A personal perspective from Dr. Craig

William E. Craig, MD — Founder of CraigCare

As a practicing cardiologist for the past forty years, I have seen considerable evolution in the practice of cardiology. There have been significant improvements in the surgical and catheterization laboratory procedures available to patients with acute cardiac problems, and new medications and treatment regimens have been shown to improve quality of life and slow the progression of disease when used appropriately. As a result, the practice of cardiology has become far more focused on the prevention and monitoring of chronic disease.

Cardiologists are no longer just managing acute heart problems. Appropriate management and prevention therapy for patients with chronic heart problems requires proactive and timely assessment and adjustment of treatment. For that reason, cardiologists often see these patients more frequently than their primary care physician does.

Effective management and prevention therapy for these patients requires the cardiologist and the office staff to spend considerable time outside of office visits collecting, assessing, and acting on information about patients. Test results and outside records must be obtained and reviewed, coordination with the patient’s other physicians is required, and medication changes and new prescriptions must be coordinated with the patient’s insurance company and pharmacy. Phone calls from patients often require staff to consult the physician about whether a medication change or further evaluation is needed. Reimbursement from office visits is not sufficient to cover the cost of these activities, which are now essential to effectively managing cardiology patients with chronic disease.

The advent of Chronic Care Management (CCM) billing codes, first instituted by CMS, gave cardiology practices a way to be reimbursed for these out-of-office activities. Over the years, CMS has gradually added codes and increased reimbursement as it has recognized the value of this work. But documenting the time spent and handling the monthly billing can be a cumbersome, time-consuming process.

I looked closely at the vendors who offered to take this off our hands, and I did not like what I found. The call-center services wanted half or more of the revenue to put my patients on the phone with people who had never met them. The software-only options handed us a login and left my staff to figure out the rest. Neither reflected the kind of care I wanted my patients to receive. So we decided to build our own.

Over the years, my practice developed a very efficient way to document the time the physician and staff spend managing these patients. The software we built makes it simple to capture that time, to develop and maintain each patient’s care plan as CMS requires, and to document the monthly calls that check in on how each patient is doing against the goals of that plan. When a call surfaces a problem that needs the physician’s attention, the system flags it and tracks it until it is resolved — so nothing falls through the cracks, and the program provides real outcome monitoring along the way.

What began as a way to better care for my own patients became CraigCare: a complete program — software, care plans, training, and compliance — that we now make available to other practices. It is fully compliant with CMS guidelines, but compliance was never the point. The point was, and still is, better care for patients with chronic disease, delivered by the people who know them best: their own physician and staff.

William E. Craig, MD Founder, CraigCare