Published by National Pain Report

As of April 2, 2018, the Center for Medicare Services has adopted modifications to its program requirements for prescribing of opiate medications in the Part D pharmacy program, implementing the recommendations generated by the Center for Disease Control (Guidelines for Chronic Pain, March 16, 2016). In Part I, I introduced definitions related to this rule change.

What exactly are multiple chronic conditions (MCC) according to the Medicare program?

Medicare tracks hundreds of health conditions that reflect various levels of chronicity. Beneficiaries may have more than one of these chronic conditions listed alone or in combination with other chronic diseases. Some of these conditions are known to occur together. A Medicare beneficiary is considered to have a chronic condition if the CMS administrative data have a claim indicating that the beneficiary received a service or treatment for a specific condition identified in the Medicare Handbook of Diagnosis Review Groups (DRG).

Hundreds of diseases are tracked within this system, but the 19 most frequently billed chronic conditions are tracked through Medicare administrative claims. Data collected about all conditions is collected as administrative data that has important limitations – in particular, their principal clinical insight comes from ICD-10 diagnostic and associated CPT codes that frequently reflect insufficient attention to case development, are of questionable accuracy, completeness, clinical scope, and meaningfulness. This is a limitation of construction of electronic health records systems which yields primarily ‘count’ or frequency data.