Why Outsourcing CCM is a Very Bad Idea for Doctors

You should outsource your patient care to a third party that you’ll never meet, who doesn’t know your patients, and might not even be licensed in your state,” recommended no one, ever.  In MBA speak, caring for your chronic patients is delivering your “core competency” to your “core clientele,” and outsourcing your core competency is disparaged by virtually every management expert for good reasons including losing connection with your clients (patients), losing control of the product (the care your patients receive), and damage to your brand (your reputation).  Here are some more specific and appropriate risks to think about before outsourcing CCM.

  1. Risk Management. Outsourcing may sound easy on the front end, but it is very hard to mitigate your risks on the back end. Medicare fraud violations cost up to $10,000 per incident and may even subject you to jail time. [1]  By outsourcing your CCM services, you are contractually accepting and bound to the fact that the vendor is performing “incident to” your supervision which makes you actively and directly responsible for multiple risk factors:
    1. Is the person performing the work appropriately credentialed to work in your state (especially nursing-staffed call centers)? Have you taken active steps to confirm this is so?
    2. Were all of the services billed for on the claims actually performed? Have you actively performed spot checks to ensure same?
    3. Are you periodically checking that the documentation you receive for these claims and services is actually legitimate?
    4. Are your patients’ privacy and HIPAA rights being protected? Do you even know how to ensure you’re being told the truth about this?
    5. Are you provided audit logs to protect you if you’re audited? How often do you receive audit logs? Have you verified their accuracy?
    6. Never Forget – an outsourced CCM vendor is paid on the volume while you hold 100% of the risk. At a minimum, this creates misaligned incentives and requires your perpetual and diligent oversight.
  2. Costs. Third party vendors may take from half up to two-thirds of the CCM reimbursement, leaving you with the expense of collecting the deductible.  When these added expenses are taken out of your payment, you may net only make $7 to $12 per patient. In addition to paying the third party, you also have the labor cost of filing the claim, paying the clearinghouse and your biller, and collecting an $8 co-pay. At some point, it stops making sense right?
  3. Added Value or Not. Carefully consider the impact of the outsourced product. What added value that can be measured does it contribute to patient care?  Many outsourcing vendors were niche software companies that became “CCM” vendors by bolting on a timer and call center when Medicare launched the new reimbursement.  If you’re reading this, you already know that’s not going to cut it when the auditor comes calling.  Ensure the CCM services you’re getting reimbursed for deliver value that can be directly measured in terms of improved patient engagement, outcomes, and better care.

Let us show you how to achieve success with CCM and keep your revenue!

[1] http://www.federalcharges.com/medicare-fraud-charges-penalties/