New CMS Initiative Aims to Boost Coordination

Posted by Cordata Health

July 19, 2017 at 3:21 PM


This past March, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative to increase awareness of its program focused on care coordination. Called Connected Care, the program aims to increase the number of providers billing for coordinated care services. Coordination improves outcomes for those with chronic conditions. Naturally, incentives to provide these services should increase their adoption and lead to more effective coordination and, ultimately, better outcomes.

But this is not the first time CMS has undergone a campaign to improve coordination. CMS first implemented an initiative back in 2015 to pay providers for specific chronic care management (CCM) services including medical record review and coordinating provider visits. At the time, those payments averaged to about $43 per month for each Medicare beneficiary providers treated.

Roughly 35 million Medicare beneficiaries were eligible to be counted for the initial benefit. Yet a year later, CMS had only received claims for 513,000 beneficiaries. Clearly, there was a disconnect. The initiative was aimed at primary care providers, though they were often too busy to do the necessary legwork for care coordination. And they were missing out on significant payments. For example, if a provider saw 500 Medicare beneficiaries and provided coordination for each for a full year, they would make roughly $285k in extra payments. That money could then be used to further bolster coordination services and technology for chronic patients.

But these services are not restricted to primary care providers. Specialists can provide CCM as well. Clearly, the initiative was not well understood. The new CMS initiative has set out clear guidelines to boost awareness of coordinated care benefits, along with focusing on supporting providers who implement coordinated care programs.

Here’s a bit more information about the new initiative. For more, CMS released an info sheet going over the most significant aspects of the program:

  • Who is eligible for CCM: Patients with multiple chronic conditions expected to last at least 12 months or until death, and that present significant risk of death, functional decline, or acute exacerbation/decompensation. Complex CCM, another track supported by the initiative, requires moderate to high complexity medical decisioning and includes 60 minutes of clinical staff time per month as opposed to the 15 required for base-level CCM.
      Eligible chronic conditions include, among others:
    • Alzheimer’s and related dementia
    • Arthritis (both osteoarthritis and rheumatoid)
    • Asthma
    • Atrial fibrillation
    • Autism spectrum disorders
    • Cancer
    • Cardiovascular Disease
    • Chronic Obstructive Pulmonary Disease
    • Depression
    • Diabetes
    • Hypertension
    • Infectious diseases such as HIV/AIDS
    • Spine disease
  • Why it was put in place: CMS felt that there was a need to lessen the disparities in health care related to geography, race, ethnicity and other controllable factors.
  • Who can bill for CCM: Physicians and other specified non-physician practitioners, including certified nurse midwives, clinical nurse specialists, nurse practitioners and physician assistants can bill for these services.

Hopefully, these incentives will convince more providers to provide coordination services for chronic patients. The more coordination there is between primary physicians and specialists, the better outcomes will be and the closer our industry will be to achieving the goals of a value-based system of care.

Topics: Navigation & Care Coordination, Chronic Care, Value-Based Care, CMS, Patient Outcomes

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