Table 1.
Overview of TCM and CCM, 2013–2016 a
| TCM |
CCM |
|||||
|---|---|---|---|---|---|---|
| 2013 (N = 7,091,497 beneficiaries) b |
2014 (N = 7,138,660 beneficiaries) b |
2015 (N = 7,142,939 beneficiaries) b |
2016 (N = 7,215,112 beneficiaries) b |
2015 (N = 7,142,939 beneficiaries) b |
2016 (N = 7,215,112 beneficiaries) b |
|
| Beneficiary level characteristics | ||||||
| Number of potentially eligible beneficiaries c | 1,598,735 | 1,583,548 | 1,612,787 | 1,625,918 | 4,691,046 | 4,746,154 |
| Total number of TCM or CCM claims d | 78,703 | 105,864 | 138,574 | 181,900 | 190,767 | 474,192 |
| Number of beneficiaries who received TCM or CCM (% of eligible, [95% CI])d | 58,909 (3.7%, [3.7%−3.7%]) |
89,194 (5.6%, [5.6%−5.7%]) |
115,888 (7.2%, [7.1%−7.2%]) |
151,298 (9.3%, [9.3%−9.4%]) |
56,875 (1.2%, [1.2%−1.2%]) |
110,197 (2.3%, [2.3%−2.3%]) |
| Mean claims per beneficiary (SD) | - | - | - | - | 3.4 (2.7) |
4.3 (3.3) |
| Practice level characteristics | ||||||
| Office-based practices e | ||||||
| Total | 161,159 | 156,631 | 151,901 | 146,069 | 151,901 | 146,069 |
| Number that billed for TCM or CCM (%, [95% CI]) |
8,262 (5.1%, [5.0%−5.2%]) |
8,747 (5.6%, [5.5%−5.7%]) |
9,787 (6.4%, [6.3%6.6%]) |
11,379 (7.8%, [7.7%−7.9%]) |
2,411 (1.6%, [1.5%−1.7%]) |
3,799 (2.6%, [2.5%−2.7%]) |
| Office-based practices with any primary care f |
||||||
| Total | 54,307 | 52,608 | 50,568 | 48,231 | 50.568 | 48,321 |
| Number that billed for TCM or CCM (%, [95% CI]) |
7,649 (14.1%, [13.8%−14.4%]) |
8,041 (15.3%, [15.0%−15.6%]) |
8,984 (17.8%, [17.4%−18.1%]) |
10,384 (21.5%, [21.2%−21.9%]) |
2,139 (4.2%, [4.1%−4.4%]) |
3,347 (6.9%, [6.7%−7.2%]) |
Abbreviation: TCM, transitional care management; CCM, chronic care management
Results based on a 20% random sample of Medicare beneficiaries.
N includes beneficiaries ≥ 18 years of age, without end-stage renal disease, and enrolled in fee-for-service Medicare for at least one month.
Potentially eligible beneficiaries have at least one hospitalization for TCM or at least two chronic conditions for CCM.
Approximately 3–5% of claims and 4–6% of beneficiaries included within these counts did not meet the claims-based eligibility requirements (i.e. hospitalization preceding TCM or at least two chronic diseases for CCM).
Office-based practices were defined as practices with at least five evaluation and management codes.
Office-based practices with any primary care were defined as office-based practices with at least one primary care physician.