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Key Questions in Selecting a Case Management Partner for CCM and/or RPM services

You are a physician considering working with a case management partner to access the revenues of CCM while easing the the burden of doing it yourself. Or, you want to provide Remote Patient/Physiologic Monitoring services for your at-risk patients. There are many companies you could choose to work with – to act as an extension of your practice. What separates the bad ones from the good ones, and particularly how do you identify the one that will work best with your practice?

Here are important parameters to consider, separated into these categories:

  1. General/Organizational
  2. Quality of Care
  3. How Turnkey is the service?
  4. Devices / Additional Device Charges
  5. Enrollment

1. General/Organizational:

    • Does the company handle both CCM and RPM services? (Assuming you are interested in both) You don’t want to learn any more interfaces than necessary.
    • When/How do you get billed? Many partners will bill you only if and after your claims are paid by insurance (CMS or commercial).
    • How much time do you spend monthly fielding calls related to care management, without being reimbursed? Would it be helpful to have someone else handle most of those calls?
    • Is vendor staff available to handle patient calls 24/7? If not, what hours, and how are off-hour calls handled?
    • Do you practice in a FQHC or otherwise see a large portion of MediCAID patients? FQHCs actually can get higher CCM reimbursements in many cases than most physicians get from the PFS. On the other hand, practices seeing MediCAID patients in nursing homes should, in many states, expect to never collect co-pays, which can take a significant bite out of net revenue after the service is paid. In such cases you will need to pay even more attention to the numbers. There are bills in both houses of Congress to eliminate the co-pay for CCM & RPM, for Medicare patients – if the change goes through, it will help significantly. We will continue to track this.
    • Do a significant portion of your chronic care patients need complex care management? Most case management companies do not provide more than basic CCM.

2. Quality of Care:

    • Is each of your patients assigned to a single nurse (and possibly a backup)? Regular contact between patient and practitioner is necessary for high quality care and is an expectation behind CMS’ decision to reimburse these services.
    • How many patients are assigned to a single nurse? Some companies do little more than operate a call center where nurses are assigned many hundreds of patients and are paid only for calls they can complete and rack up sufficient time for billing. In one extreme, little effort is spent trying repeatedly to reach each patient, especially those who are hardest to reach. In another extreme, nurses have been known to almost harass patients in order to achieve sufficient days of measurement and threshold time in status review. Neither example is good for your patients’ health or their satisfaction.
    • Can you establish different contact and escalation protocols for each patient? Since the case management partner is in more day-to-day contact with the patient, they will be the first to become aware of a change or a situation requiring escalation. You’ll want to be contacted immediately in some circumstances, but you also don’t want to be bothered with the trivial. Only you can determine what is likely to be appropriate for each patient. Many companies will allow you to specify both circumstances and how/when you or your staff is contacted regarding a new medical matter.

3. How Turnkey is the service?

    • How will YOU want to see notes generated during the monthly encounters and updates to the chronic care plan? Some physicians want all the CCM/RPM notes to be present in the patient’s chart, in their own EHR. Others find the notes generated to be of limited value and mostly see them as clutter. They would rather access these specific notes through the Vendor’s portal, and only as needed.
    • If you prefer all the notes in the same place, can the readings and notes all be entered into the patient’s chart in your own EHR? (or uploaded there as a pdf) If so, you won’t need to go into the third party EHR to find just the CCM/RPM information, and you won’t need to learn to access yet another system. Can they do this with the EHR you use? Many partners who claim full integration can only do so with a limited set of EHRs – yours might not included.
    • Is a patient ‘encounter’ created each month in your EHR just for CCM and/or RPM? If so, your billing workflow, whether you do billing in-house or outsource it, will process it as any other claim. If not, handling denials or tracking secondary insurance and patient responsibility can be complicated. You could leave money on the table.

4. Devices:

    • Are RPM devices loaned by the company, or do they need to be purchased by the practice? While most devices may be cleaned and reused by another patient, the logistics are unfavorable. Companies which loan their devices rather than require your purchase will generally charge more monthly. But working with a company which loans the devices is generally less effort and reduces financial risk. (Not many reimbursement options exist for the devices themselves, although some practices charge their enrolled patients a small monthly fee.)
    • Which devices are available? How do they map into your patient needs? The most common supported devices are BPCs, Scales, Pulse Oximeters, Glucometers and activity/sleep wearables. Not all device categories are available from all companies.
    • Do the devices connect directly with the cellular network, or do they rely on interfacing first with either the patient’s smart phone or a special provided tablet or ‘dumb’ phone? If the latter, ask about the simplicity of that interface and simplicity of setup. Some are much more turnkey than others.

4. Additional Device Charges:

    • Are there additional cellular charges? All of these devices make use of a low throughput cellular network which piggybacks on top of mobile phone networks.
    • If the devices make use of a smartphone and the patient does not have one, is there an additional charge for the necessary tablet or ‘dumb’ phone?
    • Do device costs increase if multiple devices are to be utilized? (reimbursements DO NOT increase if a patient uses multiple devices.

5. Enrollment:

    • Who generates the list of potential patients for CCM and/or RPM services? In most cases, the process starts with the company uploading information on your entire panel into their system, where they run algorithms to determine patients who qualify by virtue of both their medical history and their insurance coverage. The doctor has the opportunity to make changes to the list, and to specify any RPM devices appropriate for each patient.
    • Who is responsible for enrolling the patient? Once a list of qualified patients is approved, either the doctor (or staff) is expected to introduce the CCM and/or RPM programs to each patient and get consent, or the company will do the outreach using the doctor’s name.
    • Who supports setup of device in the patient’s residence? Some companies expect the practice to deliver the devices and take care of setup. Others will send the devices and talk the patient/caregiver through setup on the phone. You will need to factor in your informed assumptions about how well this may or may not work.

Every company providing CCM or RPM services will talk about their quality, how they are an extension of your practice, and how only good things come from working with them. But your relationship with your patients is important and if another party is representing you, you want them to treat your patients with as much respect as would your own staff and you want the extra care they get by virtue of these programs to be of the same quality as you would deliver yourself. We believe the more turnkey the service, the more sense it makes for most practices.
 


 

This is the latest in a series of articles about Remote Physiologic/Patient Monitoring (RPM) and the closely related Chronic Care Management (CCM). Others in the series are/will be:

Chronic Care Management: Do it yourself? Contract with a Service? Not enough reimbursement to bother?

What is Chronic Care Management?

Considering Remote Physiologic/Patient Monitoring (RPM)? Here is what you need to know!

Service Quality matters with outsourced CCM

You CAN deliver CCM services in Nursing homes – according to CMS!

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