Page 7 - SFHN JAN 2022

2022 Medicare CCM Payment Increases

and What Is Next Gen CCM?

The 2022 Medicare Physician bridging identified gaps in care ensures
Fee Schedule Final Rule holistic medicine. South Florida's
announced substantial payment 4) Patient safety and risk management:
increases for Medicare Chronic Vigilant care managers routinely review Monthly
Care Management (CCM), even determinants of health to assess each Healthcare Newspaper
though most other services will patient’s health risks and regularly evaluate
receive about 4% less than in at-home safety and risk of harm, from PO Box 812708
2021. The increases incentivize medications to falls. Boca Raton, FL 33481-2708
greater participation in CCM 5) Early detection and reporting of Phone: (561) 368-6950
with reimbursement for the min- patient deterioration: To improve patient
imal billable CCM services, at outcomes and reduce Medicare waste,
least 20 minutes of telephone BY SCOTT RICE, MD, PHD, MBA, MS, ongoing surveillance for patient deteriora- Website:
contact (CPT 99490), jumping AND RICHARD GROSSO tion is performed, and once detected, an www.southfloridahospitalnews.com

on average from $42.17 to alert is immediately sent to the supervising
$62.16, a 51% increase! At this survey in 2015 revealed much of the chal- physician with the intention of circum- CHARLES FELIX
new reimbursement, a practice enrolling lenge to advancing CCM is due to a lack of venting an avoidable ED visit or hospital- CAROL FELIX
300 eligible Medicare patients has the physician awareness of the program’s ben- ization. Publishers
potential to gross over $225,000 in yearly efits and a general perception that 6) Enhance patient experience of care:
CCM revenue. Creating such a profitable Medicare reimbursements for these servic- Increasing patient satisfaction resulting NANCY LAMMIE
new revenue stream helps offset the nega- es are too low. from the above strategies will improve Editor
tive financial effects of disruption and pay- CAHPS scores.
ment reductions that are contributing to Why a Next Gen CCM program? 7) High-value care: Electronical clinical JUDY GRAMM
physician loss of satisfaction and burnout. By performing an ROI/gap analysis, quality measures (eCQM) to be submitted Editorial Manager & Webmaster
Historically , the ACA in 2010 mandated most medical practices find they lack the for Medicare incentive payments are mon-
care coordination and disease manage- resources and capabilities required to itored and managed. The completion of JMC GRAPHICS
ment services be delivered to Medicare implement a profitable, high value CCM reportable measures is regularly assessed, Art/Production
and Medicaid patients having 2 or more program. However, a solution for these coordinated, and documented in the EHR lammienancy@aol.com
chronic medical conditions. In response, practices is to outsource CCM services. for each physician by CCM staff. This 412-877-5321
CMS launched Medicare CCM in January Unfortunately , some earlier CCM compa- value-added feature keeps physicians
2015 as a telephonic program for enhanc- nies viewed the program as merely a finan- updated on which measures remain to be CONTRIBUTING WRITERS
ing health and care for this targeted, vul- cial offering, failing to recognize the performed and is available to all medical Daniel Casciato
nerable patient population which utilizes importance of CCM to health care trans- practices and health care systems partici- Barbara Fallon
the vast majority (>90%) of Medicare formation. To reconcile this disparity , Your pating in the Medicare Quality Payment Vanessa Orr
funds. This critical primary care compo- Doctor In Touch (YDIT) developed a Program. For independent practices that Lois Thomson

nent of health care transformation has novel, innovative Next Generation (Next are not part of a larger organization, Next
been shown to lower total costs of care and Gen) CCM program adherent to Gen CCM will compile and file reports
improve patient outcomes; it is one of the Medicare’s vision for CCM. and attain Medicare rate enhancements for LOOK FOR OUR
top CMS innovations meeting the them as they would receive, for example,
Quadruple Aim framework that guides How does YDIT’ s Next Gen CCM as an ACO member. Thus, Next-Gen CCM NEXT ISSUE
continuous improvement in health care advance the program? increases physician income through dual IN FEBRUARY
delivery . Next Gen CCM strategies that advance Medicare payments --- direct reimburse-
Medicare CCM include: ment for CCM services plus a positive per-
Why this payment incentive? 1) Alignment and care coordination: formance payment adjustment. TO REACH US
From the start, Medicare has fully These processes involving all providers In summary , the additional benefits of FOR
intended for as many eligible beneficiaries and the patient are essential to the success- Next Gen CCM advance the Quadruple
as possible to be enrolled in CCM in order ful delivery of Next Gen CCM and they are Aim, making CCM worth re-assessing as a ADVERTISING
to meaningfully improve the health of the initiated ASAP following patient enroll- service that enhances patient satisfaction, OR EDITORIAL
high-utilizer population, and as a result, ment. conserves Medicare dollars, helps primary Call (561) 368-6950
help sustain Medicare. However, there has 2) Precision and personalization: care practices increase revenue, and most
been surprisingly slow adoption, low Patient-centricity and meeting patients importantly , improves the lives of the or e-mail
patient enrollment, and an unexpected where they’re at by asking patients “What patients who entrust their care to us every carol@southfloridahospitalnews.com

refractoriness to participating in CCM, matters?” rather than “What’s the matter?” day .
even though this primary care-focused and leveraging shared decision-making to
program improves care management, cre- engage patients in their care. For more information, contact Richard

ates a financial opportunity , and prepares 3) Whole-person health: Management Grosso at (561) 861-5141 or SUBSCRIPTIONS
participants for value-based payments! A and coordination of all aspects of care and Richard.g@ynit.us. One Year $40
Two Years $60
Three Years $75

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Call Charles at 561-368-6950 for a Media Kit

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