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Journal of General Internal Medicine

, Volume 34, Issue 10, pp 2150–2158 | Cite as

Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff

  • Andrew D. CarloEmail author
  • Andrea Corage Baden
  • Rachelle L. McCarty
  • Anna D. H. Ratzliff
Original Research

ABSTRACT

Background

Although collaborative care (CoCM) is an evidence-based and widely adopted model, reimbursement challenges have limited implementation efforts nationwide. In recent years, Medicare and other payers have activated CoCM-specific codes with the primary aim of facilitating financial sustainability.

Objective

To investigate and describe the experiences of early adopters and explorers of Medicare’s CoCM codes.

Design and Participants

Fifteen interviews were conducted between October 2017 and May 2018 with 25 respondents representing 12 health care organizations and 2 payers. Respondents included dually boarded medicine/psychiatry physicians, psychiatrists, primary care physicians (PCPs), psychologists, a registered nurse, administrative staff, and billing staff.

Approach

A semi-structured interview guide was used to address health care organization characteristics, CoCM services, patient consent, CoCM operational components, and CoCM billing processes. All interviews were recorded, transcribed, coded, and analyzed using a content analysis approach conducted jointly by the research team.

Key Results

Successful billing required buy-in from key, interdisciplinary stakeholders. In planning for CoCM billing implementation, several organizations hired licensed clinical social workers (LICSWs) as behavioral health care managers to maximize billing flexibility. Respondents reported a number of consent-related difficulties, but these were not primary barriers. Workflow changes required for billing the CoCM codes (e.g., tracking cumulative treatment minutes, once-monthly code entry) were described as arduous, but also stimulated creative solutions. Since CoCM codes incorporate the work of the psychiatric consultant into one payment to primary care, organizations employed strategies such as inter-departmental ledger transfers. When challenges arose from variations in the local payer mix, some organizations billed CoCM codes exclusively, while others elected to use a mixture of CoCM and traditional fee-for-service (FFS) codes. For most organizations, it was important to demonstrate financial sustainability from the CoCM codes.

Conclusions

With deliberate planning, persistence, and widespread organizational buy-in, successful utilization of newly available FFS CoCM billing codes is achievable.

KEY WORDS

mental health payment policy integrated care collaborative care qualitative research 

Notes

Contributors

None.

Funders

Dr. Carlo, the corresponding author, was supported by an NIH-funded post-doctoral fellowship at the University of Washington entitled “Training Geriatric Mental Health Services Researchers” (NIH project number 6T32MH073553-15).

Compliance with Ethical Standards

All interviews were facilitated by a psychiatrist skilled in interviewing techniques and were audio-recorded and professionally transcribed. No honorarium was provided for study participation. This protocol was reviewed and granted exemption by the University of Washington Human Subjects Division (00003585).

Conflict of Interest

Dr. Ratzliff receives royalties from Wiley. All the remaining authors declare that they do not have a conflict of interest.

References

  1. 1.
    AIMS Center - Advancing Integrated Mental Health Solutions. Collaborative Care - Team Structure. https://aims.uw.edu/collaborative-care/team-structure. Published 2017. Accessed May 23, 2019.
  2. 2.
    Carlo AD, Unützer J, Ratzliff ADH, Cerimele JM. Financing for Collaborative Care—a Narrative Review. Curr Treat Options Psychiatry. July 2018:1–11. doi: https://doi.org/10.1007/s40501-018-0150-4
  3. 3.
    Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems. In: Archer J, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2012:2–4. doi: https://doi.org/10.1002/14651858.CD006525.pub2
  4. 4.
    Cerimele JM, Halperin AC, Spigner C, Ratzliff A, Katon WJ. Collaborative care psychiatrists’ views on treating bipolar disorder in primary care: a qualitative study. Gen Hosp Psychiatry. 2015;36(6):575–580. doi: https://doi.org/10.1016/j.genhosppsych.2014.07.013 CrossRefGoogle Scholar
  5. 5.
    Solberg JJ, Deyo-Svendsen ME, Nylander KR, Bruhl EJ, Heredia D, Angstman KB. Collaborative Care Management Associated With Improved Depression Outcomes in Patients With Personality Disorders, Compared to Usual Primary Care. J Prim Care Community Health. 2018;9:215013271877326. doi: https://doi.org/10.1177/2150132718773266 CrossRefGoogle Scholar
  6. 6.
    Fortney JC, Pyne JM, Kimbrell TA, et al. Telemedicine-based collaborative care for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry. 2015;72(1):58–67. doi: https://doi.org/10.1001/jamapsychiatry.2014.1575 CrossRefPubMedGoogle Scholar
  7. 7.
    Engel CC, Jaycox LH, Freed MC, et al. Centrally Assisted Collaborative Telecare for Posttraumatic Stress Disorder and Depression Among Military Personnel Attending Primary Care: A Randomized Clinical Trial. JAMA Intern Med. 2016;176(7):948. doi: https://doi.org/10.1001/jamainternmed.2016.2402 CrossRefPubMedGoogle Scholar
  8. 8.
    Engel CC, Bray RM, Jaycox LH, et al. Implementing collaborative primary care for depression and posttraumatic stress disorder: Design and sample for a randomized trial in the U.S. military health system. Contemp Clin Trials. 2014;39(2):310–319. doi: https://doi.org/10.1016/j.cct.2014.10.002 CrossRefPubMedGoogle Scholar
  9. 9.
    Huffman JC, Mastromauro CA, Sowden GL, Wittmann C, Rodman R, Januzzi JL. A collaborative care depression management program for cardiac inpatients: depression characteristics and in-hospital outcomes. Psychosomatics. 2011;52(1):26–33. doi: https://doi.org/10.1016/j.psym.2010.11.021 CrossRefPubMedGoogle Scholar
  10. 10.
    Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: Systematic review and meta-analysis. Am J Psychiatry. 2012;169(8):790–804. doi: https://doi.org/10.1176/appi.ajp.2012.11111616 CrossRefPubMedGoogle Scholar
  11. 11.
    Press MJ, Howe R, Schoenbaum M, et al. Medicare Payment for Behavioral Health Integration. N Engl J Med. 2017;376(5):405–407. doi: https://doi.org/10.1056/NEJMp1614134 CrossRefPubMedGoogle Scholar
  12. 12.
    Centers for Medicare and Medicaid Services. Behavioral Health Integration Services. Medicare Learning Network (MLN). https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf. Published 2018. Accessed May 23, 2019.
  13. 13.
    Centers for Medicare & Medicaid Services (CMS). Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017. Federal Register. https://www.govinfo.gov/content/pkg/FR-2016-11-15/pdf/2016-26668.pdf. Published 2016. Accessed May 23, 2019.
  14. 14.
    AIMS Center - Advancing Integrated Mental Health Solutions. Cheat Sheet on Medicare Payments for Behavioral Health Integration Services. https://aims.uw.edu/sites/default/files/CMS_FinalRule_BHI_CheatSheet.pdf. Published 2019. Accessed May 23, 2019.
  15. 15.
    Centers for Medicare & Medicaid Services (CMS). Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program. Federal Register. https://www.gpo.gov/fdsys/pkg/FR-2017-07-21/pdf/2017-14639.pdf. Published 2017. Accessed May 23, 2019.
  16. 16.
    Basu S, Phillips RS, Bitton A, Song Z, Landon BE. Medicare chronic care management payments and financial returns to primary care practices: A modeling study. Ann Intern Med. 2015;163(8):580–588. doi: https://doi.org/10.7326/M14-2677 CrossRefPubMedGoogle Scholar
  17. 17.
    O’Malley AS, Sarwar R, Keith R, Balke P, Ma S, McCall N. Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study. J Gen Intern Med. 2017;(Ccm). doi: https://doi.org/10.1007/s11606-017-4134-7
  18. 18.
    University of Washington AIMS Center. AIMS Center - Advancing Integrated Mental Health Solutions. https://aims.uw.edu. Published 2019. Accessed May 23, 2019.
  19. 19.
    Hsieh H-F, Shannon SE. Three Approaches to Qualitative Content Analysis. Qual Health Res. 2005;15(9):1277–1288. doi: https://doi.org/10.1177/1049732305276687 CrossRefGoogle Scholar
  20. 20.
    Miles MB, Huberman AM, Saldana J. Qualitative Data Analysis. 3rd ed. Los Angeles: SAGE PublicationsSage CA: Los Angeles, CA; 2014.Google Scholar
  21. 21.
    Centers for Medicare & Medicaid Services (CMS). Medicare Program: Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019. https://www.gpo.gov/fdsys/pkg/FR-2018-07-27/pdf/2018-14985.pdf. Published 2018. Accessed May 23, 2019.
  22. 22.
    Basu S, Landon BE, Williams JW, Bitton A, Song Z, Phillips RS. Behavioral Health Integration into Primary Care: a Microsimulation of Financial Implications for Practices. J Gen Intern Med. 2017;32(12):1330–1341. doi: https://doi.org/10.1007/s11606-017-4177-9 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Center for Disease Control (CDC). Suicide Rising Across the US. https://www.cdc.gov/vitalsigns/suicide/index.html. Published 2018. Accessed May 23, 2019.
  24. 24.
    Center for Disease Control (CDC). U.S. Drug Overdose Deaths Continue to Rise; Increase Fueled by Synthetic Opioids. https://www.cdc.gov/media/releases/2018/p0329-drug-overdose-deaths.html. Published 2018. Accessed May 23, 2019.

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Andrew D. Carlo
    • 1
    Email author
  • Andrea Corage Baden
    • 1
  • Rachelle L. McCarty
    • 2
  • Anna D. H. Ratzliff
    • 1
  1. 1.Department of Psychiatry and Behavioral Sciences University of Washington School of MedicineSeattleUSA
  2. 2.Department of Biobehavioral Nursing and Health InformaticsUniversity of Washington School of NursingSeattleUSA

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