Thursday, October 29, 2015

Today's #KareoChat about Chronic Care Management & CPT 99490

Rats!  I missed today’s #KareoChat - a weekly chat on healthcare and related topics hosted by Kareo.  This week's topics were about Chronic Care Management and the chat was hosted by @CareSync. Specifically regarding the new Chronic Care Management Program that CMS implemented on January 1st of this year. Whenever I miss a chat, I go check out the transcript at Symplur.  Since this was a topic near and dear to my heart, I decided I’d go the extra mile and create a “formatted transcript.” 

So… the following is today’s #KareoChat transcript formatted by topic.  Note that this is not an exact science so some tweets may be associated with the wrong topic. And perhaps attributed to the wrong person.  In any case, I’m not charging for this.

Welcome to #KareoChat w/ our host @caresync! Today we'll discuss #ChronicCareManagement. Now, who's here?! #RollCall

Acct
Tweet
gokareo
30 mins until #KareoChat with our host, @caresync! We'll discuss #CCM with these questions: https://t.co/dYyNQwZjSG 
careyync
So excited to be hosting our first #kareochat today! Thanks for having us, @GoKareo
stuckonsw
How is #ccm defined for this chat? is it the tech like @caresync or just #ccm in general (sorry for the question)


gokareo
Q1: What have been the biggest changes we’ve seen during this first year of #CCM?
caresync
Usable data is key!  https://t.co/ZRIX1xLlUf
caresync
A focus on "between visit" care - a new way of thinking for providers and their staff.
jennhistalk
Have seen some vendors see it as opportunity to relaunch products for #CCM -  MDs seem genuinely interested but a bit gun shy
actasifsite
On the implementation side, several of my mother's physicians have send VERY confusing letters that took a while to sort out
caresync
Also - a general provider anxiety around broadening the scope of care to settings outside the exam room.
jennhistalk
Good point - opens up big doors for digital health - wearable’s, at-home monitoring, etc. (assuming MDs can use the data)
yogileana
Biggest challenge is technology and requirements I think
johnsungkim
Biggest fear is the unknown. What can they throw at doctors next??
jennhistalk
Chronic Care Management --> RT @yogileana: Biggest challenge is technology and requirements I think
jennhistalk
Exactly - I imagine they're just now breathing sighs of #ICD10 relief. Now, on to the next govt program ... MU, #CCM
leachatham
Some interest in the potential but hesitance due to the complexity
gokareo
That sounds about right :) I remember it be absurdly high haha  https://t.co/j2Ic9U5MtS
jennhistalk
Yes, would love to interview MD who's incorporated patient-generated data into their practice/workflow. New Holy Grail?
drtom_kareo
obstacles 1) 8 dollar co pay, 2) ROI - low reimbursement 3) process and staff requirements are disruptive
johnsungkim
Right! As well, I've read the codes and rules 5x - it's still not totally clear to me.


gokareo
Q2: What are the obstacles that keep providers from #CCM? 
johnsungkim
Been waiting for someone to ask that! :)
caresync
Ohhh the obstacles! Many fear it's just too much work for the reimbursement.
johnsungkim
It's a combination of fess, lack of technology + patient panel analytics and the question of who is going to actually manage?
caresync
Also, they really want proof that they're actually going to be reimbursed. Thus 2015 is year of super-early-adopters.
amberglende
The Medicare # in FL is ~83%!
johnsungkim
Can the patient copay be waived by the physician and staff?
caresync
Exactly! a FT employee can only provide services to 250-270 CCM patients compliantly,  
gokareo
The patient education is ALWAYS evolving here.  
caresync
There are a LOT of these, @JennHIStalk, some great, some opportunistic.
johnsungkim
And what the heck does "24/7 accessibility" mean? Do docs have to sleep next to their phones now?
drtom_kareo
Not really, the patient has to be asked for the payment.
shereesepubhlth
Neither CMS nor prof. organizations have furnished adequate ed. to providers regarding CCM billing rules. Yeah, I said it!
gokareo
The boilerplate messaging available is NOT human-speak. We've invested a lot into educating the seniors.  https://t.co/3j6iFMW3gJ
leachatham
Hopefully the early adopters will share their experiences and help others see it can be done
caresync
Must be available to address urgent chronic needs - doesn't need to be the actual doc. We are 24/7 as an outsource  
shereesepubhlth
Real talk: How many providers want 2 adopt stringent documentation rules when beneficiaries may not be willing 2 pay the 20% req.
caresync
So true - our docs have been incredibly helpful in educating others checking out the program.
shereesepubhlth
It’s a familiar argument but I believe fear would be mitigated by education, which is currently lacking.
jennhistalk
Obstacles keeping MDs from #CCM - time, knowledgeable staff, tech, budget for all of the above
yogileana
But you ask them first... RT @ShereesePubHlth How many prov want 2 adopt stringent doc rules when pt may not be willing 2 pay
jennhistalk
Are you referring to the #CCM copay some patients have to pay out of pocket? Still trying to understand that.
shereesepubhlth
CCM rules req. written consent from beneficiary acknowledging resp. for 20% copayment for CCM." (PYA, 2015)
amberglende
Some are doing it already though MT @caresync: A1 a general provider anxiety around broadening the scope of care
caresync
We'd love to get rid of the copay, it's been much less of a barrier than anticipated. When patients understand.  


gokareo
Q3: What would make #providers more likely to implement a #CCM program? 
actasifsite
>20% of patients have chronic conditions maybe??? #CCM
caresync
Similar to A2 - education around requirements, and confidence that patients understand what they are getting.
yogileana
Better tools/education MT @GoKareo What would make #providers more likely 2 implement 
brittanyrhyme
We have had multiple iterations and many experts help us simplify the language, Joe.
caresync
Closer to 70% 68% is the exact number if I am not mistaken!  
wilson_to
Doesn't seem to be a lot of progress addressing A2 - need new innovations in #payment #models, #technologies, #workflows
jennhistalk
Would MD participation be more if payers lent a helping hand? Offered CCM "navigators" ?
gokareo
Some recent studies point to Resistance in CCM adoption and enrollment, waiting to see how fess schedule is updated in 2016
caresync
I think there are things out there - care coordination is what we've been doing well before reimbursed.  
shereesepubhlth
There are a couple of metrics at play here" Ex. 43% of eligible providers aren't aware of the CCM existence (Ross)
dulcianhealth
#FloCCM 7 Take the High-Road, prioritize your sickest patients. Use compliance as the requirement floor.  
meddatainc
Someone needs to! Vendors who are experts can consult/support practices; so complicated for most on their own  #CCM
wilson_to
I've seen it be the case for some CINs/ACOs - CCM navigators have helped ease the transition and focus in #CCM
johnsungkim
Patients don't like to pay much if they already feel they're paying "too much" for their insurance plans :)
shereesepubhlth
If some of the rules were removed by CMS, making it more attractive to providers, CCM could still blow up


gokareo
Q4: What do #patients expect from #CCM?
wilson_to
Carrots and sticks aren't enough nowadays? Def seems like education and rules keep remerging
yogileana
Do your patients know about #CCM?
caresync
Patients! Yes! The patient-centered code. They expect help accomplishing THEIR goals for health.
jennhistalk
Is the average patient even aware of #CCM? What value-proposition do MDs use with those who fit the profile?
drtom_kareo
Patients in my experience when asked about CCM service assume they get responsive service and are not clear on CCM value add
caresync
Patients want the right info shared to right ppl at right time.
jennhistalk
MT @drtom_kareo: Patients, when asked about CCM service assume they get responsive service and are not clear on CCM value add
caresync
Also - patients (people!) just want to make healthcare easier…it's overwhelmingly hard for most.
drtom_kareo
CMS has not done a good job educating or marketing this value add to members in 2015
resultant
IMO patients have low expectations as they have always had to be the quarterback for their own care or have an advocate
wilson_to
Agreed - patient POV is around 'heal-on-demand' for relief more than sustained #CCM - hence hard for #wellness etc.
gokareo
Wish I could join #kareochat but I'm running out the door. Sort of taking you with me though... https://t.co/uiOl5GScMi
shereesepubhlth
It would stand to reason but ultimately, those who propose these programs do very little to ensure their success
johnsungkim
Valid point. The good news is that people are talking about it a lot more than January…
caresync
WOW! #KareoChat #GreatStat https://t.co/iXxQF1Tbfv
travislbond
Yep --> MT @Resultant: IMO patients have low expectations as they've always had to be QB for their own care or have an advocate
drtom_kareo
I would like to know the dollars forecasted to be saved per pt by medicare for CCM, maybe pass more on to provider
jennhistalk
So for govt #CCM incentive to work, vendors must take lead on educating patients/physicians on the value add? Is that right?
drtom_kareo
No as the provider is asking for additional out of pocket, so they are selling and this is a problem
gokareo
Tech barriers. Ability to provide full scope of service - it's intimidating for most!
esseeconsulting
Yep! Hoping education really is a theme for CCM in 2016. Patients and docs! 
powered_mb
Aren't there some vendors that offer turn-key CCM services too that did a rev share with the docs?  has anyone seen this yet?


gokareo
Q5: Has #CCM been what you expected when it was announced at the beginning of 2015?
yogileana
we expected it to take off like a rocket... but it didn't - technology barriers maybe
shereesepubhlth
Abso-freaking-lutely! #Consultants can greatly assist providers w/ understanding & navigating CCM reqs
caresync
Referenced earlier, but the adoption numbers show early adopters are proceeding cautiously.
caresync
We've also had #ICD10 as a mega distraction to #CCM.
shereesepubhlth
I expected earlier & more robust adoption but again there's the provider frustration factor etc.,  https://t.co/ohRXxjRFbA
caresync
There are lots of questions around compliance, too. It's been slow to get guidance.
shereesepubhlth
39% of providers say response from CMS on compliance issue is, "long pause; no answer!" Its a definite concern slowing adoption
jennhistalk
We need another year to truly determine how initial #CCM participants will fare - a year without competing govt timelines
wilson_to
Bad to say that 'slow adoption' should be expected? We've seen these rates (or lower) across various initiatives.
wilson_to
THANK YOU @gokareo for inviting us - this was absolutely a blast - we love talking to smart, innovative thinkers!
jennhistalk
How can CMS do a better job moving forward?
drtom_kareo
IMO remove copay, advise and market to members and improve reimbursement rates
shereesepubhlth
It’s sort of joke when I talk to provider clients. I can hear them thinking, "Here she comes w/ another program" No thank you.
caresync
Between visit care/monitoring CAN provide a ton of value. Just has to be easier for the doc/patient to access.
gokareo
Can I assume there is data showing better outcomes? If so CCM should be required w no copay -pts that dont coop shud pay co-pay


gokareo
Q6: If you could change/improve the program what would you do? 
caresync
Broken record here… remove the copay - it confuses patients. Especially when the bill comes and they've not seen doc.
caresync
Increase reimbursement for the docs - the scope of services is wide and a lot of work!
caresync
Increase guidance around #CCM. Make it more appealing and not so complicated!
shereesepubhlth
Relax the rules & throw money at the problem #ProviderReimbursement  https://t.co/DNl1lDzM7G
resultant
LOL!!! RT @ShereesePubHlth: A6 Relax the rules & throw money at the problem #ProviderReimbursement  https://t.co/y4lENFbky3



The Sandbox – Stuff I wasn’t sure about
drtom_kareo
Fun fact only 100K CCM payment codes were processed in 2015 thus far, not a business yet.
leachatham
I'm hoping 2016 is the year of being open to new opportunities in healthcare overall!
wilson_to
Was on a panel this past week on #FutureMed - seems we've (unknowingly) designed systems around acute care > chronic care
gokareo
We built 12 tips for a successful CCM implementation #ChronicCareManagement hashtag: #FloCCM
leachatham
But chronic conditions are a growing issue - obesity and diabetes are skyrocketing
stuckonsw
Melissa is working a patient engagement training (@STIinnovations) that matches #ccm codes ;)
jennhistalk
Would be great to see #HIMSS16 sessions focus on this. Maybe we'll see case/success studies presented
johnsungkim
A provider in the Peds Dept at @UCSF told me that childhood obesity was expected to be 25%+ of kids!
turbodean
Wow this seems like a no brainer for docs that don't know how or want to do on their own  is tech integration the prob?
stuckonsw
Yes " throwing money" @ a problem & ignoring the process behind it always goes well  
shereesepubhlth
But its CMS way 2 do business "Hey here's an incentive 2 perform the basic functions of your job"
stuckonsw
#CCM codes are (sort of) a way to sustain something...glad #KareoChat highlighted the secret
gokareo
Thank you @GoKareo When is the next #KareoChat ? https://t.co/VN78rpVSk7
gokareo

gokareo
And that's a  wrap! Thank you all for joining and thank you @caresync for being an incredible host! What a worthwhile discussion!

If you'd like to get more of this type of information and information on other healthcare and healthcare information technology-related topics, consider following me on Twitter I'm known @Shimcode. 

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