Outsourcing CCM

Author(s):

For practices without the resources to meet the billing requirements for chronic care management, outsourcing can obtain some of code’s clinical and financial benefits.

For practices without the resources to meet the billing requirements for chronic care management (CCM), another option is available for obtaining at least some of code’s clinical and financial benefits: outsourcing the work to a third party. That’s what Pankaj Desai, MD, FACP, and his partner in a suburban Baltimore internal medicine practice did when they decided to start billing for CCM services in March 2017.

Between them, the two providers had about 400 Medicare patients with multiple chronic conditions, but the practice lacked the staffing resources to meet the CCM requirements for even a fraction of that number. So after Desai and his partner enroll a patient in a program and develop a care plan, they turn over the follow-up contact work to CareOne Team, based in Rock Hill, South Carolina.

“They have access to our EHR, so every month they put in notes saying how much time they spent talking to each patient, what was discussed, and so forth,” Desai explains. “We review the information and sign off on it before submitting it to Medicare for payment.”

But while Desai and his partner now are able to provide CCM services, outsourcing the follow-up contacts with patients does come with drawbacks-starting with the cost. CareOne Team takes 65% of the revenues the practice gets from billing CCM.

Another problem is patient response. “The feedback we’ve gotten from a lot of patients is that they don’t know who’s calling them and we have to explain it’s someone working for us,” Desai says.

Next: Loss of continuity with patients

On the other hand, he notes, on several occasions a CareOne Team employee has alerted him or his partner that a patient needed to be seen immediately, thereby heading off an emergency department or inpatient admission.

Another problem some practices encounter with outsourcing CCM is loss of continuity with patients. That was the case with Leisa Bailey, MD, a solo primary care physician practicing in Bonifay, Florida who has been billing CCM services since 2015. Bailey did experiment briefly with outsourcing some of her CCM patients, but was dissatisfied with the results.

“They [the outside company] weren’t bad, but we just didn’t seem to know as much about what was going on with our patients when the follow-up was done by someone outside the office,” she recalls.

Whereas employees at the outside company had to stick to a script, Bailey’s care manager could provide education and advice, and patients felt more comfortable talking to her. “Using an outside firm is better than nothing, but it’s so much better when done in the office,” she says.