Primary care providers acknowledge the importance of value-based care that focuses more on prevention and thereby reduces costs for patients, providers, and taxpayers alike. Hence, Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) have been gaining traction as value-based care strategies because they actually work in producing better patient outcomes. It also helps that Medicare is incentivizing providers for their non-face time services, giving them access to a new revenue stream.
However, getting started with CCM and RPM is not that easy because providers must take into account numerous considerations. Many providers have found themselves facing huge operational and administrative challenges that could impact clinical care outcomes. If not planned well, CCM and RPM will fail despite their best intentions to provide access and optimize patient care.
Virtual healthcare services
To ensure success with virtual healthcare services like CCM and RPM, here are several common missteps to help providers learn from the mistakes of their peers without going through the same painful experiences.
So what went wrong?
Miscalculating patient churn and enrollment
With many patients eligible for CCM and RPM, one would think the practice is set up for success. CMS defines eligibility for CCM if the patient has two or more chronic conditions expected to last at a minimum of 12 months or until the death of the patient. RPM only requires one chronic condition. However, patient enrollment has proven to be one of the most difficult parts of the process of starting CCM and RPM.
Not only do providers need to identify qualified patients but they need to assess if these patients will sustain the program in the long run. Many overlooked patient churn, a very common occurrence but surprisingly, not often talked about. Patient churn is the number or percentage of patients not sticking with the program and/or leaving a practice’s care. This is a significant consideration because 70% of patients have a copay and they need lots of persuasion to believe that the money they spend every month brings them good value. In truth, handling patient churn associated with CCM and RPM is a grueling daily operational challenge. For every 10,000 enrolled patients, 7,200 may churn out; making enrollment even more complicated to ensure they opt-in for the long term.
Quite often practices do not employ an enrollment specialist with the right skill sets to communicate in a convincing manner the benefits CCM and RPM programs bring to patients. Patient enrollment is tasked to the clinician with the belief that they are in a better position to enroll their patients since they have already established a good relationship with them through the years. However, the sad reality is, that primary care providers may be good at caring for their patients but they are not as effective in enrolling them, let alone discussing how CCM and RPM optimize care. It would also be a waste of their time to review their patient’s copay, deductibles, and other compliance requirements.
Inability to scale up
Aside from not having a definitive plan or strategy that factors in costs and capabilities, most practices are unable to scale up as patient volume increases. They do not have the personnel, time, or resources to handle an increasing number of patients. Some practices have stopped altogether before they even reach 30 enrolled patients.
In a best-case scenario, a care coordinator or manager usually manages 150 patients per month translating to 50 hours spent per month if she/he spends at least 20 minutes per patient, presuming they also reach patients the first time they dial a number. Practices would often shift one of their clinical staff to a full-time role in managing CCM or hire a new one which incurs an extra expense. At the start, the care manager can handle the additional tasks, but the practice fails to consider the obstacles involved with scaling up. Not for lack of foresight, it was simply impractical to assign or train additional personnel when enrollment is not guaranteed and patient churn is almost certain.
Lost in the maze of CMS care provisions and billing
Providers need to have a clear and thorough understanding of CMS provisions on delivering care and billing for it. Without this knowledge, many practices are unable to comply with the requirements and lose the reimbursements they could earn for their CCM and RPM services.
To discuss a few of these care provisions, CMS requires patient consent to participate in a CCM program but does not specify how this is documented. Without this, providers cannot start providing the services. It is important then to be able to show proof that the patient agrees and approves their copay every month. For RPM, the provider or any qualified healthcare professional must place the order and initially deliver the care though not necessarily do the succeeding ones. There are also protocols to follow in taking the daily measurements to ensure adherence as well as in tracking interactive time in case of a Medicare inquiry.
Another important question is how can providers bill for their CCM and RPM services? Understanding and complying with the numerous CMS CPT codes can be difficult and beyond the usual capabilities of a primary care physician’s practice. They would need a billing expert to maximize their revenues and cover the costs they incur in setting up their virtual healthcare program.
Investing in software is not enough
Though a practice’s EHR is a good launching point, CCM and RPM have specific requirements that are impossible to manage in the EHR alone, particularly for CCM. A good CCM software would have time logging and tracking capabilities, a patient-centered care plan, the ability to create reports and summaries to give to patients, an intuitive dashboard to manage the participants, and the critical feature of reviewing patient data and sending alerts.
Many practices spend huge amounts of money on purchasing the most expensive software but find themselves unable to fully maximize it. Even the best management tool would still be deficient without dedicated and experienced care coordinators and a clinical team. After all, CCM and RPM do not rely on technologies alone but still need the caring touch and meaningful interaction that a dedicated clinical staff offers to patients to keep them engaged and satisfied.
In the same manner, the best and most high-tech RPM devices will not be sufficient. Although the transmission of data is automatic, patients need to be conditioned on a consistent basis to take these measurements. The clinical staff also must be able to keep the patients educated and invested in their care.
Not seeing the total cost picture
Many practices are unable to factor in the additional costs and compare them with the potential revenues they could earn.
These cost factors are plenty:
- Process cost in developing the services
- payroll expenses for the newly hired personnel
- training costs for employees
- software costs
- infrastructures like dedicated phone lines or a new office space
- purchase of new devices and equipment
- Preparing the billing reports
- Time cost in startup and managing the services
There is also a hidden and non-quantitative cost such as the disruption to normal office workflows. The plain truth is CCM and RPM are huge undertakings that not many primary care providers can ill afford or handle on their own. These missteps can be avoided by having a strategic partnership with a third-party provider who is more equipped and experienced in implementing CCM and RPM as a service.
How to avoid these missteps?
The solution is obvious. Outsourcing to a vendor with more experience and the expertise to navigate the intricate billing requirements set by CMS makes sense. Though there are many vendors in the market with their value-based care models, not all offer the full scope of services like Ascent Care Partners or ACP.
ACP offers turnkey CCM and RPM solutions as a complete service, which means assisting primary care physicians from the get-go with patient enrollment and education, preparing billing reports, and doing the essentials as the program scales up. This is not a one-time deal but a true partnership to help primary care physicians provide better quality care to their patients and realize a much-deserved income without investing in increased overhead.
