Telehealth's Role In Medicare's Chronic Care Management

Virtual Telehealth Doctor

CMS recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as reduced spending. Since January 2015, Medicare has been paying separately under the Medicare Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology (CPT) code 99490, for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions.

CPT 99490 is defined as chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:

  • 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
  • comprehensive care plan established, implemented, revised, or monitored

Health IT Outcomes recently spoke with Dr. Aristides M. Estrada, a graduate of the Univ Auto De Santo Domingo (uasd), Fac De Cien Med, Santo Domingo who works in Mine Hill, NJ and specializes in Internal Medicine and Internal Medicine — Geriatrics, to discuss the role telehealth plays in this and more.

Q: What were you hoping to accomplish by participating in Medicare’s Chronic Care Management program?

Estrada: We adopted CCM to help patients treat their chronic conditions by being better compliant and getting easier access to our services. This helps our practice fulfill the requirements of Patient Centered Medical Home as well.

Q: After successfully running a CCM program, how do you feel the benefits of a telehealth call compare to in-person visits?
The advantages of a telehealth call are it is less costly care, less intrusive for the patient, and easier to accomplish for our practice.

Q: Are monthly telehealth check-ins helpful for coordinating care when compared to the traditional model of yearly, in-person visits?

Estrada: Monthly telehealth check-ins are better than a yearly in-person visits as they are more frequent and cost effective.

Q: You decided to partner with Hello Health. How does their CCM Wellbox Solution work?

Estrada: Hello Health CCM Wellbox works by providing us with the information gathered by the nurse (or other licensed medical professional) on a same-day basis. If any issue requires immediate attention the nurse calls or emails me immediately.

Q: Have you observed any significant impact on patient outcomes and practice success since adopting CCM?

Estrada: I can't yet answer this question as objectively as I would like as we haven’t conducted a formal study yet, but I feel confident our patients with chronic conditions are better cared for now than they were before.

Q: Do you feel it’s possible to participate in CCM without an outsourced telehealth service?

Estrada: While it is possible to do it, there are several advantages of outsourcing. The infrastructure is already available and one doesn't need to re-invent the wheel, not to mention that hiring a nurse [to complete the calls] is quite expensive and has the potential to create other problems.