Chronic Care Management (CCM) You Want It & You Want It Now!
I have written separately about the way that Medicare and other insurance companies are going to change the way they reimburse doctors. The government wants to move away from paying a doctor or physician extender a fee for each visit and moving towards paying for measures of performance.
These include the percentage of patients that have had a mammogram, the doctors immunization rate, their hospital readmission rate..their management of heart failure etc…These seem like good ideas but ,as always, the devil is in the details. One of the ways that Medicare intends to reimburse doctors is based on the management of the patients chronic medical conditions and this part is called the CCM program. Although I am no fan of a lot of things about Medicare I am a big fan of this program and once you hear about it you will be as well.
Listen, I don’t have to try to sell you anything here. This is not my program. I have a program..SignatureMD …this has nothing to do with that. This is a first ever available extra level of coordination of your care, This is a program crafted by Medicare which finally acknowledges the tremendous amount of work it takes to really coordinate care properly for patients with multiple chronic illnesses. This is not for the young , or the healthy…They don’t need their care coordinated. When you start seeing more than 2 doctors regularly you qualify. When you have multiple caregivers changing medications or ordering tests you qualify. When you have two or more significant health issues on an ongoing basis you qualify. You get the idea.
Chronic Care Management means your primary caregiver is taking extra steps to have someone check up on you regularly and actively so that we know you are not missing medications, appointments etc,. You have a dedicated person overseeing all your visits. This involves making sure all the providers and whatever family members the patient has designated have all the same information. This involves more transparent but HIPPA etc compliant access to the patient’s medical history. This involves following up on all the appointments and reviewing independently all the records. This is a person reaching out to the patient on an ongoing basis to minimize the screw ups that could have serious consequences. Do I have to go there? Last month’s British Medical Journal suggested that medical mistakes could be the third leading cause of death in America. Really?! This program could significantly impact that likelihood and its covered by insurance. !!
If this is now available and you are eligible why wouldn’t you give this a try? For the doctor this is extra work
and there is an extra charge. . Most, if not all, of the cost is covered by Medicare, Medicare Advantage and Blue Cross / Blue Shield. This is an available, covered, upgrade to your medical care that could save your life or your mother’s life… if you are a child living out of town or across town worried about your momma! Accurate information , easily accessed, can make an immense difference in your care and in your ultimate health care spending and that’s why Medicare and some of the big insurance companies are so interested in it. They see the financial advantage and that’s their job… I see the advantage to your health and health care!
Your primary care physician is supposed to be the conductor of the orchestra . He’s the one that refers patients 
to other doctors and then follows up with the other appointments and tests that were ordered etc. This sounds simple and appropriate but in the real world this is very fragmented. Some patients know the medicine changes that their last specialist made and many don’t. Some patients remember all their appointments and some patients don’t. If You have multiple medical problems or see multiple specialists… good luck at keeping the communication open and up to date. This is extremely difficult in practice. One patient could have a cardiologist, a kidney doctor, an eye doctor, a vascular surgeon, etc. and each of them is trying to keep in communication with the others and is a very fragmented system. Currently the electronic medical records do not communicate well with each other. This will not be fixed anytime in the near future. It infuriates me when patients tell me… ”the doctor didn’t have the report”… perhaps you have had a similar experience?
Once a doctor recommends that the patient see a specialist he may have no way of knowing what day the visit was, what the findings were etc. until the doctor sends his report. Some offices are quick with their reports and some are not so quick. What if I don’t get a report. How can I review a report I didn’t get? What if the patient misses the appointment or a test or labs? What if another health care provider changes the patient’s medications? Sometimes important details are lost in a 310 page consultation note and it is a nightmare trying to keep the medical record true and correct let alone attend to the myriad details of the outside consultations, tests and appointments. This is very difficult and important work and finally the importance of this work has been recognized and codified.
So Medicare has offered physicians a monthly extra monthly incentive to really step up and stay on top of patient’s care. To actually “coordinate the care”. This means hiring someone in particular who will monitor the appointments, the results, coordinate communication between the medical offices etc. on an ongoing basis. I can either hire one person to manage between 200/250 patients or I can outsource it to professionals. Luckily, here in America, companies have risen to the occasion to offer this service to physicians and their patients. The internet, the fax machine and the phone enables the coordinator to work from anywhere. Anywhere for me at least means anywhere in America. The person coordinating your care will be calling you from somewhere in the USA. I understand the reasons to outsource to China but this is way too important to handle offshore.
This is a new program. These are new opportunities to improve patient care. This is actually the most proactive thing for patients I have ever seen Medicare do. EVER . I think this can really make a difference by decreasing errors and increasing communication. In terms of medical dollars this is dirt cheap and can have a big impact. It’s encouraged and covered by many insurance companies and each patient can sign up or drop out anytime for any reason. I always find that type of arrangement very reassuring. No special contracts. This is an opportunity for patients to get better coordination of their care by a incentivized caregiver. This sounds like a winwin to me.
Again, this is not some crazy program I have cooked up. This is a program that has been encouraged by the government and is part of current and future Medicare programming.
Usually the other major insurance companies follow suit. For people with complicated medical situations or any combination of serious chronic medical conditions this level of oversight can make a real difference in your health. Best of all is that this is not some limited time offer, this is not something available only to the first 100 callers… this is something your primary care practice can be doing. This, as I have said, is a new program and many practices just don’t know how to approach this program but it’s something that every office can do in one form or another. This program, like the cognition test Cognivue, passes my test. For me the test.. ”Is it in the best interest of the patient?” This could be a great thing for patients if it works out. It may turn out to be too good to be true but you must know by now that I am an Optimist. Check out this new program and how it can make a difference in your life or the life of someone you love! This is the shizzle my nizzle!
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