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least in theory — they may get through Medicare Advantage , which is administered by private insurers .
But the CCM program is open to both Medicare and Medicare Advantage beneficiaries .
The program was also intended to boost pay to primary care doctors and other physicians who are paid significantly less by Medicare than specialists , said Mark Miller , a former executive director of the Medicare Payment Advisory Commission , which advises Congress . He ’ s currently an executive vice president of Arnold Ventures , a philanthropic organization focused on health policy . ( The organization has also provided funding for KFF Health News .)
Despite the allure of extra money , some physicians have been put off by the program ’ s upfront costs .
“ It may seem like easy money for a physician practice , but it is not ,” said Namirah Jamshed , a physician at UT Southwestern Medical Center in Dallas .
Jamshed said the CCM program was cumbersome to implement because her practice was not used to documenting time spent with patients outside the office , a challenge that included finding a way to integrate the data into electronic health records . Another challenge was hiring staff to handle patient calls before her practice started getting reimbursed by the program .
Only about 10 % of the practice ’ s Medicare patients are enrolled in
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CCM , she said .
Jamshed said her practice has been approached by private companies looking to do the work , but the practice demurred out of concerns about sharing patients ’ health information and the cost of retaining the companies . Those companies can take more than half of what Medicare pays doctors for their CCM work .
Physician Jennifer Bacani McKenney , who runs a family medicine practice in Fredonia , Kansas , with her father — where Carrie Lester is a patient — said the CCM program has worked well .
She said having a system to keep in touch with patients at least once a month has reduced their use of emergency rooms — including for some who were prone to visits for nonemergency reasons , such as running out of medication or even feeling lonely . The CCM funding enables the practice ’ s medical assistant to call patients regularly to check in , something it could not afford before .
For a small practice , having a staffer who can generate extra revenue makes a big difference , McKenney said .
While she estimates about 90 % of their patients would qualify for the program , only about 20 % are enrolled . One reason is that not everyone needs or wants the calls , she said .
While the program has captured interest among internists and family medicine doctors , it has also paid out hundreds of
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thousands of dollars to specialists , such as those in cardiology , urology , and gastroenterology , the KFF Health News analysis found . Primary care doctors are often seen as the ones who coordinate patient care , making the payments to specialists notable .
A federally funded study by Mathematica in 2017 found the CCM program saves Medicare $ 74 per patient per month , or $ 888 per patient per year — due mostly to a decreased need for hospital care .
The study quoted providers who were unhappy with attempts to outsource CCM work . “ Third-party companies out there turn this into a racket ,” the study cited one physician as saying , noting companies employ nurses who don ’ t know patients .
Nancy McCall , a Mathematica researcher who co-authored the 2017 study , said doctors are not the only resistance point . “ Patients may not want to be bothered or asked if they are exercising or losing weight or watching their salt intake ,” she said .
Still , some physician groups say it ’ s convenient to outsource the program .
UnityPoint Health , a large integrated health system based in Iowa , tried doing chronic care management on its own , but found it administratively burdensome , said Dawn Welling , the UnityPoint Clinic ’ s chief nursing officer .
For the past year , it has contracted with a Miami-based company , HealthSnap , to enroll patients , have its nurses make check-in calls each
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month , and help with billing . HealthSnap helps manage care for over 16,000 of UnityHealth ’ s Medicare patients — a small fraction of its Medicare patients , which includes those enrolled in Medicare Advantage .
Some doctors were anxious about sharing patient records and viewed the program as a sign they weren ’ t doing enough for patients , Welling said . But she said the program has been helpful , particularly to many enrollees who are isolated and need help changing their diet and other behaviors to improve health .
“ These are patients who call the clinic regularly and have needs , but not always clinical needs ,” Welling said .
Samson Magid , CEO of HealthSnap , said more doctors have started participating in the CCM program since Medicare increased pay in 2022 for 20 minutes of work , to $ 62 from $ 41 , and added billing codes for additional time .
To help ensure patients pick up the phone , caller ID shows HealthSnap calls as coming from their doctor ’ s office , not from wherever the company ’ s nurse might be located . The company also hires nurses from different regions so they may speak with dialects similar to those of the patients they work with , Magid said .
He said some enrollees have been in the program for three years and many could stay enrolled for life — which means they can bill patients and Medicare long-term .
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