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Are You Leaving Money on the Operating Table: Part 1

Are You Leaving Money on the Operating Table: Part 1

As a physician; we’re all looking for ways to increase the profit in our practices. But when presented with an opportunity, the big question we always ask is, “Will it disrupt my flow?” Good news! There is actually a program that can drive new income to your practice and keep your flow intact, all while providing patients with a much-needed value service.
This sounds-almost-too-good-to-be-true opportunity is called CCM, an abbreviation for Chronic Care Management. It’s a program for elderly Medicare patients, and it’s not new. But have you heard of it?
The CCM program has actually been around for over five years. When it launched in January 2015, many doctors looked at it and said, “This is a great program, but I can’t make it work in my practice. I’m just too busy.” Consequently, it was off to a slow start for the first couple of years. But that has since changed as more doctors have realized the across-the-board benefits. Nowadays, the CCM program is a mainstay for physicians—a perfect solution to a growing demographic that has yet to be reached.

CCM Is Here to Stay

Dr. Brian Hazelgren couldn’t help but be intrigued when a couple of doctors called him in 2014. “Medicare’s going to be releasing a new program called chronic care management,” they announced. “Since you’re in medicine and health care, can you help us hire people to call our Medicare patients? This program will reimburse us an average of $42 per patient per month if we spend twenty minutes on the phone with them every month. That’s 20 minutes per month, not per call.”
After accepting this offer, Dr. Hazelgren’s company RX2Live started working on this program during the last quarter of that year in preparation. In January 2015, the CCM program launched, and so did RX2Live’s participation as they became one of the pioneering companies. They hired medically qualified military veterans to make patient calls.
In 2016, they were told that about 14% of the 48-million Medicare population possessed six or more chronic illnesses or conditions. Then a 2016 survey reported that Medi-care was spending about 49% of its annual costs on these chronic conditions.
Still, many doctors bowed out of using the program, believing the $42 per patient per month reimbursement wasn’t enough anymore. But RX2Live saw the opportunity to not only serve Medicare patients but the doctors by making those phone calls for them. They decided to keep moving forward with the program—even created software that records patient conversations and prepares their annual care plans—and they’re glad they did.
Fast forward to today… close to 20% of the now-56-million Medicare population have six chronic conditions. Spending on these chronic conditions has increased to over 51%. Obviously, it continues to grow and is not slowing down… and so does the need.

CCM Requirements

In order to qualify for the CCM program, the patient has to meet only three requirements:

1. was seen by their physician in the last twelve months

2. consents to calls from CCM during the month to ask questions and see if they’re okay

3. has at least two chronic conditions, which consists of about 72.5% of today’s 56-million Medicare beneficiary population

Based on the above statistics, that means 40.6 million recipients have at least two chronic conditions, yet only 2.8 million are enrolled in this program. There’s still many more—almost 30 million—who could benefit from CCM.

Additionally, Medicare requires us to address three concerns during every phone call and ask:

1. Are you taking your medications as prescribed?

2. Are you following the care plan that the doctor and you have agreed upon?

3. Is there anything else you’d like the doctor to know about, or would you like to come in and see the doctor?
Requirements are simple, yet they provide much-needed care and a proactive approach for your patients.

Money on the table Part 2
Top Doctor Magazine
Top Doctor Magazine

Top Doctor Magazine is a magazine from doctors for doctors and patients. We cover everything from cutting-edge medical techniques and procedures to enterprising doctors, dentists, surgeons, naturopaths, chiropaths, orthodontists, and more who are thought leaders within their own medical practice and changing the way we all experience medicine for the better.

We wish to be your one-stop digest for inspiration by other professionals in your field who are making waves and setting trends. If you, too, are a trend-setter, reach out to us so we can interview you for your own spotlight within an upcoming Top Doctor Magazine issue!

Brianna Connors & Derek Archer Co-Editors

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