While most physicians surveyed recently saw a need for chronic care management services, barriers to adoption include patient skepticism, doctor unfamiliarity with Medicare reimbursement, and physician concern over complicated coding.
Most primary care physicians would like to offer chronic care management (CCM) services to their Medicare-eligible patients, but there are several barriers to adoption, a recent survey found.
Chronic conditions include hypertension, cancer, arthritis, and diabetes. These kinds of conditions are not only associated with long-term impairment, but also 71% of healthcare costs, according to the Quest Diagnostics survey, "Hidden Hazards: Closing the Care Gap Between Physicians and Patients with Multiple Chronic Conditions."
"Three in four Americans over the age of 65 have two or more
chronic health conditions. These patients are generally sicker, more likely to use hospitals and emergency rooms, have greater limitations
in their daily living, and experience accelerated decline in their quality of life," the survey authors wrote.
CCM services are designed to guide and support patients who have multiple chronic conditions (MCCs). CCM services include electronic and phone consultation, medication management, and 24-hour access to care providers. Medicare Part B pays for CCM, with average reimbursement ranging from $42 to $62.
Physicians see a need for CCM, according to the survey, which polled 801 primary care physicians and patients over 65 with MCCs:
- 93% of the physicians wished they had help ensuring MCC patients were adhering to their care plans
- 92% reported MCC patients struggled with adhering to their care plans
- 85% said they lacked the time to provide adequate care for MCC patients
- Only 9% said their MCC patients were getting the care and attention they needed
There are several barriers to CCM adoption, the survey found:
- MCC patients surveyed said they were largely satisfied with the care provided at their primary care physician office, with 92% reporting they were getting all the attention they needed at their PCP
- Only 51% of physicians surveyed knew that the Centers for Medicare & Medicaid Services pay separately for CCM under the Physicians Fee Schedule for qualified patients with MCCs
- 77% of the physicians said they had not implemented CCM, with 43% citing complicated coding, 37% citing burdensome paperwork, and 25% citing low Medicare reimbursement
There are three strategies to overcome the barriers to CCM adoption, according to the survey:
- To address the perception of CCM complexity among primary care physicians, adoption solutions should include simplifying the process such as providing coding expertise.
- PCPs can make convincing arguments to patients to use CCM services, including medication adherence and reassuring patients that CCM has only modest copays under Medicare.
- Physicians can explain to patients that CCM helps address health concerns before they become major medical problems. In the survey, the Number One worry among patients was "getting another medical condition" (43%).
Christopher Cheney is the senior clinical care editor at HealthLeaders.