What Endocrinologists Can Expect From Obamacare
What Endocrinologists Can Expect From Obamacare
ACOs, which promise to share savings when doctors and hospitals provide efficient, high-quality care, have piqued the interest of endocrinologists.
In 2013, among endocrinologists who participated in the Medscape Compensation Report, 25% said that they were either participating in an ACO or planned to join an ACO in the coming year. That number was 9% in 2012.
"I think for the endocrinologist, an ACO is a great tool to take care of the whole patient," said Ernest Asamoah, MD, who works for Community Health Network in Indianapolis, Indiana, which is currently positioning itself to become an ACO. It's a move he supports.
"Currently, we have siloed healthcare. No one is responsible for the patient. I see them, they get out of my system, and then I don't see them for 6 months," he said. Under an ACO model, "I'm obliged to feel responsible not only for their diabetes, but also for the high blood pressure, their cholesterol, and all that," he said.
In April 2012, Dr. De La Rosa's group, Jackson Purchase Medical Associates, was chosen by the Center for Medicare & Medicaid Innovation to become one of the first Advance Payment ACOs. In a nutshell, Jackson Purchase was given start-up money to hire new staff, upgrade their computer servers, and buy new equipment. The upgrades have helped the group run more efficiently.
"We have cut back on the number of laboratory tests that we duplicate and stuff that gets missed," Dr. De La Rosa said. "We have a system where it flags the treating physician every time a patient comes in. If the patient is due for something, a red flag and prompts you to remind the patient to go to their primary care provider and get it done."
Doctors in the practice can ask each other questions electronically in real time. These messages are given priority when they pop up on the computer tablets used to view patients' records. "If someone asks me, 'Should I do this test or not?' I get a message while I'm looking at my charts, and it's flagged, so I can say, 'No, you don't need to do that test. You can wait 2 weeks.' It saves a lot of time," he said.
Payments are processed more quickly, too. "Our turnaround time for billing is 2 weeks or 10 days," he said. "It used to be that we had to dictate, wait for the dictation to come back, correct it, and send it back. By the time you can drop the bill and send your consult out, it's 4-5 weeks," Dr. De La Rosa added. Now, as soon as he closes out of his notes at the end of the day, the system sends his bill.
Because they volunteered for the first wave of health reform, CMS sweetened the deal. They don't have to pay back any of the money if they don't realize any savings from their efforts. But they do have to collect data, and plenty of it, on the 5000 Medicare patients in their practice. "We are required to meet 80-85 metrics, and Medicare has a requirement to meet about 18 of those in the first year," he said.
Dr. De La Rosa says some of those targets include A1c levels, smoking cessation, immunizations, diabetic foot examinations, and body mass index. It's too early to know whether they have made improvements in care, he said. The first few months of the program just establish a baseline. But once enough data is collected, CMS will send regular reports to let them know how they are doing.
ACOs have to demonstrate a 3% annual cost savings to stay in the program. On the basis of preliminary data, the group seems to be at a 9% savings. If the numbers hold, the government will split the savings 50/50 with the group at the end of the first fiscal year.
Sharing the savings with Medicare is great, but Dr. De La Rosa says Jackson Purchase has its eye on bigger fish. "Our eventual goal is to demonstrate improved care across the board, so that we can take those data to private insurers and show them we're adding value to what we're doing," he said. "We take that data to the Humanas, the Blue Crosses, and everyone else and say, 'Look, we're improving care.' If we're going to negotiate our contract a year or 2 from now, we'll have an upper hand over groups who don't demonstrate better care," he added.
Getting In on an ACO
ACOs, which promise to share savings when doctors and hospitals provide efficient, high-quality care, have piqued the interest of endocrinologists.
In 2013, among endocrinologists who participated in the Medscape Compensation Report, 25% said that they were either participating in an ACO or planned to join an ACO in the coming year. That number was 9% in 2012.
"I think for the endocrinologist, an ACO is a great tool to take care of the whole patient," said Ernest Asamoah, MD, who works for Community Health Network in Indianapolis, Indiana, which is currently positioning itself to become an ACO. It's a move he supports.
"Currently, we have siloed healthcare. No one is responsible for the patient. I see them, they get out of my system, and then I don't see them for 6 months," he said. Under an ACO model, "I'm obliged to feel responsible not only for their diabetes, but also for the high blood pressure, their cholesterol, and all that," he said.
In April 2012, Dr. De La Rosa's group, Jackson Purchase Medical Associates, was chosen by the Center for Medicare & Medicaid Innovation to become one of the first Advance Payment ACOs. In a nutshell, Jackson Purchase was given start-up money to hire new staff, upgrade their computer servers, and buy new equipment. The upgrades have helped the group run more efficiently.
"We have cut back on the number of laboratory tests that we duplicate and stuff that gets missed," Dr. De La Rosa said. "We have a system where it flags the treating physician every time a patient comes in. If the patient is due for something, a red flag and prompts you to remind the patient to go to their primary care provider and get it done."
Doctors in the practice can ask each other questions electronically in real time. These messages are given priority when they pop up on the computer tablets used to view patients' records. "If someone asks me, 'Should I do this test or not?' I get a message while I'm looking at my charts, and it's flagged, so I can say, 'No, you don't need to do that test. You can wait 2 weeks.' It saves a lot of time," he said.
Payments are processed more quickly, too. "Our turnaround time for billing is 2 weeks or 10 days," he said. "It used to be that we had to dictate, wait for the dictation to come back, correct it, and send it back. By the time you can drop the bill and send your consult out, it's 4-5 weeks," Dr. De La Rosa added. Now, as soon as he closes out of his notes at the end of the day, the system sends his bill.
Because they volunteered for the first wave of health reform, CMS sweetened the deal. They don't have to pay back any of the money if they don't realize any savings from their efforts. But they do have to collect data, and plenty of it, on the 5000 Medicare patients in their practice. "We are required to meet 80-85 metrics, and Medicare has a requirement to meet about 18 of those in the first year," he said.
Dr. De La Rosa says some of those targets include A1c levels, smoking cessation, immunizations, diabetic foot examinations, and body mass index. It's too early to know whether they have made improvements in care, he said. The first few months of the program just establish a baseline. But once enough data is collected, CMS will send regular reports to let them know how they are doing.
ACOs have to demonstrate a 3% annual cost savings to stay in the program. On the basis of preliminary data, the group seems to be at a 9% savings. If the numbers hold, the government will split the savings 50/50 with the group at the end of the first fiscal year.
Sharing the savings with Medicare is great, but Dr. De La Rosa says Jackson Purchase has its eye on bigger fish. "Our eventual goal is to demonstrate improved care across the board, so that we can take those data to private insurers and show them we're adding value to what we're doing," he said. "We take that data to the Humanas, the Blue Crosses, and everyone else and say, 'Look, we're improving care.' If we're going to negotiate our contract a year or 2 from now, we'll have an upper hand over groups who don't demonstrate better care," he added.