Proposed Bill Will Expand ccp
In late June, US Representatives Suzan K. DelBene (WA) and Peter Welch (VT) introduced an amendment to the Social Security Act entitled Chronic Care Management Improvement Act. This bill, H.R. 3436, would remove patient responsibility for chronic care management (ccp) serviced under the Medicare program. The bill has been introduced to both the House Energy and Commerce Committee and the House Ways and Means Committee.
Chairman of the Ways & Means Committee, Rep. Richard Neal (MA), cited the bill’s positive impact on the committee’s constituents in his opening statement. He stated that the bill’s provisions would help to ease access to care for thousands of Medicare recipients. This is especially true for rural recipients. Rep. Neal stressed that patient responsibility for ccp was a significant barrier to participation in an “important Medicare benefit. If enacted, this bill would erase that barrier for millions.
Supporters of the Chronic Care Management Improvement Act
Quite a few healthcare organizations agree with Representative Neal. Chief among them are the American Medical Association, the American Diabetes Association, the Association of American Medical Colleges, and the National Association of ACOs. Shortly after the bill was introduced in Congress, these groups wrote a letter of support to Rep. DelBene. In this letter, the group cited the positive patient outcomes their members had reported and stressed the need to reduce barriers to the program. One such barrier is patient responsibility. These organizations believe that their patients are missing out on an important program because of this requirement.
The American Academy of Family Physicians (AAFP) took their show of commitment one step further and sent a letter to the Chairman and the Ranking Member of the Ways and Means Committee. Since the program’s implementation, AAFP has urged Congress and CMS to remove patient responsibility from ccp . They argue that the elimination of cost-sharing requirements would increase involvement in the program. Their members have found that many patients are interested in ccp until they learn about the potential cost to themselves. AAFP believes that patient responsibility is the main barrier to broad utilization of Chronic Care Management
Connect Care Plus Supports Elimination of ccp Patient Responsibility
With over four years of enrolling patients in Chronic Care Management, our experience at Connect Care Plus supports these findings. We also see that potential participants frequently decline enrollment after learning of the cost. While Connect Care Plus achieves high rates of enrollment, we agree with other supporters that patient responsibility limits participation. Unfortunately, the savings of the program is not visible to the patients, as their main concern is focused on what comes out of their pockets each month.
This cost to the patient hides the overall savings to Medicare and participating provider groups. Nationally, Medicare savings per member per month are up to $74 after 18-months of enrollment. As the leading provider of ccp to ACOs across the nation, our clients report savings even higher than the national average. By lowering barriers to participation, Medicare and participating providers will actually increase their savings per patient enrolled.
Closing Gaps in Care with the Expansion of Chronic Care Management
With 20% of the chronic care patient population unqualified for Medicaid and unable to afford secondary insurance, the cost bars a great number of Medicare beneficiaries from participation. In addition, not all secondary insurances reimburse for Chronic Care Management. By eliminating patient responsibility, the Chronic Care Management Improvement Act would bring greater opportunities to those patients who are in the secondary insurance gap and those whose secondary does not cover ccp. If the main purpose of ccp is to prevent patients from falling through the cracks and to bring care coordination to those most in need, then removing the financial burden of the program would close one more gap in care.
BPCI ADVANCED: A NEW VOLUNTARY BUNDLED PAYMENT MODEL
CMS announced earlier this month that they are launching a new voluntary bundled payment model which they have named, “Bundled Payments for Care Improvement Advanced,” or BPCI Advanced. Like its predecessor, this new model gives participants an opportunity to earn additional payment when expenditures for an episode of care is lower than the spending target. According to the CMS announcement, BPCI Advanced will help providers “improve quality, coordination, and cost-effectiveness for both inpatient and outpatient care.”1 As such, participation in BPCI Advanced also qualifies as an Advanced Alternative Payment Model (Advanced APM).
Improvement in quality, coordination, and cost can be met in various ways. First, CMS expects participants to redesign care delivery to control costs. As with all Advanced APMs, participants are required to user Certified Electronic Health Record Technology. CMS has also tied specific quality performance measures to these 32 different types of clinical episodes within the model.2 Formal, independent evaluation will be conducted to assess the quality of care and changes in spending.
NEW CODE G0511 HELPS EXPAND CHRONIC CARE MANAGEMENT AT FQHCS
As QPP and MIPS become the standard for the majority of Medicare providers, expansion of programs into Federally Qualified Health Centers (FQHCs) is necessary. However, FQHCs are not like other providers. They have a high percentage of Medicaid patients and a completely different pay structure. How then, can FQHCs implement quality initiatives, like Chronic Care Management (ccp)? Through creating a new code, G0511, Centers for Medicare & Medicaid Services has enabled FQHCs to offer ccp on a much larger scale.
Saving Money and Expanding Care at FQHCs
A 2016 study of 13 states showed that the majority of FQHCs demonstrated Medicaid savings when compared to other primary care settings. FQHCs did this through lowering Emergency Department use and general decreases in spending.(1) One of the keys to controlling spending is that providers are paid a flat salary and they do not code for higher levels of service.(2) As of January 1, 2018, CMS has extended this method of billing for ccp with the creation of billing code G0511.(3)
As discussed in our September post, “Implementing Chronic Care Management at FQHCs: Changes for 2018,” billing G0511 will be initiated on January 1, 2018. Like other FQHC codes, G0511 incorporates multiple codes to keep costs down. The three CPT codes that fall under the G0511 umbrella are 99490, 99487, and 99484. This means that reimbursement for all chronic care management and collaborative care management for behavioral health is the same rate. CMS has set this rate at approximately $61.00.(4) This is a 50% increase over the average reimbursement rate for 99490.
G0511 Recognizes the Role of Primary Care Providers in Behavioral Health Management
Not only is CMS trying to lower overall costs for ccp, they are also recognizing the often overlooked reality of Primary Care Providers. Often, PCPs are the front lines of behavioral health services for many patients. For a significant number of patients, PCPs are the first and last resource for addressing behavioral health conditions. As such, they are frequently called upon to provide plans of care and treatment coordination.(5) Now, CMS is recognizing this role and shoring up continuity of care by offering a code for PCPs to charge. With G0511, FQHCs can recoup the costs associated with long-term behavioral health care and coordination.
Staying Competitive and Delivering Quality for FQHCs with G0511
These changes could not have come at a better time. It’s no secret that FQHCs infrequently track profit and have difficulty with revenue diversification.(6) Coupled with these trends is the rise in competition. Not only do FQHCs compete amongst themselves for low-income patients, they face stiff competition from new sources. (7) There has been a marked increase in the number of urgent care centers and retail-based clinics in low-income neighborhoods in the past decade. These alternate treatment sources have larger economies of scale and can weather fluctuations of income better than FQHCs.(8) Although these new resources are sorely needed, they are not required to take indigent patients, which gives them another edge on FQHCs.
The implementation of G0511 will help FQHCs diversify revenue while offering a beneficial service to their patients. Through ccp, FQHCs can give their patients something that urgent care centers, hospitals, and retail-based clinics cannot, continuity of care. With Chronic Care Management, FQHC administrators are not only protecting their bottom line, they are giving their organizations a valuable tool. Competitive, quality care that low-income patients cannot find anywhere else, will help FQHCs remain viable in this fluctuating market. ccp adds value to an organization, and it adds value to patient care.
Closing Gaps in Social Care: Doing the Work for Underserved Populations
The reality is that many FQHC providers are currently furnishing their patients with some form of care coordination. This stems from the recognition that social detriments strongly affect patient health. Addressing these issues is part-and-parcel
of good patient care for low-income populations.(9) However, prior to G0511, this time could not be captured in the billing to Medicare and Medicaid.
Utilizing Chronic Care Management strategies, like those developed by Connect Care Plus, allows FQHCs to provide much needed services to low-income patients. In this way, the creation of G0511 supports strengthening connections to patients and diversification of funding. By capitalizing on this unique area of competitiveness, FQHCs ensure their long-term viability.
IMPLEMENTING CHRONIC CARE MANAGEMENT AT FQHCS: CHANGES FOR 2018
Implementing Chronic Care Management at FQHCs is an expanding field. Centers for Medicare and Medicaid Services (CMS) is boosting this trend with their proposed changes to the Physician Fee Schedule for 2018. Many FQHC administrators are wondering how it will affect them. The big take away is the continued support for expansion of Chronic Care Management enrollment. With ccp’s success in improving quality of care for patients in other provider groups, CMS is looking for ways to make implementation of ccp smoother for FQHCs. By streamlining ccp processes for FQHCs in 2018, CMS is hoping to increase enrollment and lower billing and reporting burdens. With these changes, Chronic Care Management will be a much better fit for FQHCs.
Combined coding of 99490, 99487, and G0507 into GCCC1
Consistent with other FQHC payment methodology of averaging actual cost
Eliminates tracking of additional time once 20-minute threshold is met
Cannot be billed with TCM or home health supervision
Can be billed with other services furnished during FQHC visit
Claim submitted on or after 1/1/2018 for CPT 99490 will not be paid
Combined with the changes from 2017, CMS is generating momentum for Chronic Care Management implementation in FQHCs. Connect Care Plus is strategically positioned to assist FQHCs with both ccp and TCM. As the new year approaches, now is the time to prepare for the new Physician Fee Schedule.
AN UPDATED CARE PATHWAY FOR NEPHROLOGY CHRONIC CARE MANAGEMENT
There is good news for patients with Chronic Kidney Disease (CKD) this week. A study published in the American Journal of Physiology reports that closely monitored exercise for patients, who do not require dialysis, does not impair kidney function. This is an important finding, as previous treatment recommendations for people with CKD discouraged exercise. The former recommendation is based upon the belief that the release of creatinine into the bloodstream caused by exercise would stress kidney function.(1) On the contrary, moderate exercise reduces glomerular filtration rate (GFR), the best indicator of kidney function. This finding will change the guidelines for Nephrology Chronic Care Management and Connect Care Plus is positioned to quickly implement improved patient education.
Care Pathways and Nephrology Chronic Care Management
The National Kidney Foundation recommends Chronic Care Management to CKD patients for two main reasons. First, it assists patients with building and maintaining a health routine that ought to include diet and regular doctors’ visits.(2) With Connect Care Plus’s Care Pathways, the needs of individual patients are met through expert evaluation and personal, monthly assessments. Second, and just as critical, is patient education. Although there are numerous medical websites that provide education to CKD patients,(3) there is no substitute for human interaction. Good Care Coordinators, like those at Connect Care Plus, can evaluate gaps in knowledge. Also, they can provide answers to specific questions that are directly applicable to the individual CKD patient’s life.(2) Through case oversight and patient education, Nephrology Chronic Care Management can slow disease progression and help CKD patients live healthier lives.
Updating Treatment Recommendations through Care Pathways
When patients are proactive in their care and use multiple sources, new methods of treatment and recommendation implementation is faster. However, incorporating new guidelines into patient education can often lag when patients only have one source of information. Unfortunately, Medicare patients face barriers to accessing these sources. This is where a Care Pathway is essential. As part of their individualized Care Pathway, all Connect Care Plus patients are routinely assessed by Care Coordinators. Therefore, changes in health recommendations can reach them faster.
The best role a Care Coordinator can play in the fight against CKD is that of prevention. The risk factors for developing CKD include a long list of chronic conditions that would qualify a patient for Chronic Care Management (ccp). The most common being diabetes and hypertension.(5) In fact, many these patients could already have CKD and be unaware of it.(6) Care Coordinators can reduce risk and slow progression by educating existing patients on the need to modify their diet, exercise regularly, take medications consistently, smoking cessation, and the increased risk for minorities.(4) Because Care Coordinators contact their patients monthly, they can deliver on-going patient education. Care Coordinators develop rapport with their patients and help them see the benefits of changing their habits and lifestyle.
Versatility Provides a Safeguard to Patients
Changing guidelines for Nephrology Chronic Care Management highlights the effectiveness and utility of Care Coordinators in managing Chronic Kidney Disease. ccp is more responsive than physician oversight because of the greater frequency of patient interaction and the flexibility inherent in Care Pathways. As such, experienced management of Care Pathways allow for the skillful oversight of patient health. Through responsiveness, flexibility, and frequent contact, Care Coordinators at Connect Care Plus can provide patients with another line of defense in their efforts to improve health outcomes.
ACO TRACK 1+: REVENUE SHARING FOR SMALL PROVIDERS
At the end of 2016, CMS announced a new Advanced Alternative Payment Model (APM) for Track 1 participants and small providers, or even hospitals, who want to create an Accountable Care Organization. The ACO Track 1+ model is a hybrid of Track 1 and Track 3. While Track 1 is a one-sided risk model, Track 1+ incorporates the two-side risk model with the more popular elements of Track 1.(1) As with all existing ACO models, Connect Care Plus is a qualified third-party service provider that will help you meet ACO quality goals.
By combining different Track aspects, CMS minimized the risk for participants in Track 1+ through lower loss sharing rates and incorporating the flexibility of both Track 2 and Track 3. ACO Track 1+ is a great option for organizations that want to be part of an Advanced APM and receive the five percent incentive payment in 2019 for participation in 2017.(2) Participation will also give you the opportunity to avoid the penalties that non-MSSP participants will incur in 2019.
Increased Flexibility and Decreased Liability: How ACO Track 1+ is Different
Track 1+ is open to ACOs currently participating in Track 1 or new ACOs, but not Track 2 or 3 participants. By lowering the loss-sharing rate and providing more flexibility, CMS is hoping to attract physician-only groups and rural hospitals. The following is a list outlining details of the new program:
Loss sharing rate fixed at 30 percent
This percentage is based upon ACO composition
Physicians-only and rural hospitals may have lower levels of risk
Skilled nursing facility option
Option to request 3-Day Rule Waiver
Prospective beneficiary assignment
Allows ACO to know assigned populations in advance
Shared savings of up to 50 percent
Symmetrical thresholds that are available under Tracks 2 and 3
ACO Track 1+: A Good Starter Program for Two-Sided Risk
Although a one-sided model is no longer available, the risk in ACO Track 1+ is much lower than other programs. CMS also added popular features of Tracks 2 and 3 to offset the costs. More importantly, switching to Track 1+ will not rebase the historical benchmark of Track 1 participants. This presents a good alternative to shifting to a stricter two-side risk model. By taking on the lower risk option now, ACOs can begin to prepare their organizations for higher risk programs they will join in the future.
Track 1+ is also attractive to groups or small providers looking to create a new ACO, since it is no longer possible to create a one-sided ACO. However, small providers and rural hospitals may not be able to afford the possible 10 to 15% loss rate that Tracks 2 and 3 could incur. The loss rate for ACO Track 1+ will range from four to eight percent, which is much more palatable for groups getting into a new program. Coupled with the possible shared savings and other benefits of this program, Track 1+ is a good entry plan for groups looking to create an ACO.
Connect Care Plus Can Help You Meet ACO Track 1+ Quality Measurements
Like all of Medicare’s Quality Payment Programs, CMS evaluates ACO Track 1+ on qualitative performance. Connect Care Plus provides services that meet all four quality-measure categories. The biggest component of Connect Care Plus’s service is care coordination. Implemented through the creation of Care Pathways by our skilled Care Coordinators, care coordination is an integral part of ACO quality measurements. Care Pathways are also integral to preventive health care and addressing at-risk populations. These categories are part of CMS’s metrics for determining the achievements of an ACO. In collaboration with Connect Care Plus, your ACO can also increase patient satisfaction. Your CMS surveys will reflect our excellent customer service. Contact us today, to see how we can help your organization can successfully adapt to the changing Medicare landscape.
MEDICARE PREVENTIVE SERVICES: A VITAL COMPONENT OF CHRONIC CARE MANAGEMENT (99490)
In June, the Centers for Disease Control and Prevention (CDC) released their 1999-2014 statistics on Cancer Incidence and Mortality. Once again, breast and prostate cancers topped the charts. The good news is that early detection is driving survival rates up.(1) In order to keep this positive health trend going up, Medicare patients need to take advantage of Medicare Preventive Services. Preventive medicine is important to these vulnerable populations, especially people with chronic conditions. Studies show that Chronic Care Management (ccp), like that offered by Connect Care Plus, increases adherence to preventive measures, such as cancer screenings.(2) Connect Care Plus provides patients with the support they need to utilize Medicare Preventive Services and protect their health.
More than Prevention: How Preventive Medicine Works
Preventive medicine is many faceted and encompasses a wide-variety of programs and specialties. The aim of these efforts is twofold. One is to reduce the incidence of disease, or primary prevention. The second is early diagnosis and treatment, or secondary prevention. While most people associate preventive medicine with the vaccines of childhood, it plays a large role in healthcare for adults, as well. According to the CDC, screenings and early treatment leads to better quality of life and lower healthcare costs.
It may seem counterintuitive to think of preventive medicine when talking about chronic conditions, but these patients are actually at greater risk. Due to comorbidity and weakened immune systems, many patients with chronic conditions require greater vigilance. It is critical for these individuals to stay educated about their preventive needs, be up-to-date with their screenings and shots, and to keep their healthcare provider informed of any symptom changes.
Medicare Preventive Services: What Does it Cover
Medicare preventive medicine covers an Annual Wellness Visit (AWV) and much more.(4) These benefits include, but are not limited to:
- Cardiovascular Disease Screening
- Bone Density Screening
- Pneumococcal Vaccine
- Diabetes Screening
- Cancer Screenings
- Depression Screening
- Glaucoma Screening
- Influenza Virus Vaccine
Despite the availability of these services, AARP estimates that less than one third of Americans age 50-64 are up-to-date with basic clinical preventive services.(5) Their top recommendation is the use of provider and patient reminder systems. Through Connect Care Plus’s Care Pathways, our Care Coordinators remind patients which services they require and the necessity of these programs. By facilitating the use of Medicare Preventive Services, Connect Care Plus helps patients maintain their quality of life and access early intervention for serious diseases.
Case Study: Medicare Preventive Services and Influenza
Every year the CDC issues guidelines for influenza vaccines in its efforts to decrease the spread and severity of influenza.(6) Despite the warnings and guidelines, aIn an effort to lower costs and experiment with different incentives and systems, CMS created several programs to promote coordination within the healthcare system and improve the quality of care for chronically-ill patients.(1) As part of Medicare’s transition from volume-driven care to value-based care, the Accountable Care Organization (ACO) model provides incentives for healthcare providers to promote quality over quantity.(2) This effort is supported by the American Medical Association, because the organization understands that ACO success encompasses much more than cost-savings.(3) With a focus on systems to improve patient care, ACOs are well-situated in a consumer-oriented market.
Over the past decade, CMS has argued that providers will increase quality of care when they share in savings from better-coordinated preventative, diagnostic, and therapeutic services. As a result, ACOs are responsible for providing their patients with healthcare management services. In order to realize the benefits of cost-savings through evidence-based healthcare management strategies (e.g. vaccines, flu-shots, cancer screenings, Annual Wellness Visits, etc.), they must furnish their patients with management services. Consequently, partnerships with a third party, such as Connect Care Plus, are an effective way to provide these services.
Medication Use Practices: An ACO Success Story
ACO success is most prominent in the optimization of medication use practices. As CMS shifts to non-monetary evaluations, medication adherence is a common metric utilized to track progress. Recent reports have confirmed that ACO achievements are strong in this area. Some examples are:
- increase in patient education
- integration with pharmacy systems,
- increased appropriate use of generic medications
- the development of better systems to track preventative care gaps
- an increase in electronic transmission of prescriptions
- the creation of better systems for potential adverse-events notifications(4)
Because ACOs are created with an emphasis on collaboration, streamlining many aspects of medication use is a logical first step.
Although they are largely successful with these substantial improvements, ACOs still lag in a few areas. For instance, pharmacy notifications for cancelled prescriptions are slow. In addition, ACOs continue to encounter problems with delivery of discontinued prescription notifications to care providers. Much of these delays in implementation can be attributed to technological barriers, reimbursement methods, and reporting difficulties.(4) In other words, medication use practices are changing for the better, but there is still room for improvement.
Other Strategies for ACO Success
The ACO model is advantageous in other areas, as well. ACO success is most notable in the reduction of duplicate services and readmissions. This has yet to translate into large savings, but many experts say that it is too early to assess. The goal is to maintain and even increase quality of care, while lowering costs. Therefore, the focus is on the former as methods and strategies are tested. Any analysis of these programs must consider experience. Implementing new methods, purchases of new technology, as well as training and increasing staff are costs associated with shifts in policies. Older programs demonstrate increased savings, which CMS says is expected.
Connect Care Plus: For Faster Implementation and Lower Start-up Costs
The greatest barriers to ACO success are start-up costs and staff positions to perform Chronic Care Management (ccp). ACOs face increased initial costs in healthcare IT and staffing.(6) As such, many ACOs are looking outside of their organizations to contract with third parties, such as Connect Care Plus. With healthcare IT and trained care coordinators already in place, Connect Care Plus offers a faster path to implementation.
Second, although ACOs have accomplished much in traditional healthcare services, they are still inadequate as key support service providers. Frequently, social
components prevent treatment plans from being effective. For instance, issues with food and housing insecurity and lack of transportation are social barriers to healthcare that Medicare patients face. Connect Care Plus facilitates the connections these patients need to local and federal resources that ameliorate obstacles to good health outcomes.
Chronic Care Management and ACOs
As CMS increases its efforts to shift from fee-for-service models of payment to value-based care, membership in new programs, like ACOs, is essential to remaining a viable, Medicare provider. Connect Care Plus is positioned to help healthcare groups integrate these programs into their practices. ccp increases medication adherence, provides connections to social services, and increases appointment compliance. All three of these services are components of CMS’s evaluations of ACO success. By collaborating with Connect Care Plus, ACOs can quickly, and cost-effectively, provide
their patients with high quality chronic care management they need.
significant number of older Americans avoid getting the shot in the false belief that it will make them sick.(5) In fact, the opposite is true. Influenza vaccines prevent complications among people with chronic conditions. Yes, a small percentage of people who receive the shot develop influenza, but the consequences are not as severe.(7) In addition, some patients need different types of vaccines, depending on their condition.(6) Through monitoring individual patient’s Care Pathway, Connect Care Plus’s Care Coordinators can help keep patients on track and decrease hospitalizations.
MOVING FORWARD: FIBROMYALGIA PATIENTS IN PRIMARY CARE
Fibromyalgia is a complex chronic pain syndrome that affects up to five percent of the American population. Common symptoms include muscle and joint pain, stiffness, fatigue, headaches, and irregular sleep patterns. The syndrome primarily occurs in young and middle-aged women, but men and children develop the illness as well. Diagnosis is also high among people with existing chronic illnesses. Although the majority of Fibromyalgia patients in Primary Care are women, they come from all backgrounds and span all ages.
Unfortunately, the cause of Fibromyalgia is unknown. This ambiguity presents a challenge to traditional primary care settings.(1) Therefore, it is extremely important that patients stay educated and maintain good communication with their physicians and other healthcare professionals. One effective tool for both patients and practitioners is Medicare’s Chronic Care Management program(CPT 99490). Through proven patient engagement methods and information management, a ccp coordinator provides the guidance and synchronization to ensure effective treatment for Fibromyalgia patients.
Finding a Home: Fibromyalgia Patients in Primary Care Settings
Fibromyalgia is a functional pain syndrome. In other words, the body amplifies ordinary sensations as pain. Since there is no known organic cause, researchers are unsure if Fibromyalgia is a singular disorder, or if it is a collection of similar diseases categorized under one umbrella.(2) As such, there is no real consensus in the medical community regarding diagnosis or treatment. Despite breakthroughs in identifying biomarkers and documenting impacts of the disease on the nervous system, there is no verified diagnostic test or medical intervention.(3) (4) Because of this, a diagnosis of Fibromyalgia comes with an unclear treatment path.
Without an understanding of the underlying cause of Fibromyalgia, without a definitive diagnostic guideline, and without replicated testing of the physiological impact it has on the body, the medical community struggles to find Fibromyalgia patients a home.(5) Instead, patients are sent to a variety of specialists to rule out other diseases and disorders that have more conclusive tests. This means that patients frequently see rheumatologists, neurologists, psychiatrists, psychologists, general internists, osteopathic physicians, chronic pain clinics, as well as multiple visits with their PCP. Coupled with the lingering social stigma of the syndrome, many patients defer treatment efforts and they lack the support needed to cope with a chronic condition.(5)(6) All of this make Fibromyalgia patients in Primary Care Practices a challenge.
Pain and Fatigue: A Reinforcing Circle
The most common symptom of Fibromyalgia is pain. This pain can be dull and achy, or acute and sudden. The pain can occur in any part of the body and often begins without an outside cause. While many people experience muscle pain, others experience joint pain, and some experience both. Levels of pain and areas that are affected can change throughout a person’s life.(7) Most patients experience flares, or times when symptoms increase. Some patients experience periods of “remission,” or times when the symptoms are barely noticeable, but these intervals are rare. Therefore, pain management is essential to any Fibromyalgia patient.
The second most common symptom is severe fatigue. This symptom can vary in intensity and duration, just like pain. Currently, it is unknown if fatigue is directly caused by the syndrome, or if it is caused by pain induced sleep deprivation.(8) No matter what the source, the consequences are clear. Over three-quarters of patients report memory lapses, difficulty staying awake, interference in activities of daily living, absences from work, and disruption of social life.(5)(8) In spite of its prevalence, fatigue is often overlooked during diagnosis and treatment. Usually, Fibromyalgia patients find relief with good management of other symptoms.
Fibromyalgia Patients: Providing Resources
Treatment plans, therefore, need to provide both immediate relief and long-term planning. A many-pronged approach is the most effective way to treat Fibromyalgia patients in Primary Care. A strong foundation begins with patient education. Afterwards, physicians can start the process of finding the right combination of self-management and medical intervention that will work for their patient. This is a time consuming process and not all practices are equipped to invest these resources.
This is where ccp comes into play. Through partnership with Connect Care Plus, a leading ccp coordination provider, physicians can be confident that their patients are receiving the education and guidance they need. Care coordinators, in conjunction with physicians, create care plans for each patient. They track medication compliance, symptoms, and exercise regimens. In addition, care coordinators help participants keep track of their multiple doctors’ appointments and referrals. This added service enhances treatment effectiveness, which is a difficult process for both patients and physicians. In short, Fibromyalgia patients in Primary Care settings greatly benefit from the assistance that care coordination offers. Providing this service, through Connect Care Plus, adds substantial value to Fibromyalgia patient care.
COMPREHENSIVE PRIMARY CARE PLUS (CPC+): ROUND 2 ANNOUNCEMENT
Round 2 of their Comprehensive Primary Care Plus (CPC+) program.(1) Currently, CPC+ has 54 aligned payers in 14 regions, which encompasses close to 3,000 primary care practices of varying sizes and structures. In support of delivering comprehensive primary care, CPC+ is a payment redesign that offers the financial resources and flexibility practices need to make investments that will improve primary care and increase revenue.
CPC+ Round 2 Changes
To promote the shift from Fee For Service (FFS), CMS will be offering for CPC+ participants Comprehensive Primary Care Payments (CPCP), while at the same time, reducing FFS payments.(2) Typically CPCP payment amounts should be larger than the FFS payment amounts. CPCP payments will include a non-visit-based, monthly case management fee (CMF) and paying performance-based incentive payments (PBIP) for participants that meet or exceed annual performance thresholds.(2)
This effort to improve quality, access, and efficiency of primary care spotlights key CPCP functions. CMS believes that these payment structures will change the way practices deliver care and will shift focus to (1) Access and Continuity; (2) Care Management; (3) Comprehensiveness and Coordination; (4) Patient and Caregiver Engagement; and (5) Planned Care and Population Health.(1) Track 2 will also increase Information Technology requirements, which includes a letter from a supporting technology vendor such as Connect Care Plus.
As with Track 1, CPC+ cannot be combined with Chronic Care Management (ccp), which encompasses CPT Codes 99490, 99487, and 99489.
CPC+ Round 2 will be offered in the following regions: (1)
- Louisiana: Statewide
- Nebraska: Statewide
- North Dakota: Statewide
- New York: Greater Buffalo Region(Erie and Niagara Counties)
Eligible practices located in these regions may apply to participate in CPC+ Round 2 from May 18, 2017 until July 13, 2017.
More Enrollment Information
CCP expects to add 1,000 practices in this round of enrollment. Practices are expected to participate for the full five-year performance period. However, there will be no penalty for voluntary withdrawal.