RHCs and FQHCs for Chronic Care Management

Chronic diseases such as cancer, stroke, cardiovascular disease, arthritis and diabetes are the leading causes of death and disability in the United States and throughout the world. Statistics show that more than 40% of U.S adults suffer from chronic diseases making the diseases responsible for about 23% of all hospitalizations in the U.S. Statistics show that cancer and heart disease account for more than 50% of all deaths among elderly people.

Although some chronic diseases are very common and costly, many of them can be managed. Many of them are linked to lifestyle choices that one is capable of changing.  Engaging in physical activities, eating nutritious foods and quitting smoking are some of the measures many can take to prevent and manage chronic diseases.

Chronic Care Management

You can manage chronic diseases at home, but not all of them. Also, some stages of chronic diseases need medical attention. This is the reason why chronic care management (CCM) is important.

The Centers of Medicare and Medicaid services (CMS) recognize CCM as an important component of primary care that help in improving health and care for individuals. Chronic care management allows healthcare providers to be reimbursed for the resources and time they utilize in managing Medicare patients’ health during face-to-face appointments. Chronic care management services can be improved for Medicare patients with multiple chronic conditions who are at high risk of death, functional decline and acute exacerbation.

Apart from chronic care management offered in a doctor’s office, CCM services can also be offered by Rural Health Clinics (RHCs) and Federal Qualified Health Centers (FQHCs). The following is a list of health care professionals who can bail for CCM services:

·         Nurse practitioners

·         Physicians

·         Certified nurse midwives

·         Physician assistants

·         Clinical nurse specialists

In 2018, changes have been implemented to the way Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) bill Medicare for chronic care management services. With the new G0511 General Care management code, everything has been made easier for FQHCs and RHCs to implement chronic care management services. This has as well enabled them to offer quality between visit care and coordination services for their patients.

A Timeline of Care Management Information for RHCs and FQHCs 

2015 - This is the year CCM program was first introduced and FQHCs and RHCs were excluded from participating in billing for CCM services.

2016 - In this year practices for FQHCs and RHCs were allowed to bill for CMM services but with limitations that they were required to provide their services under direct supervision.

2017 - In 2017 there was a change from direct supervision to general supervision by CCM which made it easier for RHCs and FQHCs implementations. This is because they were allowed to contract with third parties to help provide chronic care management to patients on their behalf. In addition to those changes in 2017, the program also removed some administrative and enrolment burdens to help provide more opportunities to improve health outcomes and also support the patient overall well-being. The program also made payments more in line with provider’s efforts.

2018 - This was a game changer year for FQHCs and RHCs. In the year, 4 care management services including Behavioral Health Integration (BHI), Transitional Care Management (TCM), Psychiatric Collaborative Care Model (CoCM) and Chronic Care Management (CCM) were introduced meaning that FQHCs and RHCs will be able to receive more robust support that ever before which will help them effectively manage the care of patients with chronic diseases.  This support includes the increase in CCM related reimbursement with the new G0511 General Care Management code which has led to a reduction in burdensome reporting requirement and a much greater consistency with the FQHCs and RHCs payment methods.  Such changes were made in the.

0knowledge that 3 out of 4 people aged 65 years and above have multiple chronic conditions.

With these changes which were made effective from January 2018, FQHCs and RHCs are in the best position to improve support from their trusted third party to help deliver CMM services on their behalf. For nor RHCs and FQHCs whore the leader in chronic care management can:

     ·         Achieve maximum reimbursement after proven patient engagement

     ·         Deliver chronic care management to patients with less demands on available resources

     ·         Improve access to care by providing support 24/7/365

     ·         Provide care services that support patients, their caregivers, their family members and the whole          community

     ·         Schedule routine and referral healthcare appointments

     ·         Offer patient-centered oversight and care management

     ·         Reconcile medication list and also review for any potential interactions

     ·         Ensure there is timely sharing and use of healthcare data or information

     ·         Build and also maintain a perfect care plan

     ·         Offer 20 minutes minimum monthly care coordination

     ·         Manage all healthcare transitions between healthcare professionals and settings

                 

Savings and Health Benefits ofFQHCs and RHCs Chronic Care Management

Major benefits of FQHCs and RHCs in chronic care management include:

          1.      Benefits to providers, payers and patients

According to recent statistics, providers get an additional $636 per member per year in average revenue, patients save about $200 on average per year and payers see an average saving of about $888 per member per year on average revenue. This shows how CCM is a cost saving program.

         2.      Derives patients back to primary care

       For the last few months, there has been a growth in expenditures for professional services meaning that there is a higher rate of primary care visits after improvement of CCM services. In addition, there is evidence that suggest that patients enrolled in CCM programs took a greater advantage of healthcare benefits that were made available such as better management of end-of-life care and advance care planning.

        3.      Reduce healthcare spending

Chronic care management has led to slower rates of growth in total Medicare expenditures which currently range from $28 to $74 per beneficiary every month after subtracting the average monthly CCM charges.

In general, individuals with CCM have experienced lower emergency department, inpatient hospital and skilled nursing facility costs. They have as well experienced care that has reduced the chances of hospital admissions related to pneumonia, heart disease, diabetes and urinary tract infections, relative to the comparison beneficiaries.