It can probably go without saying, but hospital stays are incredibly expensive. Hospitalization alone accounts for one-third of the $2 trillion spent annually on healthcare in the United States, and there is a high rate of hospital re-admissions due to poor planning and transitional care.

In just the Medicare program, the 30-day readmission rate for patients with some chronic conditions is as much as 23 percent. Research has shown that millions of these re-admissions may be preventable, saving billions each year in Medicare spending. One way to manage hospitalization, help with transitional care, and prevent many of these costly re-admissions is through the use of chronic care management services.

Hospitalization and Transitional Care Challenges

According to data from the Healthcare Cost and Utilization Project (HCUP), older adults (aged 65 and up) account for 40 percent of hospitalized adults in the U.S. and nearly half of all healthcare dollars spent. The leading admission diagnoses among these patients are cardiovascular diseases, pneumonia, and septicemia. Not only are many of these hospital stays more expensive for older adults due to the seriousness of the conditions, but the average length of stay is longer than with younger patients. Both cost savings and better patient outcomes in these cases can be achieved through the use of chronic care management services.

Chronic Care Management Services as a Solution

One of the major predictors of whether or not your patient will end up back in the hospital within 30 days is the number of chronic conditions that they have. Fortunately, the chronic care management (CCM) program was specifically tailored to help patients with more than one chronic condition. A care coordinator assists the provider with this risky population through monthly non-face-to-face clinical staff time that can help address items on the physician’s care plan related to hospitalization management and transitional care. During these calls, the care coordinator can address several issues that both help with transitional care and prevent re-admissions. Among these are:

  • Medication Management. The care coordinator provides medication reconciliation services, which have been shown to cut down on hospital re-admissions.
  • Patient Education. Patients are provided with educational materials about their illnesses, including instruction on prevention.
  • Medical Care Coordination. The care coordinator reviews the patient’s personalized care plan, can coordinate home health care services, and assist with other transitional care needs.
Chronic care management

Chronic care management services can help reduce readmission rates and deliver better patient outcomes.

Limitations on Chronic Care Management Services

While chronic care management services can help manage hospitalization costs and transitional care, there are a few limitations to the CCM program. Medicare limits the billing of certain services occurring on the same day, so providers will need to make sure that concurrent services aren’t rendered for:

  • Home Healthcare Supervision code G0181
  • Hospice Care Supervision code G0182
  • End Stage Renal Disease (ESRD) codes 90951-90970
  • Transitional Care Management codes 99495 or 99496

Otherwise, a CCM care coordinator can be an invaluable tool for primary care providers and patients to both save costs and deliver a higher standard of care. Contact us to find out how chronic care management services can help your practice and to calculate your revenue potential through the use of this valuable resource.