do you have the right population of patients with two or more chronic medical problems? The more you have, the more it makes sense,” he said. “The challenge is crystallizing these haphazard and irregular activities into a streamlined process that can be documented to justify it to CMS.” The financial rewards likely would
offset the cost of an EHR upgrade or new personnel, he adds. Even for a larger system like ADC, “we are in- vesting a significant amount of money to get this to take off. But we estimate that if 6 percent of our patients have two or more medical problems, the system will generate enough money to cover the cost. Financially, it may be nil to the clinic, but it will be positive to the physician and the patient, and that’s still a very reasonable business case.”
“It’s important for all payers to realize that physicians are the most efficient means to engage patients and promote the behavior change we all want to see.”
BOON OR BUST? Within a few months of implement- ing the CCM program, Southwest Provider Partners ACO has seen tan- gible improvements and efficiencies in care that also helped further the group’s goal of generating additional shared savings for participating phy- sicians, says the ACO’s Director of Quality Improvement Gurneet Kohli, MD. “When I heard about this pro- gram, I was ecstatic. At the end of the day, doctors felt like they were getting the short end of the stick. This is defi- nitely a step in the right direction for CMS to see the value in this work.” The Austin internist says the hard
part for physicians was not identifying eligible patients, enrolling them, and creating a clinical care plan; it is really tracking the time spent on non-face- to-face interventions and ensuring the necessary monthly follow-up. For that, they enlisted the ACO’s care coordina- tors and Innovista’s population health management tool. Regular communication with pa-
tients has since helped pinpoint im- portant health and social issues that normally don’t come up in a face-to- face visit.
48 TEXAS MEDICINE September 2015
Until a nurse called, one of Dr.
Kohli’s patients never mentioned her medication was causing her diarrhea because she didn’t want to bother the doctor. The practice adjusted the dose. Other times, he had no idea why patients didn’t show up for appoint- ments until care coordinators discov- ered they didn’t have transportation because a family member got stuck at work.
“These are such small things for
us, but such big things for the pa- tient. And we are moving beyond just measuring blood sugar or cholesterol levels to things that quality measures don’t measure,” Dr. Kohli said. When it came to getting patients
on board, “most said it’s about time [Medicare] did this,” he added. With two or more chronic conditions, most patients easily meet their annual Medicare deductible, and their sec- ondary insurance kicks in to cover the $8 copay. “I had a wife who enrolled, but her husband was more ‘wait-and see.’ Two weeks later, I got a message he was so happy with the service provided to his wife, he wanted to join, too,” Dr. Kohli said. “We have higher patient satisfac- tion and retention, and this could be a competitive selling point for a practice. The more positive results I got, the more strongly I could advocate for the next batch of patients to enroll.” Convincing patients of the pro-
gram’s benefits was not so easy for Athens family physician Douglas W. Curran, MD. The TMA Board of Trustees chair was “very optimistic” when he heard about the program, but what he described as “busy-work, not patient care work,” quickly turned that optimism into “overwhelming burden.” His 14-physician group already has
an EHR system but found it lacked the capabilities to fulfill the CCM pro- gram’s documentation requirements. “We do 20 to 40 medication refills a
day. We’re keeping patients out of the hospital, and we know the ones who follow the rules and the ones who
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68