Why are doctors skipping chronic care reimbursement?

From the mHealthNews archive
By Eric Wicklund
01:51 pm

Likewise, CPT Codes 99487-99489 cover some of the same ground in preventive care and follow-up services, 99490 represents the first time that Medicare allows physicians to separately bill for reimbursement.

"It sounds simple, but it really takes a lot of time," said McKamy, citing national statistics that indicate the typical physician sees 2,500 patients a year, and can spend about 15 minutes a day on each case. "It's just a ton of burden to do the normal, everyday things."

And EMRs aren't helping. "Most are not designed to capture recorded minutes on the phone, for example," she said.

Despite the drawbacks, McKamy says 99490 is a step in the right direction, albeit a small one. "The benefit, aside from reimbursement, is in reaching out, calling in and checking on (patients) every month," she said. "It's important for the doctor to make that connection, because most of their chronic care patients won't even go to their annual wellness visits. It's important that the government is at least acknowledging that coordination is needed."

[See also: mHealth to providers: Join the party]

And she feels CMS won't stop with 99490.

"They are looking for innovation from the marketplace," she said, noting 99490 was developed after a series of successful transitional care and telehealth demonstrations. "They're looking aggressively at different technologies."

Others don't think they're looking fast enough. A coalition of organizations led by the American Telemedicine Association and the Personal Connected Health Alliance recently sent a letter to CMS seeking revisions to the proposed Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for CY 2016 that would, among other things, expand the qualifications for reimbursement under CPT Code 99490 and create new opportunities to reimburse providers for using remote patient monitoring technology.

"A well-established and ever-growing body of clinical evidence suggests that interoperable remote monitoring improves care, reduces hospitalizations, helps avoid complications and improves satisfaction, especially for the chronically ill," the letter states. "Use and provision of (remote patient monitoring) is restrained in Medicare by CMS' decision to provide no reimbursement for it. We urge CMS (and other federal payers) to (use) every opportunity to incorporate RPM and other proven eCare technology … to work towards a connected healthcare system."

Donald Voltz, an anesthesiologist, researcher, medical educator and entrepreneur, also feels that 99490 might be a step in the right direction, but a flawed one. Writing in HIT Consultant, he says the code is too difficult for most physicians to use, and should nevertheless be part of a more comprehensive chronic care management program.

"CMS requires at least 20 minutes are spent on care coordination activities each month in order to bill for this for patients enrolled in the program. Without a seamless component to log such activity, the efficiency of the overall process comes into question," he wrote. "A comprehensive CCM application must address the practice management side to account for and generate monthly reports of the CCM activities completed."



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