Medicare's Care Management Codes Might Not Support Primary Care As Expected

• Published in: Health affairs (Millwood, Va.) Va.), 2020-05, Vol.39 (5), p.828-12
• Main Authors: Agarwal, Sumit D, Barnett, Michael L, Souza, Jeffrey, Landon, Bruce E
• Format: Article
• Language: English
• Subjects: Accountable care organizations; Beneficiaries; Charges; Chronic illnesses; Claims; Codes; Compensation; Dual enrollment; Enrollments; Family income; Health care management; Management; Medicaid; Medical practices; Medicare; Patients; Physicians; Primary care; Services
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2019.00329

To enhance compensation for primary care activities that occur outside of face-to-face visits, the Centers for Medicare and Medicaid Services recently introduced new billing codes for transitional care management (TCM) and chronic care management (CCM) services. Overall, rates of adoption of these codes have been low. To understand the patterns of adoption, we compared characteristics of the practices that billed for these services to those of the practices that did not and determined the extent to which a practice other than the beneficiary's usual primary care practice billed for the services. Larger practices and those using other novel billing codes were more likely to adopt TCM or CCM. Over a fifth of all TCM claims and nearly a quarter of all CCM claims were billed by a practice that was not the beneficiary's assigned primary care practice. Our results raise concerns about whether these codes are supporting primary care as originally expected.