Small prac­tices need al­lies

Modern Healthcare - - NEWS - —Howard Wolin­sky

Dr. Joe Sch­lecht started out as a coun­try os­teo­pathic physi­cian 43 years ago in the small town of Jenks, Okla. To­day, he runs a two-doc­tor pri­mary-care prac­tice in what has be­come a fast-grow­ing sub­urb of Tulsa.

Sch­lecht isn’t afraid of MACRA, al­though he knows the de­sign of the new Medi­care pay­ment sys­tem will be chal­leng­ing for small prac­tices like his. “Most pri­mary-care physi­cians are still prac­tic­ing like they did 10 years ago. They don’t even know how to spell MACRA,” he said.

MACRA will pro­vide tech­ni­cal as­sis­tance to el­i­gi­ble pro­fes­sion­als in small prac­tices and to prac­tices in health pro­fes­sional short­age ar­eas. MACRA has al­lo­cated $20 mil­lion a year from fis­cal 2016 through 2020 for this as­sis­tance.

Sch­lecht thinks his group, which is af­fil­i­ated with the 70-mem­ber mul­tispe­cialty War­ren Clinic in Tulsa, and other small prac­tices, even in ru­ral ar­eas, can come out on top with MACRA.

He has con­fi­dence be­cause his group ben­e­fited from par­tic­i­pat­ing in Medi­care’s ex­per­i­men­tal Com­pre­hen­sive Pri­mary Care ini­tia­tive of­fer­ing pop­u­la­tion-based care-man­age­ment fees and shared-sav­ings op­por­tu­ni­ties to par­tic­i­pat­ing pri­mary-care prac­tices. Sim­i­lar pop­u­la­tion-based in­cen­tives will be of­fered through MACRA.

“Most pri­mary-care physi­cians are still prac­tic­ing like they did 10 years ago. They don’t even know how to spell MACRA.” Dr. Joe Sch­lecht

Sch­lecht said a key to suc­cess is hir­ing a care guid­ance nurse, whose sole job is to mon­i­tor the qual­ity out­comes of pa­tients. He said his group’s nurse has de­vel­oped reg­istries of pa­tients with con­di­tions such as di­a­betes and chronic ob­struc­tive pul­monary dis­ease so the nurse can fol­low them and en­sure they re­ceive rec­om­mended care. The nurse also tracks pa­tients as they tran­si­tion from hos­pi­tals into other set­tings.

Sch­lecht said this pop­u­la­tion man­age­ment ap­proach doc­u­mented im­proved care of his pa­tients and re­sulted in mod­est in­creases in re­im­burse­ment. “Pay­ment has pretty well cov­ered the cost of us putting the care guid­ance nurse in place and the in­fra­struc­ture to sup­port her,” he said.

The CMS said it will pro­vide ac­com­mo­da­tions to small prac­tices and those in ru­ral ar­eas. For ex­am­ple, clin­i­cians with 100 or fewer Medi­care pa­tients and no more than $10,000 in Medi­care charges would be ex­cluded from the Merit-based In­cen­tive Pay­ment Sys­tem’s pay ad­just­ment.

Sch­lecht ex­pects many small prac­tices in ru­ral ar­eas and small towns to “vir­tu­ally in­te­grate” with larger prac­tices, such as War­ren Clinic.

“Our group is al­ready go­ing to some of the ru­ral prac­tices to try to strike deals. We will sup­ply to them, for a rea­son­able cost, the elec­tronic health record. We will sup­ply to them a care guid­ance nurse, who would work with two or three prac­tices. That is where I think the fu­ture for the small ru­ral prac­tice is go­ing to be,” Sch­lecht said.

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