Wiki chronic care management

[Dorthi]

I have a question on doing the CCM. We are part of an ACO and they are doing our CCM for our patients. They are telling our providers that some of our patients are too sick to be part of CCM. I do not think they can be too sick for that from what I am reading. Does anyone else know?


Also we are being told that we have patients that are too sick to be part of the ACO. Who makes that decision? Medicare or the ACO?

 

[thomas7331]

It's not all clear to me what is meant by a patient being 'too sick' for a particular kind of service. As far as being a part of the ACO, it's possible that they mean that the patients who are sicker may fall into 'high risk' category and will have a higher cost of care, and thereby may not qualify for participation under the terms of a particular cost management or shared savings program - this could be behind what they are saying to the providers, but I'm really just guessing. It's hard to know what exactly they are meaning or why, and I think you'll need to ask the people who are telling the providers this to give you morning information.