Beginning in 2015, CMS has placed an emphasis on improving the quality of care and outcomes by instituting care management programs. Principal Care Management (PCM), a sibling of Chronic Care Management (CCM), was introduced by CMS in 2020 as a tool for specialty providers, such as oncologists, to use to help patients and providers better manage care in between visits for those patients with a high-risk or chronic condition. Recognizing that care management requires provider and clinic staff time and resources, CMS adopted CPT codes to reimburse clinics for their efforts and time.
Like CCM, PCM focuses on managing patient care outside physical appointments and routing services between appointments. This includes patient follow-up in the form of medication management or even reviewing a patient’s after-visit summary with them so they can better understand their care plan. PCM activities involve a range of common services you currently provide today, including follow-up after hospital visits, referral coordination, management of transitions of care, revising care plans, and assisting with the receipt of preventative services.
Why is this important? Many clinics, including in particular oncology clinics, are looking at ways to fill the gap in reimbursement payments when the Oncology Care Model (OCM) sunsets in June 2022. Luckily both PCM and CCM are two programs that continue to encourage the care management model adopted by OCM and recognize the need to compensate providers for these additional services.