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Dr Sharaf Case Study - CCM Revenue

GatewayMD specializes in the world of chronic disease management, particularly remote patient monitoring (RPM). Given the new rules and reimbursement rates for chronic care management (CCM) services, which is a similar service to RPM, GatewayMD has seen a drastic uptake in CCM programs. So much that 83% of GatewayMD’s clients now offer both CCM and RPM to their patients enrolled in their telehealth programs.

In essence, both RPM and CCM set out to achieve a common goal: to remotely manage a patient’s chronic condition, keeping them healthy between office visits and out of the hospital. These chronic conditions include, but not limited to, hypertension, diabetes, CHF and obesity.

Where they differ stems from the Centers for Medicare & Medicaid Services (CMS) requirements regarding patient qualification and patient interaction. Although very similar programs, GatewayMD’s Chief Executive Officer, Milan Nesic, has outlined 3 main differentiators. “CCM requires the patient to have at least two chronic conditions, as opposed to RPM where the patient may be enrolled with only one. Another would be that the supervising physician must create a care plan for the patient under CCM, which is an easy process that GatewayMD helps with. Lastly, RPM incorporates biometric data from the patient that automatically transmits to their clinical team, whereas CCM does not require such data.”

So, what are the benefits of running both RPM and CCM programs simultaneously? From a clinical outcome standpoint, the patient gets twice as much time with a clinical provider each month. This results in more patient transparency, support, data, and confidence. There is also financial value for the patient and provider as well. For clinicians, this means billing CPT codes for both RPM and CCM that result in more revenue per patient per month. Patients also enjoy the costs savings from optimizing office visit frequencies, reduced wait times and urgent care visits.

This case study looks at one of GatewayMD’s partners, Dr Sharaf, out of Sugar Land Texas and the financial impact of adding CCM in adjunct with their RPM telehealth program. Dr Sharaf had started her RPM program June of 2021. In Dec 2021, Dr Hirani added CCM to her telehealth program.

As of 2022, CMS has changed the reimbursement rate for CPT code 99490 (non-complex CCM is a 20-minute timed service provided by clinical staff) from $42 to $62 per patient per month. When looking at profitability per patient per month we need to consider all factors such as expenses, secondary insurance plans, and operating costs from what is collected. With these costs considered, Dr Sharaf has reported profits of $28 per patient per month for each patient enrolled into her CCM program.

Figure 1.1 illustrate the increase in revenue for Dr Sharaf by adding CCM to her RPM program.

It is also important to note the limitations of adding CCM to their telehealth program as well. CCM is more sensitive to patient engagement given the interactive component must be completed via live-synchronous patient communication resulting in lower completion rates compared to RPM.

Dr Sharaf was able to generate an additional $10,926 of profit over a six-month period. Over the six months, Dr Sharaf has also reported no change in overall workload to her telehealth initiatives after adding CCM.

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