Crain’s Health Pulse October 2, 2014 LINK An investment group of hospitals have acquired a 50% stake in Beacon Health Partners, an independent physician association based in Westbury, L.I. Catholic Health Services and St. John’s Episcopal Hospital agreed yesterday to buy half of Beacon, which has 400 doctors. Beacon participates in the Medicare Shared Savings…Details
The dust has settled and we can now fully and fairly reflect on our first performance year in the Medicare Shared Savings Program. While the program itself has some warts and there are fingers we could point at CMS for the disappointment of not achieving a shared savings bonus, I see the glass as half-full.…Details
Module 1: Shared Decision Making. CAHPS Practice Improvement initiative by Kelli Mastellon, LCSW
This is our shared savings distribution model for the MSSP and commercial shared savings arrangement.
Recently a thoughtful physician on our Board asked a simple, but profound question…
“What can I do to save money?”
We are participating in shared savings contracts and although raising the bar on the quality of care we provide to our population is a priority, cutting costs and therefore saving money is essential if there is to be any shared savings bonuses to distribute. Moreover, it is the success in our shared savings contracts that will allow us to grow and bring bigger and better opportunities of all sorts for our network.
So, how can a physician impact our savings? I’m glad you asked Dr. L.
Keep patients out of the hospital
Hospital admissions and inpatient costs make up the majority of our total population spend. Anything that can be done to keep patients out of the hospital when it isn’t completely necessary is helpful in terms of our overall cost savings. See our cartoon video on a Population Health dilemma to see the impact.
Once a patient is discharged from the hospital it is important that readmissions are minimized. Therefore, the transition of care from the hospital is crucial period. It is during this time that it is important the patient sees the PCP, medications are reconciled, necessary services are in place and steps are taken to avoid preventable readmissions.
Emergency rooms are expensive. They are also often attached to even more expensive hospitals where the barrier to entry is not always sufficiently high. While undoubtedly there are times when an ED visit is appropriate, I believe we all recognize there is overuse of the ED. In contrast, increased utilization of urgicenters or even better, outpatient physician offices are much cheaper and often preferable alternatives.
Our care management team under the leadership of our CMO, Dr Jacqueline Delmont is here to help coordinate care, services and assist in keeping your patients healthy and out of the hospital. Our care managers are also combing the data we are receiving with analytics to find the high or rising risk patients under your care. Working collaboratively with our team can improve care delivery, identify gaps in care and potential risks that can lead to increase costs. To contact the team our referral form is HERE, our hotline is 516-734-0848 and secure fax 855-825-0848. If there are questions our Director of Care Management is Doreen Tansi, RN (email@example.com)
Increased utilization of network providers is important for many reasons. If we are all rowing in the same directions and incentives are aligned it makes sense to use likeminded Beacon colleagues. The use of out-of-network physicians can be more expensive and can lead to more costly procedures and testing. The increased utilization of Beacon physicians is also a way to support one another towards our shared success. Please see our online directory (updated monthly).
Where a procedure, lab or radiologic study is done can have a profound impact on the bottom line. While we may have preferred vendors in an area, in general free standing, non-hospital based procedures and studies are significantly cheaper. So, if the quality is deemed to be equivalent, please make every effort to use lower cost providers. If there is ever a question about this please contact anyone on the Beacon team.
Although it may seem counterintuitive, go ahead and take us up on it. Please use these high paying office codes. The net effect is positive. Annual wellness visits and transition care codes are important ways to create win-wins. Both of these codes have short term effect of increasing cost, but this is fine. It helps the practice to generate revenue, but the net effect is savings when gaps of care are identified and coordination of care leads to a decrease in hospitalizations or readmissions (for more on these codes please stay tuned for an upcoming coding seminar or visit Yammer for more details).
Patient Centered Medical Home initiative has many advantages to providers and patients. There are efficiencies and reimbursement opportunities for physician practices who embrace the principles of PCMH and gain recognition. We have a dedicated team and resources to help all qualifying practices (for more information please contact Maria Sanchez at firstname.lastname@example.org). We see ourselves as a patient centered organization and embrace the philosophy of PCMH. PCMH is built around coordinating care in a patient centric manner which can lead to decreased hospitalizations and ER utilizations thereby helping our efforts to decrease our per capita cost.
In this era of population health as we strive to manage our sickest (most expensive) patients, it is important to keep our healthiest (least expensive) patients active and engaged. Reaching out to these patients allows a practice to generate revenue and offer preventive or wellness opportunities to patients. In addition to the benefits to the practice, there are organizational benefits as well. Maintaining the attribution of these lower cost patients to our population pool acts to depress our overall spend while we deliver high quality care.
It is an extraordinarily exciting time in healthcare. Sure there is some uncertainty, but there is also plenty of opportunity. We strive to be leaders in providing the highest quality care, improving the patient experience and as detailed above, there are several ways everyone can help to decrease the cost of caring for a population. Working together to maximize our current and future value-based contracts is unquestionably in our collective best interest. We are just getting started and don’t have all the answers, but if we are all moving in same direction we will surely succeed with bigger shared savings bonuses and opportunities for all.