions.

Thank you for taking the time to read my book. I hope you find it valuable for your practice.

Why I Wrote This Book


Why I Wrote This BookChapter 1: Protecting Your Independence

The business of ambulatory medicine has changed dramatically over the last de-

cade, and the changes will continue. There are positive and negative aspects of

the changes depending upon who you consult.

Being a good physician with strong patient relationships is still of paramount im-portance, but it will take more than that to maintain an independent practice. Both government and commercial payers’ demands have become more complicated. To remain independent, your practice will have to meet those increased demands.

Consider your EHR. Original research conducted in 2016 by the Annals of Internal Medicine involving trained researchers and rigorous time and motion studies of 57 physicians in 4 medical specialties showed that the EHR is probably even more in-vasive than you think. During the office day, physicians now spend only 27% of their time on direct clinical face-to-face time with patients.

Here is the conclusion, word for word:

Conclusion:

Within the clinic day, for every one hour physicians provide direct clinical face time to patients, they spend nearly two additional hours on EHR and desk work. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing addi-tional computer and other clerical work.(1)

That amount of time is the considerable ‘soft cost’ to your EHR. The monthly sub-scription, license, and support or maintenance fees are in addition to the cost of any productivity loss. The EHR also plays the additional role of central repository for the information you’ll have to report to the government.

To remain independent in the future, you’ll need additional reliable ancillary revenue and a stellar reputation among patients and peers.


As you’ll read in the following chapter on MACRA, there is more coming from the government/documentation side of the world. Take heart, EHR technology will evolve as the stimulus bolus works itself through and systems must stand on their merits. There is other technology available today that can ease your practice bur-dens, improve care, add ancillary revenue and ease practice burdens.

There has always been a market for technology that delivers clear benefits. Be-fore the EHR and stimulus push, electronic billing platforms achieved rapid mar-ket adoption in only a few short years by delivering faster reimbursements, easier accounting, and lower transactional costs. Rational economic behavior will return to the healthcare IT market, and you will see measurable benefits in the areas of in-teroperability, patient engagement, and mobile technology. EHRs will also improve, but they are in ferocious competition with one another at least in the short term as the market shakes out all the weaker players.

With the trend towards value-based care, expect that payers will follow Medicare’s demands and MACRA’s requirements for increased clinical documentation. You can expect more non-clinical red-tape from commercial payers. According to the Kai-ser Family Foundation, 23% of the Medicare formulary now requires pre-certification from commercial payers. In a physician survey referenced by the AAFP, 75% of phy-sicians surveyed described their prior-authorization burden as ‘high’ or extremely ‘high,’ and 90% report that prior-authorizations sometimes, often, or always delayed patient access to care.(3) It also reported the average medical practice completes 37 prior authorization requirements per physician per week consuming some 16 hours of combined physician and staff time.(6)

Here’s the point. Protecting your independence will require additional revenue

to free you from some distractions. It will also require strong outcomes to in-

crease referrals as well as maintain payer and health system interest.

1. Additional Revenue – You’ve seen how additional demands such as pre-certs, documentation of quality initiatives and non-clinical red tape have increased the cost of running a practice. It will continue to become increasingly expensive to

Protecting Your Independence Chapter 1


run. This means you’ll need to pay for the completion of some of these non-clin-ical activities so you can focus as much time as possible on patients. As the future brings more of these activities (MACRA comes to mind), you may ultimate-ly be hiring additional resources. So it’s imperative that you understand the full range of reimbursements, especially when they represent care that drives better outcomes which reinforces MACRA which drives higher payments.

2. Payer Participation - The outcomes that ‘outcomes based medicine’ wants to drive is keeping the patient out of the hospital. That’s the general direction of the 1/6th of the US economy that is tied up in healthcare. Payers (commercial and advantage included here) can be powerful advocates for independent practices, especially when they are delivering good outcomes that reflect fewer hospi-talizations and better patient care and specifically, lower costs for them. New technology enables your staff to have persistent situational awareness of at-risk patients between office visits. For the first time, you’ll know how your at-risk patients are trending in time to identify and halt problems before they become adverse events. Not only is there now good reimbursement for this service, technology enables it to be scaled profitably while simultaneously delivering better care and keeping payer responsibilities out of expensive hospitals. The outcomes you produce for the patients are even more favorable. Physicians report that automated chronic care platforms enables them to identify disease progression sooner, intervene and prevent adverse or unplanned events such as hospitalizations.

3. Patient Satisfaction – As health systems become increasingly competitive with one another for business, increasing pressure is applied to ensure that patients are referred internally within the health system rather than external-ly outside of the system. When patients go outside the health system, this is called ‘leakage,’ and administration views it negatively. However, as specialists, cardiologists depend on referrals. Being known in the community and espe-cially among your peers as a top-notch physician with very satisfied patients will protect your referral patterns and is and essential to remaining independent.



Questions to Consider:

What are some additional resources or ancillary services you could provide your patients that would increase net new revenue, deliver better outcomes and lower payer cost as well as deliver added value and satisfaction to your patients while making a positive impression on your peers?

Would having a color coded dashboard displaying your fragile and chronic patients with trending patients on alert and getting paid between $42 and $140 per patient per month to manage it help meet some of your objectives to remain independent?

Feedback from Appomattox River Medical Group After Implementing Automated

Chronic Care Management

Dr. James Bush, M.D. is board certified in Internal Medicine as well as Pediatrics. He is also the President of Appomattox River Medical Group and Chief Medical Officer at John Randolf Medical Center (HCA) in Hopewell, Virginia.

“We have been doing chronic care management since the beginning of 2015 and were looking for something that would make it easier for us to do it. Automated chronic care management has enabled us to do just that. We’ve been pleased. It is a lot eas-ier than trying to do things manually. Patients have been very responsive, and really like just to send us their data on their phone or computer. Patients are very compli-mentary of the system. I think it’s given them peace of mind putting in their numbers and knowing that I’m looking at it. I’ve got some people who are ninety years old sending in data every week. I’ve had a couple of people that have had blood pres-sure readings in the 150s/90s that I’ll review in our system, send off a message to the medical assistants and say add this blood pressure medicine. A few weeks later, when I look at their profile, there will be this big drop off where that medicine was added and now they’re running in the 120s/70s. Which is perfect.



“We’ve had the opportunity to take better care of patients, not only provide better access to our practice but manage their chronic conditions through the app. With-out patients sending us the data through our automated chronic care manage-ment system, we would not have been able to do this easily, if at all.

“I can do a lot more for a patient with fifty blood pressure readings than I can with only 2-3 per year taken in my office. We set patients up with standing questions that can be responded to anytime they want to answer. Then we prompt them once a week with unique questions specific to their condition and disease state. That seems to be the sweet spot for everybody. They send the data via the app, we review it, and it doesn’t seem overbearing for anyone patient or staff member. I mean it is huge for the patients not only because they can send us their data, but they don’t have to call or get in touch with us if they don’t want, but they do know that if they put their answers in there, that we are going to see it. That gives them a feeling of security and attachment because they know someone is going to see it right up on a dashboard and we are going to reach out to them if something seems outside of normal. I’ve had some people that are not super tech savvy, although it’s not that complicated to set up. It’s so simple to use, most of the patients have no trouble setting it up the first time and then never have to worry about setting it up or logging in after the first time.”



Why I Wrote This BookChapter 2: MACRA

MACRA is the 2,400 pages of rules and regulations that replaced the SGR in 2015

and dictates how you will be reimbursed. It is a ‘quality-based’ initiative that

rolls up other reporting programs (Meaningful Use Stages I, II, and III, PQRS, and

VBM), as well as measures your ability to electronically exchange information

and whether or not you participate in what is called ‘clinical practice improve-

ment activities.’

Here’s the important thing. If you didn’t apply and get accepted into something called an “Alternative Payment Program,” and you have more than 200 Medicare patients or $90,000 in Medicare payments you are going to be forced into the mer-it-based Incentive Payment System (MIPS). MIPS will measure your practice from January 1, 2017, through December 31, 2018, and will then impose an increase or decrease to your Medicare reimbursements by up to 9% when fully implemented. There are two reasons why you must participate:

• Your finances: cardiology has a significant component of Medicare patients within its panel. MACRA can swing the reimbursement of your Medicare panel by as much as 18%. There is no opting out. If you do not submit, the harshest penalty will be applied by default, and it applies to all of your Medicare reim-bursements across the board. You must participate.

• Your reputation: the metrics you submit for MACRA will be listed and com-pared against your peers on Medicare’s “Physician Compare” website. It is called a “Composite Performance Score.” The numbers and activities it mea-sures are associated with best practices so that the score will be widely asso-ciated with quality and broadcast to the public under claims of transparency in healthcare. It will have a reputational as well as a financial impact on you.

You don’t really have a choice


Reading on MACRA policy is lengthy, and we suggest you implement with guided assistance in the preparation, execution, and submission. In ensuing years, MACRA will also measure the total cost of your patients’ claims both at your practice and at others’. MACRA is one of the additional costs and complexities of running an ambu-latory business that will increase your practice’s need for revenue. It will continue to become increasingly expensive to operate an independent practice which means you have got to drive new revenue. If you’re like almost every other doctor in Amer-ica, you are already maxed out on patient volume and margins are already rail thin.

Question to Consider:

Are there any new services available that can benefit your patients, benefit your

practice, benefit your bottom line, and speak well about you professionally?

Fortunately, effective chronic care management gives you a much-needed quadruple boost in the MACRA arena. Here are the four benefits of Chronic Care Management:

1. Your staff is already performing much of the work necessary to bill for CCM and now you’re eligible to be paid for it so it is not a heavy lift to accomplish.

2. It pays very well. Reimbursement is between $42 and $114 per patient per month, and it is not unrealistic for a cardiologist to add over $10,000 in new monthly recurring revenue without adding a single patient visit.

3. It makes patients think even more highly of you, improves their well-being and their outcomes. While patient satisfaction is a soft benefit that will reflect well on you personally, outcomes such as fewer ED visits, lower rates of hospital-ization and re-hospitalization are hard numbers that reflect well on you profes-sionally, within MACRA and at the negotiation table with payers at contracting time.

4. You get separate points in MACRA for doing chronic care management and transitional care management that our product automates.

MACRA Chapter 2


Feedback From Dr. Wang After Implementing Automated Chronic Care Man-

gament

“It has definitely helped us out a lot!

“Tiana does the lion’s share of the work when we have patients with issues, and they aren’t necessarily medical issues. We are now able to easily connect with these pa-tients who just need a little bit more time and a little bit more attention to guide them from point A to point B. We were very early adopters of chronic care management and had a lot of patients excited about the benefits. We did it manually, were able to enroll them and at first, they all thought the program was ‘cool.’ However, after 6 months they decided that it wasn’t for them and dropped out.

“We have “re-booted” the program with an automated chronic care system because patients like the way that we collect their information and have come back into the program.

“The system fits in perfectly because normally a patient ends up in an emergency room where they spend 15 hours and $50,000. All they get from that is a medication and instructions to follow up with their PCP next week. With the platform, it is easy for pa-tients to answer a few simple questions and that data gets pushed directly to us where we can quickly analyze and easily identify those that need that extra help or an extra set of eyeballs. We can get in front of it and help break the cycle that is the traditional healthcare model. We’ve seen several patients that were boomeranging in and out of the ER because their blood pressure goes up and down. Now, because they are regularly providing us with information, we’re keeping tabs on them when they aren’t in the office.

“Before, patients would decide to just go to the ER. With our auotmated chronic care management system, we can use the data we’ve received from them to identify and pro-actively reach out to those who need attention. With the information that was previously unavailable, we can adjust medications, ‘talk them off the cliff’ or bring them into the

MACRA Chapter 2


office for evaluation instead of a hospital visit. Before implementing automated CCM, we were trying to go through the motions as best we could and had to treat these patients episodically. Not only was this not as beneficial, but it was also a tremendous burden on my staff.

“Our M.A.’s were tasked with physically calling all of these patients to check in and see how they were doing. Most of whom were hard to reach or really didn’t like to be bothered. Some would even hang up, simply not answer. I think in terms of leveraging technology and managing the data it’s very, very useful because before, we were using 1970’s thinking with 2000’s technology.”

Tiana:

“The way we were handling CCM before having an automated platform was insane. It got to the point where we had to find some way to keep the program viable, or we would have discontinued it.

“I would call patients off a list not knowing precisely which ones had a problem. Now I can see who is having problems and who I need to get to first. When I call the patients now, they know I picked up on something potentially out of whack and are more recep-tive to my call and eager to engage with me regarding the issues they are experiencing.

“There are cases where we caught a patient’s reported swelling and were able to bring them into the clinic or adjust their diuretics to bring their swelling down. Also, we have patients that self-report spikes in their blood pressure and were able to adjust medica-tion to stabilize it, no doubt preventing worse events down the road.

“I have been with Bowie Internal Medicine for five years and running the CCM program for about two years now. Almost every time I speak to these patients, they tell me how appreciative they are of this service. It is the best thing we have seen for manag-ing chronic patients efficiently and easily capturing the time and compliance pieces required for reimbursement.”

MACRA Chapter 2


Why I Wrote This BookChapter 3: Patient Relationships

Physicians report the patient relationship is the most rewarding part of their ca-

reer. However, non-clinical demands upon physicians have reached an all-time

high. Cardiologists already work the most hours in medicine, over 60 hours a

week on average.

Doing your rounds at the hospital, taking care of cases in the cath lab, and seeing patients in a clinic are some of the activities keeping you on your feet. There are only so many hours in the day so when we’re maxed out on time, how do we main-tain our patient relationships as well as strengthen them?

Spend more time seeing patients?ts? Give up some of your patients so you can see others?

Neither of these are good options for you if you want to give the best possible care to your patients and run a successful practice. So what is the answer here?

Maintaining and strengthening patient relationships in an environment that is increasingly competitive for your time.


Fortunately, this is an area where technology can help you be more efficient and stay more connected to your patients. Imagine for a moment that you had perfect situational awareness of all of your at-risk patients and that you knew very well what each patient’s status was without them having to come to your office. Simply by looking at a computer screen, your staff would know who was doing well and who probably needed some attention.

With mobile technology today, a key component of the care some chronic patients receive is already being automated. In fact, chronic patients simply answer ques-tions when they appear on their smartphones or tablets, or in their email or even text. Based on the responses they provide your staff will be able to get involved immediately. So whether you are titrating a labile hypertensive on multiple meds, avoiding patient decompensation, halting disease progression sooner, diverting an ED visit or ensuring an extended recovery without re-admission, you are now giving real-time care to your patients in less time than it used to take. Your patients love you for it because they spend less time in the hospital, have a better quality of life and feel much more secure all the while taking up far less of your time. Even the very elderly are participating to everyone’s benefit. Read some of the feedback below from patients and staff.

Feedback from Patients and Staff After Implementing CCIQ

Mrs. D. Smith of Birmingham, AL reports that although she speaks to her doctor less often, she feels closer to him than ever before. “It helps me just to feel more confident that my doctor is going to be more aware of what’s going on,” she says. And her doc-tor also reports that they have a much stronger relationship. Mrs. Smith responds to prompts on her cell phone for updates about her health status, and she appreci-ates not having to spend as much time on the phone with the office. On any day a clinical algorithm tracking her vitals, personal observations and symptoms might ask her for her weight, blood pressure, whether she’s noticed any new swelling, has had more good or bad days that week, or how many pillows she’s slept with, etc. Her

Patient Relationships Chapter 3


responses are calculated and displayed on a color-coded dashboard that alert staff if she has crossed a clinical threshold or is trending in the wrong direction. “Patients love it because they know if something is wrong, they know we’ll call,” says Callie, a Nurse Practitioner.

Mrs. B. Hanks uses it to update on her husband’s condition for him since he suffers from dementia. “If I knew somebody (else) who was a chronically ill patient, I would tell him to ask the doctors if they had that app available if they didn’t already know about it. It’s been very effective.” Prior to being enrolled, Mrs. Hanks kept written records doc-umenting her husband’s vitals but prefers the technology because it’s easier and the doctor receives them in real time. “We’re connected every day. It takes just seconds really and has resulted in changes to his treatment. This is much better.”

Staff who use the system point out that enrolling the patients who frequently call not only significantly lowers call volumes which permeates greater efficiency



through the entire practice, but also provides better service for the patients. “If they have changes in symptoms, I know it immediately. It eases their anxiety, and it also puts trust in us that we’re taking their best interest at heart.” Donna – MA.

Physicians using automated CCM report having stronger relationships with their patients too. This is especially effective in cardiology where you have large pan-els of particularly sensitive patients. “We know a lot more about what is going on than we’d normally get in a phone call,” is how Dr. Flowers puts it. “We’ve got trends. We can spot ‘white coat’ hypertension, and we know much more quickly how they’re responding to changes in medication. We start to know our patients differently and much better through the questions they answer. We’re able to care for them better and in less time.”

“And it really saves me a lot of time,” reports Fred K. “I can just do this from home rath-er than come into the office, which is a neat thing. All I have to do is enter the numbers, it takes less than five minutes.”

“We are better in touch with our patients; patients feel better knowing that they have daily or regular contact with our office, and we have improved communication with fewer phone calls,” states Dr. West, an internist in Georgia.

As a clinician, think about this from a loved one’s perspective, perhaps a family member in someone else’s care. Wouldn’t you feel better knowing that they were sending regular updates and their physician would be alerted if something looked like it was moving in the wrong direction? I think it will be a gold standard in the future of healthcare and Medicare pays for it, so it makes sense.



Why I Wrote This BookChapter 4: Knowing That You Are Doing Your Best Work

For those of us that love what we do, doing a great job is important. Knowing that

your customers are being taken care of and are happy is even more important,

and when you are dealing with peoples’ lives, there is nothing more important.

With all the non-clinical activities that need to be done and with all the legisla-

tion and regulations that have been passed, it can sometimes feel like a moun-

tainous task to be able to provide the best possible care to your patients.

There is, however, nothing more rewarding than getting this right. To know that you have provided the best possible care to your patients both in the office and out of the office, to know that you have actually saved, extended, or improved someone’s life because you were able to provide the right care at the right time.

A recent study on what doctors found was the most important thing to consider in their practice showed that next to a patient’s gratitude, knowing that they did the best job possible for the patient is listed as the second most rewarding part of being a doctor, the third is money. Is this true for you?

Dr. Flowers was one of the first cardiologists in America to support a chronic care management program within his practice. He started it initially with his nurse practi-tioner, but it grew beyond their ability to manage it without additional staff. “About 50 patients is where we hit the breaking point. Based on promising results of patients, they decided to hire an MA specifically for chronic care management. “We add 10 to 15 patients a week. I expect that to increase,” he states. “It’s the right thing to do.”

Dr. Flowers can cite specific examples of many patients that have benefitted from chronic care management. On one patient in particular, “he’s not quite end-stage systolic congestive heart failure, but he’s close, and before I started following him, he had been admitted multiple times. He is very compliant, so it’s not that he has not been active in his care, but it is just a difficult balance of managing his medications and his diet and all the complexity of dealing with a severe heart failure patient.”


Before enrolling him, they’d see him at the office every 2 to 4 weeks, but now they’re able to follow his symptoms much more closely. “It has been impactful for him. He is able to stay out of the hospital and is not having to come to the office nearly as often. I think the last time I saw him was a three-month interval. We’re still making pretty significant adjustments in his medications, but it does not require much of my time. It has been really interesting. From his perspective, he feels like he has someone who’s communicating with him more frequently.”

“The color-coded dashboard makes it easy for me to know which patients may need attention,” states Patty, a nurse in Georgia. If a patient’s status changes from green to red, Patty confirms with the patient before involving the Doctor. Her physician, Dr. West finds that this kind of filtering process more quickly identifies patients in need, reduces multiple calls and messages, and increases office productivity.

“I have an elderly CHF patient who is cared for closely by her daughter. The daugh-ter would bring in notes and figures but only on scheduled visits. On one visit, I was alarmed that my patient had gained 16 pounds. However, her daughter was unaware of the weight gain. We tried to treat her as an outpatient, but she was in heart fail-ure and had to be admitted. After she was discharged, we enrolled her in our CCM program. Where before, her daughter was keeping her notes and figures in her spiral notebook, she is now entering them into her phone so my nurse gets them immediately, and my patient has not had a heart failure exacerbation since.”

“Our patients enrolled in the program are engaging at a rate above 85%. This kind of elevated care is not happening anywhere else. I could have never provided this level of care without this technology,” states Dr. West.

Knowing That You Are Doing Your Best Work Chapter 4


Feedback from Dr. James West After Implementing CCIQ

“We’ve been able to use Medicare’s CCM and an automated CCM program not only to generate new revenue but also to improve patient care.

“It provides enhanced care, we have real-time awareness of patient status in between visits. Patients report feeling more secure and involved in their care and compliance rates exceed 85% on average.

“We’re seeing greater revenue. We’re now being reimbursed by our commercial payers, advantage plans and Medicare. Another benefit has been reduced call volumes. Pa-tients felt comfortable that we were monitoring their status and their need to call into the office was virtually eliminated.

“We are better in touch with our patients. Patients feel better knowing that they have daily or regular contact with our office and we have improved communications with a significant decrease in office call volume. “This kind of elevated care is not happening anywhere else. Even as a concierge physician, I could have never provided this level of care without autromated CCM.”

Dr. West’s Administrator, Ginny Skipper, had this to say about starting with their automated CCM system: “It fit right into our workflow and didn’t slow us down at all. Simple. Fast. Nothing at all like an EHR or anything major. Staff and patients have really taken to it and it’s made dealing with complex patients a lot easier and they’re a lot happier too.”

Knowing That You Are Doing Your Best Work Chapter 4


Why I Wrote This BookChapter 5: Net New Revenue in Healthcare

Think of how much more complex your practice is today, compared to just 10

years ago. If someone mentioned regulatory burdens, we would have all thought

it was related to OSHA. A “Bundled payment” meant an insurance carrier had

combined the procedure code for a blood draw along with the test and buried it

somewhere in the small print.

The topic came up in a conversation with Alex, the Administrator of an eight-doc-tor cardiology practice in a Houston suburb. “Chronic care management was such an easy decision to make compared to the others,” he offered. “We were evaluating different comp plans, joint ventures, a P.E.T. camera, all big, most very expensive. CCM was something we could just do, with existing patients, without capital expense or a lot of extra staff. We were already treating thousands of chronic patients that would benefit and we were already providing a lot of the follow-up care, so it was a natural decision when Medicare introduced the reimbursement.”


Ambulatory practice business needs will continue to grow in sophistication, if not complication. Your practice will require additional sources of revenue to offset those needs. Most physicians are already maxed out on patient volume and must look externally or to ancillary services for additional revenue, so your choices are somewhat limited. It has to fit with your practice, your image, and your respected place in the community. It would not make sense for a cardiologist to rent out office hours on the weekend to a massage therapist, to sell vitamins at the front desk, or perform laser hair removal.

Chronic Care Management (CCM) and Transitional Care Management (TCM) reim-bursements are still viewed by many as new, although Medicare introduced and funded them in 2015 and 2013 respectively. CCM pays up to $141 per patient per month and TCM pays roughly double a complex office visit upon a patient’s dis-charge from the hospital. In 2017 Medicare dramatically increased reimbursement for CCM. It’s a perfect code for independent cardiology practices because it treats patients already within the practice, it keeps the cost of managing chronic diseases low, and cardiac patients are typically more motivated and compliant. You should be expecting to bring in more revenue with TCM and CCM.

How much exactly?

Between $500 and $1,500 per patient per year. Medicare estimates that 68.6% of its beneficiaries are eligible, which is probably higher within a cardiology panel. CCM is a reimbursement for the non-face-to-face activities staff perform in support of your chronic patients. Says Alex, “It’s a market that’s already made. Through CCM, patients get better care and we’re able to get paid on services that we’re already per-forming in many cases.”

TCM – or Transitional Care Management – this is a timely office visit post-discharge from the hospital to encourage the patient to be quickly re-oriented into ambulatory care and designed specifically to help reduce costly readmissions. It involves some

Net New Revenue in Healthcare Chapter 5


specific compliance requirements such as a contact and an office visit within a cer-tain time frame post-discharge, care coordination and planning, and the creation of a care plan. TCM visits are also eligible for an extra CCM g-code payment when the patient is enrolled in CCM at the TCM visit. Topping out at over $300 for an office visit, and with relatively non-invasive compliance requirements, TCM should not be ignored as a revenue source. Correctly claiming just one of these patients a day will add $38,000 a year. It is worth paying attention to.

How Getting Reimbursed Makes All The Difference

CCM or Chronic Care Management Services are now reimbursed via CPT code when it can be established that staff has spent twenty minutes or more of total non-face-to-face time in a calendar month for the coordination of care for patients with 2 or more chronic diseases. In 2017, Medicare doubled down on chronic care man-agement by adding new codes increasing the range of reimbursement from $42 for non-complex CCM to $142 for ‘complex’ CCM. This is monthly, recurring reimburse-ment when the compliance requirements are met. Our automated CCM system helps us to meet the compliance requirements while ensuring patients get reliable care and much-needed feelings of greater security.

Medicare isn’t the only payer. Many Commercial and Advantage plans routinely pay also. Dr. West adds, “We’re now reimbursed by all of our payers: commercial, advan-tage plans, and straight Medicare. It is good revenue, and it makes a difference.”

Net New Revenue in Healthcare Chapter 5


Why I Wrote This BookChapter 6: The Future of Healthcare

Healthcare is on an unsustainable course, driven by chronic disease. Nowhere

is it more prevalent and dramatic than in the field of cardiology. Cardiovascular

diseases are not only the most expensive conditions in the US, but the sheer

volume is also extravagant.

An adult dies of a cardiovascular condition every 40 seconds in the US.(4) One in three adults has at least one type of cardiovascular disease(3) and they cause 31% of all mortalities.(5)

• 86% of national healthcare spending is attributed to people with chronic disease(3)

• 99% of Medicare spending is for patients with chronic conditions(2)

• 2/3rds of Medicare beneficiaries have 2+ chronic conditions(2)

• 7 out of 10 deaths in the US are due to chronic disease(3)

• More than 1 in 3 adults have at least one type of cardiovascular disease(4)

Chronic Disease is the leading cause of disability, kidney failure, lower limb am-putations, new cases of blindness among adults(7), and by extension: bankruptcy, disability and loss of independence.

According to MedAxiom(8) the average age of a cardiologist in the US is 54 years old. According to CMS, 68.6% of Medicare beneficiaries have 2 or more chronic conditions. And, 10,000 new baby boomers turn 65 and enter the Medicare roles each day and will continue to do so for the next 15 years. For that matter, some derivative thereof now turn 70 each day also, and soon it will be 75, then 80 and so forth. One can only wonder what the cardiovascular landscape would have been without the gains in smoking cessation. The internists among you are staring at a full-on crisis displayed by the gains in obesity and corresponding diabetic and pre-diabetic statistics.(9)

Physicians have the highest suicide rate of any profession. A male doctor is 141%


more likely to die by suicide than the average male, and a female is 227% more likely to die by suicide.(10) It is because you care. And that is what puts you at risk. Cardiologist work on average more hours than any other medical professional. You practically sacrificed the entire decade of your twenties becoming an internist and then a cardiologist. Will you take some of that personal time you sacrifice and apply it back to Medicare’s significant reimbursements for a more preventative form of care? We traded smoking for processed foods and obesity but we’ll get it right. In the short term, the internists will be working with the diabetics, you’ll be working with the afib and heart failure patients, and you’ll share the hypertensives. But, you might be able to work a little less. With TCM and CCM automation, your practice can have the bandwidth and reimbursement necessary to provide the best care for these high utilization patients, while making them feel included and better cared for, and give you the right information at the right time to help your patients make the right decisions.

Without the right technology platform, these new CMS programs have shown themselves to be invasive and burdensome. But, when technology automates the routine tasks and pro-actively reaches out to your at-risk patients to accumulate and trend critical data that you wouldn’t otherwise have, you have a powerful tool to care for your highest need patients. You are now able to physically and emotion-ally include them in their on-going care, and obtain the reimbursement that makes delivery of this ‘unprecedented level of care’ worthwhile. Perhaps, like others, you’ll even discover that you can scale back your patient load a bit.

The Future of Healthcare Chapter 6


We can, that’s why we are in this business. Being a chronic care patient myself I

am dedicated to enabling you to be proactive with your chronic, at-risk patients

so that they can can engage and help you provide them with the best care pos-

sible. I want to see your practice grow and flourish in a way that you don’t get

swallowed up by big health systems and insurance companies.

Imagine the care you could provide with a color-coded dashboard showing you exactly which patients were symptomatic, decompensating, trending poorly or had crossed important clinical thresholds in real time. Imagine the financial security your practice will enjoy with monthly recurring reimbursements between $43 and $141 per patient per month for more than 2/3rds of your Medicare population.

Here’s what you need to do:

1. Book a demo using this link.2. One of our experts will walk you through what it can do and how easy it is to set up.3. You will be presented with 3 options depending how many patients you want to get

on the system.4. Choose your package and we help you set up and we train your staff so you can

implement quickly and start getting return immediately.

If you want to speak to someone immediately, you can call us at (885) 999 8089Or you can email us at [email protected], and one of our experts will get in touch with you.

We are excited to help you automated your chronic care management, provide the best possible care to your patients and grow your revenue with a solution that is simple to use and will change the way you take care of your patients.

Can We Help You?

https://chroniccareiq.com/request-a-demo/

mailto:info%40chroniccareiq.com?subject=


Matt Ethington is a successful serial entrepreneur and seasoned professional

with two decades of experience in the healthcare and IT space.

In 2000 he was diagnosed with Type I diabetes at an unusually late age and devoted his

career to medical technology. Prior to ChronicCareIQ, he founded and led the award-winning

simplifyMD which grew from concept to managing more than 45 Million electronic medical

records for doctors on two continents, including the largest hospital in the Southern Hemi-

sphere. He has held sales and executive leadership roles in healthcare IT and telemedicine

firms. Ethington has served on the Dell OEM Advisory Council as well as

the Metro Atlanta Chamber. He is a member of the Atlanta CEO Council,

a TEPR award winner and a former faculty member of the Medical Re-

cords Institute. He is a graduate of the University of Nebraska.

Thank you for reading my book.

REFERENCES

1. 6 DECEMBER 2016 The Annals of Internal Medicine Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties Christine Sinsky, MD; Lacey Colligan, MD; Ling Li, PhD; Mirela Prgomet, PhD; Sam Reynolds, MBA; Lindsey Goeders, MBA; Johanna Westbrook, PhD; Michael Tutty, PhD; George Blike, MD 2. CMS https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-02-21-CCM-Presenta-tion.pdf Accessed 8/23/20173. https://www.cdc.gov/chronicdisease/overview/index.htm Accessed 8/23/20174. Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF – 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed November 18, 2014.5. Beaton, Thomas https://healthpayerintelligence.com/news/top-10-most-expensive-chronic-diseas-es-for-healthcare-payers?sthash.qlDY6jdV.mjjo Accessed 8/23/20176. http://www.aafp.org/news/practice-professional-issues/20170609priorauth.html Accessed 10/15/20177. Centers for Disease Control and Prevention. Leading causes of death and numbers of deaths, by sex, race, and Hispanic origin: United States, 1980 and 2014 (Table 19). Health, United States, 2015. https://www.cdc.gov/nchs/data/hus/hus15.pdf#019 [PDF – 13.4 MB]. Accessed June 21, 2017.8. Sauer, Joel Cardiology Workforce Analysis – MedAxiom https://www.medaxiom.com/clientuploads/docu-ments/Workforce_Analysis.pdf Accessed August 23, 20179. Centers for Disease Control and Prevention, National Diabetes Statistics report, 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf10. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis) Eva S. Schernhammer, M.D., Dr.P.H. Graham A. Colditz, M.D., D.P.H http://mwia.net/wp-content/uploads/2012/07/SuicideRatesAmongPhy-sicians.pdf

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chronic care management · 2020. 10. 5. · regulations. one such topic is on reimbursements for...

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