By Dr. David K. Haseltine, Pawleys Pediatrics & Adult Medicine
As many healthcare professionals know, reimbursement for Chronic Care Management (CCM) services by the Centers for Medicare and Medicaid Services (CMS) commenced on Jan. 1, 2015 to improve non-face-to-face services for Medicare beneficiaries who have multiple, significant chronic conditions. For those outside the industry, the program helps patients manage complicated conditions on a regular basis and provides treating physicians with financial incentives. To date, most media attention has focused on the logistical and administrative complications of these programs. Few case reports exist surrounding the effectiveness of CCM from a patient perspective.
In our practice, a number of examples prove how CCM improves patient care. One stands out in particular: Robert Grove, an 81-year-old resident of Georgetown, S.C. and retired Army officer who recently experienced these benefits firsthand.
Originally a native of Pennsylvania, Grove had served in the Army both abroad and stateside. He had a long and productive military career until he was forced to retire due to complications from insulin dependent Type 1 (diabetes) incurred while serving in Vietnam in 1965. He relocated to South Carolina and began attending Pawleys Pediatrics & Adult Medicine.
With the advent of the CCM program, our staff at Pawleys reached out to him about enrolling. At first, Grove was reluctant, uncertain of the added benefit. He agreed to a trial period, however, with the understanding he could disenroll if he found no value to the program. As part of the program, a registered nurse at Pawleys named Catherine Byrd called him weekly to check on his health (glucose levels, diabetic concerns, etc.). Eventually, Grove transitioned to monthly phone calls because there were no immediate health concerns, other than his controlled diabetes.
In the fall of the same year, Grove developed slight chest pain and shortness of breath which lasted a couple of weeks. During an ensuing call on December 7, 2015, Grove mentioned the discomfort he was having. He had planned on ignoring the symptoms, thinking they were due to another medication. Immediately, Byrd encouraged him to come to the office for a visit with me. I checked an EKG and sent him for a stress test, which was abnormal, and subsequently referred him to a cardiologist. Grove had a catheterization three days later which revealed three blockages of his main heart vessels at 50 percent, 70 percent, and 90 percent blocked. Five days later, he underwent surgery for coronary artery bypass grafting.
Had he continued to wait until the chest pain manifested as a heart attack, Grove would have had permanent heart damage. If severe, the damage could have been fatal; if less severe, he could have been left crippled with congestive heart failure. Instead, after his surgery, two follow-up visits with the cardiologist, and seven weeks of physical therapy at Tidelands Georgetown Memorial Hospital, he is fully healthy again. Aside from a barely visual scar on his chest, he doesn’t feel any side effects.
Additionally, the health system as a whole benefits from better-controlled problems at lower cost. Had Grove waited until his symptoms became more severe, he would have incurred the additional expense of an ER visit. Had he sustained a heart attack and been left with congestive heart failure, the healthcare system would have paid for recurrent hospital visits for congestive heart failure exacerbations, as well as multiple medications, in addition to the surgery he incurred.
Grove admits the whole process happened very quickly was surprised he needed heart surgery because he had always been active and fit. Also, stress tests had always shown his heart was in good condition. He doesn’t take his health for granted, however, and he’s thankful for his enrollment in the CCM program. It saved him from experiencing far more serious health issues and allowed him to get back to his busy schedule, including spending time with family and friends. He now uses the fitness center in his community to work out regularly and stay healthy. This past summer, Grove traveled with friends for a month-long trip across the western U.S., visiting Yellowstone National Park, Oregon, Lake Tahoe, and San Jose, CA. Without the rapid intervention from the CCM program, which helped to diagnose his heart condition and prevent more serious illness, this trip would not have been possible.
Bob Grove’s story is important because patients with chronic illnesses are often more susceptible to other serious health issues. By closely monitoring the health of patients through CCM programs, physicians can improve the quality of patient care and prevent potentially life-threatening conditions.
While not required by the program, Pawleys chose to hire an extra staff member (Byrd) since reimbursement for the program easily covered her cost. Physicians have found their workload lighter since they can assign tasks like medication refills, tracking down outside records, and coordinating social services to the CCM nurse. At Pawleys, the CCM program has also been such a success because the day-to-day requirements are very similar to the typical responsibilities of the staff. Each nurse and physician only tracks his or her time more closely to comply with the regulations put in place by CMS.
Fortunately, the EHR system used throughout the practice made this process extremely simple. Combined with the ability to quickly manage a patient’s entire medical history through the EHR’s other capabilities, our team at Pawleys was able to seamlessly install an effective program for all patients willing to participate. To date, there are 230 patients enrolled in our CCM program, and we expect that number to increase as we move into 2017.
Click here for more information about Pawleys Pediatrics & Adult Medicine. For additional details about the practice’s chronic care management program, feel free to reach out via the interactive patient portal.