Part 2 of a 2-part series (See ISMA e-Reports for Part 1 of this series.)
The physician experience
While David Rau, M.D., had started improving processes at Rau Family Medicine through meaningful use of his electronic health record (EHR) and information on the American Academy of Family Physicians website, the TransforMED project to create a patient-centered medical neighborhood (PCMN) accelerated change for him.
“It encourages us to improve our health system and our own offices through alignment and collaborative integration,” he said. Previously, practices had no organized way to measure the patient experience. Now, they have a patient survey and process improvement to address the results.
Dr. Rau is motivated by his belief that quality of care and best practices must be number one. ”We saw lots of opportunities to improve our IT systems,” he said.
Number two is to learn where you are dependent on information. “If hospitals and ERs are doing testing for your patients, having good relationships with those testing sites to assure timely data is a big benefit,” Dr. Rau said.
|David Rau, M.D., says their patient-centered medical neighborhood project requires “a critical commitment to chronic disease management.”
The medical neighborhood involves changing the way primary care and specialty care are connected in a community. Improving access to care, practices determined how many same-day appointments they should allow to meet patient needs and held open that number of appointments each day.
|VHA, TransforMED and Phytel project that their combined work across the 16 communities in the project will drive better quality and a superior patient experience at a more affordable cost, potentially saving Medicare as much as $53 million over a three-year period.
“We are just beginning our PCMH/PCMN journey and are still learning,” said Tracy Salinas, M.D., with Doctors Park Family Medicine. “But we have experienced improvement in same-day access, patient satisfaction, care coordination, population management and self-support.”
Improving transitions in care will be a big goal for year three when service agreements will become standard between primary and specialty care practices. The primary care doctor will commit to taking certain steps when referring patients, and the specialist will commit to follow up and collaboration.
Physicians do recognize value in the patient-centered medical home (PCMH) model, but it is not painless, said Joseph Sheehy, M.D., chief medical officer of Columbus Regional Health Physicians. Though he noted the improvement in processes, he said, “NCQA certification requires a lot of documentation – some good and some not so good.”
Dr. Salinas concurred. “It’s not easy work,” she said. However, if you want to be a PCMH but not achieve NCQA certification, you can pick and choose what processes to adopt.
She acknowledged an increase in workload for both physicians and staff, but also noted, ”All seem to realize PCMH is resulting in better health outcomes and a better experience for our patients.”
Concerns about the future
There’s agreement that implementing or sustaining the PCMH/PCMN models requires systems support. “It has to be supported with both services and expertise,” noted Dr. Rau. The Columbus physicians have relied on TransforMED and Phytel, but it’s unclear whether they will have the resources to continue after the grant runs out next year.
Dr. Sheehy said lack of reimbursement is a major complaint and an obstacle to growth. “Most find lots of usefulness in PCMH, but no one is happy with the reimbursement to pay for the activity.”
The health care system is evolving from fee-for-service to value-based pay, but the compensation formula is not changing as quickly as the physician practices. “A major insurer is now paying $2 to $3 per member per month,” said Dr. Sheehy. ”That is inadequate but it’s a start.”
Dr. Rau said he is working harder but reimbursement continues to be a growing concern. “With our current compensation system, I find it difficult to foresee how what we are doing with PCMH will result in securing an appropriate paycheck.”
Anthem value-based pay agreements focus on preventative care to cut costs
Anthem announced in April that it had contracted with 1,400 physicians from 38 practices – 28 percent of the primary care doctors in Indiana – to work under its new value-based arrangement called the Enhanced Personal Care initiative.
The arrangement is intended to promote patient-centered care and offer doctors two ways to earn revenue:
- Monthly payment for care coordination
- Annual shared savings payments
Practices must meet quality performance goals. Over time, Anthem estimates the program will improve quality and health while also improving medical costs as practices transform to better manage the health of patient populations.