Physi­cian Per­son­als: Spe­cialty group seeks pri­mary-care prac­tice

Modern Healthcare - - NEWS -

for The sin­gle life may prove trou­ble­some spe­cialty group prac­tices un­der MACRA.

David Fitzger­ald, CEO of Pro­liance Sur­geons in sub­ur­ban Seat­tle, said spe­cialty prac­tices are in the dark about their fate un­der the new physi­cian re­im­burse­ment sys­tem.

Things are clearer for pri­mary-care prac­tices in de­ter­min­ing costs and qual­ity in­volv­ing care for Medi­care pa­tients, he said. But spe­cialty prac­tices like his, which has 420 providers and gen­er­ates $400 mil­lion an­nu­ally in rev­enue, will have to wait un­til the CMS re­leases its fi­nal reg­u­la­tions in Novem­ber.

The un­cer­tainty could forge greater al­liances be­tween the two worlds.

Pro­liance, where 25% of its pa­tients and 17% of its rev­enue come from Medi­care, has had some ex­pe­ri­ence with Medi­care’s Bun­dled Pay­ments for Care Im­prove­ment ini­tia­tive, which re­quired the group to put some rev­enue at risk. Start­ing about a year ago, Pro­liance opted in for di­ag­nos­tic-re­lated groups for or­tho­pe­dic surgery and ig­nored those for gen­eral surgery, where it has small vol­ume.

It’s worked out well so far, Fitzger­ald said. In the first quar­ter, Pro­liance saved Medi­care about $400,000, yield­ing a $22,000 bonus. “It isn’t a nee­dle mover for us yet. We’re hop­ing MACRA moves the nee­dle more for us,” he said.

He said that spe­cialty groups and pri­mary-care groups will need to im­prove care co­or­di­na­tion with hos­pi­tals and skilled-nurs­ing fa­cil­i­ties be­cause of MACRA. In the past, Pro­liance didn’t know to­tal costs of care for an episode and didn’t nec­es­sar­ily know if a pa­tient had been read­mit­ted later.

Fitzger­ald said a ma­jor is­sue fac­ing spe­cialty groups is co­or­di­nat­ing in­for­ma­tion with pri­ma­rycare groups, which use a raft of elec­tronic health record man­age­ment sys­tems that don’t talk to each other. “MACRA is forc­ing us to fo­cus on the pa­tient, which is the right way to be, but right now we are op­er­at­ing nine dif­fer­ent elec­tronic health records,” he said.

He said his group is con­tem­plat­ing “a data ware­house ap­proach” that will en­able it to deal with mul­ti­ple med­i­cal record sys­tems to com­pile data it needs for MACRA on costs and qual­ity.

Fitzger­ald said his group aims to be in the bet­ter-com­pen­sated Al­ter­na­tive Pay­ment Model groups un­der MACRA. He noted, how­ever, that a spe­cialty group al­most by def­i­ni­tion can­not man­age pop­u­la­tions like an ac­count­able care or­ga­ni­za­tion.

Pro­liance’s strat­egy is to team up with pri­ma­rycare groups to man­age pop­u­la­tions. “MACRA has helped us open those doors,” he said. —Howard Wolin­sky

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