Welcome to the ProfitableMD blog. We’re eager to start sharing with you everything we can to help you successfully implement Chronic Care Management (CCM) Services into your practice. We want the employment of CCM services to be the easiest step you ever take, that results in the greatest overall improvement of your practice.

Quick Introduction

ProfitableMD is a division of iSALUS Healthcare, a provider of healthcare software solutions for practices across the U.S. We were created specifically to help practices that don’t have the time or resources to build a CCM program from scratch. With all of the complexities and growing compliance requirements in healthcare, practices can find it challenging to keep up. That’s where ProfitableMD steps in, acting as an extension of your practice to provide the same personal service your in-house staff provides. But enough about us. We want to start helping you.

Understanding Chronic Care Management

In reality, more and more eligible providers are simply too distracted by the requirements of quality incentive programs such as Meaningful Use and the Physicians Quality Reporting System (PQRS) to put forth the time and effort that is required to implement CCM services into their practice. As a result, there is a huge financial resource that is not being tapped into. Not only are providers missing out on a chance to improve their bottom line, but these same services also improve the quality of patient care, patient satisfaction and even help providers meet some of the quality measures that the above-mentioned programs necessitate. It’s become a catch-22. Providers know it will benefit them and their patients but cannot invest the time or finances to implement it.

However, the need for CCM cannot be denied. The research is done and the facts are very clear. Chronic Conditions are responsible for:

  • 81% of Hospital Admissions
  • 91% of Prescriptions Filled
  • 75% of Physician Visits

After the realization that, in general, healthcare providers were caring for patients with chronic conditions on more of a “needs basis” than providing care that was actually managing overall health, a deeper look was taken into how providing chronic care management could be an answer to the startling statistics mentioned above.

In a case study by the Journal of Aging Health in 2010, over 1,100 patients with a median age of 65 years old were followed for 6 months to evaluate the effectiveness of Chronic Care Management Programs. The results were very positive. The study found that patients receiving CCM services saw a decrease in emergency room visits and hospitalization all the while improving their overall quality of life. This means that by providing CCM services, your practice can contribute to improved quality of care, patient satisfaction and, now that Medicare has acknowledged the need, you can also contribute to an improved bottom line.

Unfortunately, in the last quarter of 2015, CMS admitted to having received CCM claims for only 100,000 Medicare beneficiaries thus far. This means that less than ½ of 1% of qualifying patients are receiving the services that could dramatically improve their health.

Why is CCM so Hard to Implement?

Although the average U.S. reimbursement for providing CCM services is $40.83 per month, per patient, the majority of eligible providers have yet to take the steps needed to implement the service. Why? Industry experts have speculated on a number of reasons that include:

  1. Lack of adequate education regarding CCM billing rules
  2. It’s too much work to implement and document for too little reimbursement
  3. Patients will not want to pay the 20% co-pay that may be required by some depending on their coverage
  4. Providers are waiting to see the results of the first couple years before implementing CCM themselves.

Recently, a national study on CCM was released by Pershing Yoakley & Associates, PC (PYA). They found that of the participating practices, approximately 25% of them had implemented CCM but less than half of them had yet successfully submitted a claim and received payment. (Click Here for the Full Report)

While those numbers are disheartening to say the least, we know there’s hope. In this blog, we hope to provide you with the resources you’ll need to successfully implement CCM services into your practice, whether it be in-house or by utilizing an outsourcing service.

It’s Imperative to Move Forward

The truth is, most practices can’t afford not to implement CCM services. Think of it this way. According to MGMA, the average provider in a family practice will see 3,279 unique patients on an annual basis. The average percent of those patients covered by Medicare is 21.83%. The average percent of Medicare beneficiaries that qualify for CCM services is 68%. This means you will have an annual number of 2,296 unique Medicare patient visits on an annual basis which equates to $245,799 in additional income for your practice (based on the national reimbursement average). Those numbers cannot be ignored. Especially in today’s healthcare environment where potential negative payment adjustments from quality incentive programs are threatening everyone’s bottom line.

To find out the potential income for your practice, click here use our CCM Revenue Calculator.

We look forward to providing you resources to help you successfully implement CCM services into your practice so that you and your patients can be rewarded financially and with better overall health.