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Journal of General Internal Medicine

, Volume 33, Issue 11, pp 1892–1898 | Cite as

Use of Chronic Care Management Codes for Medicare Beneficiaries: a Missed Opportunity?

  • Rebekah L. Gardner
  • Rouba Youssef
  • Blake Morphis
  • Alyssa DaCunha
  • Kimberly Pelland
  • Emily Cooper
Original Research

Abstract

Background

Physicians spend significant time outside of regular office visits caring for complex patients, and this work is often uncompensated. In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a billing code for care coordination between office visits for beneficiaries with multiple chronic conditions.

Objective

Characterize use of the Chronic Care Management (CCM) code in New England in 2015.

Design

Retrospective observational analysis.

Participants

All Medicare fee-for-service beneficiaries in New England continuously enrolled in Parts A and B in 2015.

Intervention

None.

Main measures

The primary outcome was the number of beneficiaries with a CCM claim per 1000 eligible beneficiaries. Secondary outcomes included the total number of CCM claims, total reimbursement, mean number of claims per beneficiary, and beneficiary characteristics independently associated with receiving CCM services.

Key results

Of the more than two million Medicare fee-for-service beneficiaries in New England, almost 1.7 million were potentially eligible for CCM services. Among eligible beneficiaries, 10,951 (0.65%) had a CCM claim in 2015. Massachusetts had the highest penetration of CCM use (9.40 claims per 1000 eligible beneficiaries); Vermont had the lowest (0.54 claims per 1000 eligible beneficiaries). Mean reimbursement per physician was $1745.98. Age, race/ethnicity, dual-eligible status, income, number of chronic conditions, and state of residence were associated with receiving CCM services in an adjusted model.

Conclusions

The CCM code is likely underutilized in New England; the program may therefore not be achieving its intended goal of encouraging consistent, team-based chronic care management for Medicare’s most complex beneficiaries. Or practices may be foregoing reimbursement for care coordination that they are already providing. Recently implemented revisions may improve uptake of CCM services; it will be important to compare our results with future utilization.

KEY WORDS

chronic care management Medicare primary care care coordination 

Notes

Acknowledgements

We thank Rosa R. Baier, MPH, and Daniel Harris, MPH, for their insightful feedback on earlier versions of the manuscript.

Prior presentation

We presented an earlier version of these results as a poster at the Society of General Internal Medicine Annual Meeting in Washington, DC, in April 2017.

Funding

This study was funded by Contract Number HHSM-500-2014-QIN014I, titled Excellence in Operations and Quality Improvement, sponsored by the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. CMS reviewed the manuscript and provided comments, but did not have any role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation or approval of the manuscript. The authors assume full responsibility for the accuracy and completeness of the ideas presented.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4562_MOESM1_ESM.docx (27 kb)
ESM 1 (DOCX 27 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Rebekah L. Gardner
    • 1
    • 2
  • Rouba Youssef
    • 2
  • Blake Morphis
    • 2
  • Alyssa DaCunha
    • 2
  • Kimberly Pelland
    • 2
  • Emily Cooper
    • 2
  1. 1.Department of MedicineAlpert Medical School of Brown UniversityProvidenceUSA
  2. 2.Healthcentric AdvisorsProvidenceUSA

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