Cheri Lattimer is one of most widely recognized leaders in Care Coordination today. Many of Ankota's readers recognize Cheri from her pioneering role as the Chair of the National Transitions of Care Coalition (NTOCC) and Executive Director of the Case Management Society of America (CMSA). This is an exerpt of a recent interview with Cheri about the new care coordination payments enacted by CMS and the opportunities that they present to providers.
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The field of care coordination, which spans the healthcare continuum, took a tremendous leap forward in 2013, when the Centers for Medicare and Medicaid Services (CMS) began reimbursing for care coordination-specific activities, chiefly centered around “transitional care management” performed in post-acute settings.
Two new codes – 99495 and 99496 – now allow physicians and qualified staff to achieve payment incentives for performing post-hospital follow-up services that aim to keep patients safe, on track with discharge plans, and ultimately out of the hospital.
Recently, Case In Point Weekly sat down with Cheri Lattimer, executive director of the Case Management Society of America (CMSA) and project director of the National Transitions of Care Coalition (NTOCC), to gain an industry perspective of these groundbreaking new codes.
According to Lattimer, both CMSA and NTOCC were influential in CMS’ creation of the reimbursement codes, and they will continue to work for the healthcare industry to “go even further” in recognizing – and reimbursing – care coordination pursuits.
In the article below, Lattimer shares her perspective on care coordination, case management and the wider impact on the industry.
Q: What is the significance of the new codes focused on transitions of care?
A: The first thing is to recognize and applaud CMS, because it really is the very first time that they have recognized the need to align the incentives with the services around care coordination and transitions.
It also creates excellent support that it’s just not physicians but physician assistants (PAs) and advanced practice nurses (APNs) that are also able to utilize these codes. And, under those codes, the physicians are able to use nonphysician staff in their offices to be able to provide certain levels of codes.
We just expanded the reach of being able to provide the services, being reimbursed for the services, and the ability to improve the patient communication and care coordination.
Q: What does this mean for the case management community?
A: First, the independent case manager who is not an APN or a PA is not able to bill independently under the code. But the services they provide in the offices definitely are covered under the codes.
Q: How do the new codes relate to other dominant movements within healthcare, such as accountable care organizations and medical home?
A: Between accountable care and the patient-centered medical home, and even focused on reducing hospital readmissions, this focuses in on that transition from the hospital back to the community, to the skilled nursing facility, or into the primary care office. You now have the continuity of being able to share that information, review that information, and follow up on that information based on coding – which is really a significant improvement on what you have seen in the past.
In the past, if a patient was discharged from the hospital, other that [clinicians] were supposed to ensure that documents got somewhere, there really was no follow up – but you need to reconcile the medications, see if the treatment plan has changed, be able to ascertain if there’s a new diagnosis from the hospital stay, etc.
What we’re done is really kind of connected the dots that were somewhat disparate prior to this. We have aligned performance with the payment incentive and we have acknowledged that this is a collaborative effort of the clinical team. It’s just not payment for individuals; it is acknowledging the multidisciplinary team and the ability to be able to support that from multiple directions.
Q: Will the change in post-acute care affect working relationships between post-acute clinicians and acute staff?
A: I would absolutely hope so. Because if both parties do bidirectional sending and receiving and the patient is part of this equation, along with their family caregiver, we are closing many of the gaps that we have seen in the past for having a safe patient and family caregiver transition.
If the collaborative team from the hospital is transitioning appropriately out into the community (to primary care, a specialist, or a skilled nursing facility), and if in receiving that [the post-acute clinical team members] are also following the coordination and attributing those transitional care management services, we not only have provided a better experience fro the patient, we have improved patient safety. And, in fact, the reality is we probably have reduced a hospital readmission because we’re closing the gaps that often are related to that. This isn’t going to work if we don’t have good collaboration.
If you look at the codes and you look at the scope of which those codes actually cover, and then you go back and look at the services that can be provided in a non-face-to-face by a physician or qualified staff, you have to say there’s no way this should not improve.
Q: Why should physicians and staff be happy about these new codes?
A: On the outpatient side, where these codes have the impact and can be charged, many times the argument has been in the past that physicians in private practice, in clinical practice, cannot afford to have those services or have a nurse a case manager provide these services – just because they’re not reimbursed. This kind of shoots an arrow into that argument and there is funding that is available for that and, utilized appropriately, it does allow you to provide those services.
It helps to align not only the performance along with the payment initiative to be able to support the provider and the patients and the family caregivers in this process.
Q: Overall, where do you hope to see the industry go from here?
A: This is a great start, but it’s not far enough. Care coordination occurs at every part of our continuum. It isn’t just from the hospital to the community. It is within every aspect of what patients and family caregivers go through. The more medically complex they are, the more difficult those transitions become.
I applaud CMS and I think we can go even further and with that we can enhance patient safety and the healthcare experience for all of our patients and their family caregivers.
The upcoming webinar, Newsflash: CMS Now Reimbursing for Care Coordination: Everything You Need to Know About the New CMS Codes, will take place Wednesday, March 20, 2013.