Gut issues are on the rise in the U.S., impacting an estimated 60 to 70 million Americans. According to research conducted by the American Gastroenterological Association (AGA), 40 percent of Americans put off daily activities due to bowel issues. However, a third of those individuals say they’re hesitant to discuss the issues with their physician unless the physician brings it up first.
Individuals put off talking to physicians about their gut issues for many reasons, often due to fear of invasive tests like colonoscopies or esophagogastroduodenoscopies. However, because gut issues can be related to other, often more serious, health issues, early detection is critical. Because of the chronic nature of many gut issues, successful outcomes depend on a physician’s ability to extend care beyond the traditional annual exam.
Challenges of Chronic GI Care
Patients with chronic gut issues typically require more—and more complex—care than those with other types of chronic conditions. Many, such as those with inflammatory bowel disease (IBD), also face a higher risk of being hospitalized, which can increase the cost of care and negatively impact outcomes. Enrolling these patients in a chronic care management (CCM) program is a proven way to improve outcomes and reduce costs.
Many GI physicians are hesitant to implement a CCM program because of the extra time it requires for documentation, tracking minutes and special end-of-month billing. Because of ongoing staffing shortages, they may also feel they don’t have the time or clinical staff necessary to deliver the level of attention that chronic care patients need to manage their conditions effectively. As is the case with many GI practices, they may also have a long waiting list for patients to get appointments. This can make it difficult to add the additional appointments required for patients in those programs.
The good news is that there are proven strategies GI physicians can implement to make managing a chronic care program easier and more effective.
Optimize Chronic Care Management Codes
Although CCM programs require extra billing effort, the time spent is well worth it, especially in the era of value-based care, where physicians are compensated based on outcomes. In fact, federal data show that around “4,500 physicians received at least $100,000 each in CCM pay in 2021.”
To be accurately reimbursed, physicians must understand CCM codes and when to use them. The Centers for Medicare and Medicaid Services has prepared an in-depth booklet that covers all CCM codes and how and when they can be used, along with changes for 2024. The booklet also provides an overview of patient eligibility, what types of facilities can participate and what type of clinicians can provide care and be reimbursed.
Avoid Workflow Disruption
Lifestyle modification is a vital component of CCM, yet it’s difficult to adequately cover this topic in just one or two 15-minute exams once or twice a year. To be truly engaged, patients must have more frequent in-depth conversations about how to make healthier, more informed decisions about their health. Doing so can help improve care plans and medication adherence, which are critical to successful outcomes. The challenge is how to provide this extra care without interrupting existing workflows.
The good news is that much of the care required in a CCM program can be provided by clinicians other than the GI physician. For example, the initial visit can be with a physician assistant (PA), and nurses, care management representatives, social workers, dieticians or other clinicians can manage the ongoing appointments, documentation and casework. This helps ensure the program’s success without disrupting existing workflows or adding more stress to GI physicians.
Enhance Patient Education and Communication
For GI physicians to be reimbursed for care provided to patients in a CCM program, insurance companies require that patients opt-in. This means GI physicians need to educate their patients about the program, what it entails and what is expected of them in terms of financial responsibilities and commitment to follow the program, attend all appointments, etc.
At GI Alliance, our patients enrolled in our CCM program receive an initial two-hour phone call with one of our PAs. During this call, patients are educated about their condition, how it progresses and the long-term implications of not managing their disease appropriately. We share how the program works and talk about the importance of sticking with their treatment plan. We also discuss the importance of lifestyle changes and how we will provide the tools they need to be successful.
Create Multidisciplinary Care Teams
The most effective CCM programs are those in which CCM clinicians work as a multidisciplinary case management team to ensure patients have the necessary resources to achieve adherence. This includes identifying financial, environmental or other barriers that can impede a patient’s ability to follow their care plan. By using these codes, our metabolic-associated fatty liver disease, metabolic-associated steatohepatitis and IBD patients gain access to nutritionists, dietitians, social workers and other care coordinators within a structured CCM program—services that health insurance typically doesn’t cover outside of chronic care codes. For example, if patients cannot afford their medications, the care team can provide coupons or identify other resources to help. If patients lack reliable transportation to get to their appointments, the care team can work with community resources to find ride services available to patients at low or no cost.
Stay Informed
The increasing number of individuals with GI issues and the complexity of providing that care have made the role of the GI physician more vital—and stressful—than ever. Today, the number of pharmaceutical therapies available to patients has escalated, which is great news for patients but can make staying on top of those new therapies challenging for physicians. The best approach to staying informed is by participating in ongoing educational programs like those offered through ASGE. These programs not only provide GI physicians with new information and tools to apply to their patients, but they also provide them with opportunities to collaborate and connect with their peers.
Getting Started
Although research shows that chronic care management can reduce hospitalizations and ER visits, just 4 percent of those eligible for the program are enrolled. GI physicians can change this trend by implementing a CCM program for eligible patients. Through patient education, optimizing CCM codes, avoiding workflow disruptions, embracing a multidisciplinary approach and staying on top of the latest advancements, GI physicians can make a significant impact on their patients’ lives while also improving the financial health of their practice.
Timothy Ritter, MD, FASGE, is the senior medical research director of GI Alliance and senior medical director of the Department of Research and Education and assistant professor of medicine at Texas Christian University School of Medicine.