Beginning January 1, 2015, the Medicare Physician Fee Schedule (PFS)
reimburses qualified providers for Chronic Care Management (CCM)
services for Medicare beneficiaries with two or more chronic health
conditions. Pharmacists can participate in CCM as clinical staff, with
their services being billed incident to by a qualified provider. CCM
services include five core activities:
- Recording structured data in the patient’s health record
- Maintaining a comprehensive care plan for each patient
- Providing 24/7 access to care
- Comprehensive care management
- Transitional care management.
The Centers for Medicare & Medicaid Services (CMS) estimates that
approximately two-thirds of Medicare patients have two or more chronic
conditions, and CCM aims to better coordinate the care these patients
receive. Through CCM and complex CCM, CMS pays for non-face-to-face care
coordination services furnished to Medicare beneficiaries who reside in
the community setting that meet the following requirements:
- Multiple (two or more) chronic conditions expected to last at least
12 months, or until the death of the patient;
- Chronic conditions place the patient at significant risk of death,
acute exacerbation/ decompensation, or functional decline; and
- Comprehensive care plan established, implemented, revised, or
monitored.
CCM could be a powerful base payment mechanism for pharmacists and their
prescriber partners who are collaborating on the care of a patient
population. Additionally, CCM and complex CCM could provide the
fee-for-service mechanism for pharmacists to be compensated for some of
their services as pharmacists and physicians enter into emerging
quality-based and risk-sharing payment structures.
APhA's CCM Resources
APhA collaborated with two Quality Improvement Organizations, Health
Quality Innovators and Delmarva Foundation, to create Chronic Care
Management (CCM): An Overview for Pharmacists. This guide
describes the requirements for CCM and how pharmacists may play a role
as clinical staff.
CCM in
Practice. Learn about how Michelle Thomas, pharmacist at
Chickahominy Family Physicians in Virginia, has integrated CCM into her
pharmacy practice.
The CCM Patient Consent Checklist was created in collaboration
with Telligen and can be used to help guide members of the CCM care team
as they collect necessary information for patient consent to participate
in CCM service.
What Can Chronic
Care Management Do for You? - This webinar helps the whole
care team learn what CCM is, how pharmacists can engage, and
strategies for reimbursement/sustainability. Free CE is
available for all clinicians.
Additional CCM Resources
CMS Guidance on Chronic Care Management Services
CMS FAQs on CCM
CMS Summary of CCM Changes for 2017
CMS Connected Care Initiative