While physician groups in the U.S. are speeding up their adoption of the government’s Chronic Care Management (CCM) program, they still remain in the dark about the details of MACRA (the Medicare Access and CHIP Reauthorization Act), which the CCM initiative has come to support.
These findings come from a recent survey of 438 physicians, practice managers, and health system executives who were asked about MACRA and strategies like CCM that can help them meet MACRA’s requirements. The research was conducted by Smartlink Health Solutions, a Cary, N.C.-based provider of value-based healthcare solutions.
The survey found that 41 percent of physician groups have launched a CCM program that meets the requirements for reimbursement by the Centers for Medicare and Medicaid Management (CMS), representing a 141 percent increase in adoption since Smartlink first asked the question of physician groups in a 2015 survey.
In January 2015, CMS established the CCM program to control costs and provide seniors with better long-term care for chronic conditions. The program incentivizes improved care for seniors with chronic illnesses while building the infrastructure for value-based care. Under the program, CMS reimburses the provision of non-face-to-face care to seniors who have at least two conditions that are expected to last at least 12 months, such as Alzheimer’s disease, cancer, diabetes and heart failure. Improving care management for poly-chronic patients is a critical facet of the transformation to value-based payment models such as MACRA.
CMS launched an education initiative in March to education both physician groups and Medicare beneficiaries on the CCM program, which pays providers a monthly fee for historically unreimbursed services: non-face-to-face patient care between office visits such as coordinating with other healthcare professionals. The program can potentially increase revenue for participating physicians by having qualified healthcare professionals spend at least 20 minutes per month monitoring patients diagnosed with two or more chronic conditions.
As such, while CCM awareness and participation has risen, the survey showed that physician group leaders generally lack detailed knowledge of the law that the CCM program supports: MACRA. Just 17 percent of respondents said they are very familiar or an expert on MACRA, compared with 25 percent who said they had either never heard of it or are very unfamiliar. The majority of respondents fell somewhere in between on the scale awareness, according to the findings, which are in line with various other surveys conducted on MACRA familiarity. Healthcare Informatics recently ran its own exclusive MACRA survey which found that many physicians, particularly smaller practices, are not yet ready to meet the law’s core requirements.
- There were several other key takeaways from the survey, as it relates to both the CCM program and MACRA, including:
- Forty-seven percent of respondents said they don’t know which of MACRA’s two payment tracks they will fall under, indicating that most are still trying to figure out the ins and outs of the program.
- Of those who said they will fall under MACRA’s MIPS (Merit-based Incentive Program) payment track, a larger percentage than expected (47 percent) reported that they plan to participate in the program for the entire year in 2017. Only 14 percent of respondents said they will report to MACRA at the minimum level, which CMS is allowing in the first year.
- Nearly half of responding physician groups that fully outsource their CCM programs (46 percent) said they consistently bill 80 to 100 percent of their enrolled Medicare beneficiaries. By contrast, only 7 percent of groups that use their own staff to provide CCM services reported consistently billing 80 to 100 percent of enrolled beneficiaries.
- Physician groups that participate in accountable care organizations (ACOs) are more likely to have rolled out a CCM program (46 percent) than those in independent practice (41 percent) or non-ACO employed providers (34 percent). Adoption of CCM is highest among providers in large groups of 20 or more physicians; a turnaround from 2015 when groups of 6-10 physicians led in adoption.
- Nearly all respondents (94 percent) say they provide annual wellness visit (AWV) check-ups for their Medicare patients. The visits are the most common way for patients to learn about and be enrolled in a chronic care management program. However only 1 in 10 respondents provide the visits for more than 80 percent of their patients; 44 percent are providing annual wellness visits to fewer than 40 percent of their Medicare patients. Physician groups that participate in ACOs provide the wellness visits to a higher percentage of their patients than independent or employed providers.
"MACRA has created a national competitive dynamic that wasn't there before. Winners in this new healthcare payment era will be those that act quickly to manage both short-term and long-term patient outcomes effectively, while leveraging insurer incentives to achieve better care," Siu Tong, CEO, Smartlink Health, said in a prepared statement. "High ROI government initiatives such as CCM and AWV are key variables in the value equation. The survey data bears out that while the market is now recognizing the importance of these programs, most clinics lack the resources and expertise to deploy them at a scale that will optimize the impact."
