About Chronic Conditions
What is the Definition of a Chronic Condition?
According to the Centers for Medicare and Medicaid Services (also known as CMS or Medicare), a chronic condition is defined as follows:
A health condition that is expected to last one year or more; and requires ongoing medical attention and/or limits the activities of daily living.1
Trace the rise of chronic conditions through the evolution of public health. An acute condition — sudden onset issues, such as a broken bone or a heart attack — is different from a chronic condition, which develops over time. Two centuries ago, life expectancy was such that treating acute conditions was primary. Scientists discovered the effects of improved sanitation and nutrition. Public policies applied the principles of sanitation and nutrition. With them, living standards improved and life expectancy increased. Over time, slower-developing health issues (chronic, or long-term conditions), came to the forefront of medical care.
Chronic conditions can’t be cured, but can be managed through medication or in combination with lifestyle modification therapies.
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About Chronic Care Management (CCM)
What Is Chronic Care Management?
Facing the rapid rise in healthcare costs, in 2015 Medicare introduced a means to counteract the health effects and costs of chronic conditions. Chronic Care Management (CCM) oversees ongoing medical problems that patients and their care providers must manage effectively to maintain the best possible health and avoid unnecessary hospitalizations. With CCM, patients with two or more chronic conditions receive monthly care from a medical practitioner or clinical staff by telephone or video conference. These interactions assist people in managing their conditions, and provide additional care coordination and engagement between office visits. The service is billable to Medicare by the provider, and paid by the patient’s Medicare supplement.
Chronic care management is care coordination services done outside of the regular office visit for patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient. These conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. These services are typically non-face-to-face and allows eligible practitioners to bill for at least 20 minutes or more of care coordination services per month.6
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Chronic Care Management Service
What is PharmD Live’s Service Offering?
PharmD Live’s clinical pharmacists have an answer to improving patient satisfaction, reducing the stress of proper documentation, with the advantage of their advanced training and knowledge of pharmacology. With PharmD Live on your team, drug-drug interactions, therapeutic interchanges, and informatics, we provide patients who have complex medical conditions the best health outcome possible based on Medicare’s Chronic Care Management program.
Implementing an efficient Chronic Care Management program will mean achieving high-quality measures in patient care experience, care coordination, patient safety, and preventive health. Achieving these measures will yield significant population health revenue for your practice. The amounts reimbursed by Medicare will depend on the number of patients enrolled in the CCM program and your ability to reach specific thresholds. Reimbursement amounts by Medicare can become quite lucrative, with providers earning upwards of $100,000 in additional revenue.
One caveat for consideration: a lot of administrative time needs to go into preparing the Medicare documentation which is why partnering with PharmD Live for Chronic Care Management services is highly recommended. We enroll and develop monitoring relationships with your patients, take care of documentation, recording in EHRs, and make detailed CCM billing seamless for office staff.
Additional Reading
References
- https://www.cdc.gov/chronicdisease/about/index.htm
- https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/ccm/hcpresources
- https://www2.ccwdata.org/web/guest/home/
- https://www2.ccwdata.org/web/guest/condition-categories
- Boersma P, Black LI, Ward BW. Prevalence of Multiple Chronic Conditions Among US Adults, 2018. Prev Chronic Dis 2020;17:200130. DOI: http://dx.doi.org/10.5888/pcd17.200130
- https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/connected-hcptoolkit.pdf
- Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States
[PDF – 392 KB]. Santa Monica, CA: Rand Corp.; 2017.
- Martin AB, Hartman M, Lassman D, Catlin A. National Health Care Spending In 2019: Steady Growth For The Fourth Consecutive Year. Health Aff. 2020;40(1):1-11.
- https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf
- https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/ccm/hcpresources#resources-for-you
- https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs