Supporting the independent practicing physician

May 27, 2016

It’s not an overstatement to say that today’s healthcare environment is a difficult one to navigate for the primary-care physician and private practice owner. Declining reimbursements, increasingly stringent reporting requirements, and never-ending consolidation mean the pressure is on for doctors who have traditionally been on the front line making sure that the healthcare industry operates as intended.

It’s fairly certain that, at some point, the small independent physician practice will return to being a viable, prestigious, and profitable professional setting within the community. However, right now the promise and joy of providing patient care solely from one’s office is a financial challenge and as such, the traditional patient/doctor visit is now in decline.

Like all adaptive businesses, there are still ways to thrive financially without compromising the quality of care being provided. The advent of reimbursable codes from Medicare is an example of how new-found payments dovetail into the hallmarks of what an independent physician represents. This connects directly with the idea that personal and meaningful checkups can be delivered successfully via the phone (i.e., telehealth). Maybe TV doctor Marcus Welby M.D.’s black bag and house visits are gone, but these services ensure Dr. Welby is still making monthly calls!

From a practice standpoint, telehealth essentially protects one of the primary tenets of being independent: the ability to truly get to know the patient and the family. From the patient’s point of view, these in-bound calls are personalized and are a concrete testament to the practice’s full attention, negating the idea that they’re just another body in the waiting room. With the advent of telehealth – monthly checkups (that are paid) are a win for all parties involved. They continue the longstanding tradition of an essential connection between patient and practice.

Patients with multiple chronic conditions

For primary care physicians, patients with multiple chronic conditions (MCCs) are quickly becoming their most at-risk population, as the onus is on the practice to effectively manage a wide range of co-morbid symptoms and compounding factors. But just how important are these patients to a private practice?

Here are stats to consider:

  • Approximately one in four Americans has a MCC, including one in 15 children.
  • Approximately 66 percent of total healthcare spending is associated with care for the over one in four Americans with a MCC.
  • Among Americans age 65 years and older, as many as three out of four persons have a MCC. In addition, approximately two out of three Medicare beneficiaries have a MCC.

Further, a report released from The Commonwealth Fund suggests that the United States is still not effectively managing its patients with multiple chronic conditions. The results found that up to one in four U.S. primary care doctors believe their practices aren’t well prepared to manage care for patients with multiple chronic conditions.

So effectively, our most expensive patients the are ones that many primary care physicians don’t feel they can manage well. This care gap not only significantly affects outcomes for MCC patients, but also detracts from physicians’ bottom lines, and by extension, the entire healthcare industry.

How can we fix that?

One of Medicare’s most promising initiatives is the Chronic Care Management (CCM) program, which reimburses physicians under CPT 99490 for providing once-a-month telehealth calls to elderly MMC patients.

These monthly calls are seemingly perfect for patients with MCC, as events occurring in between check-ins and appointments are often the most integral to the overall treatment outcome. The ability to effectively manage these patients during this “down time” is near invaluable – a fact that the industry is quickly realizing.

Under CCM, medical professionals from the practice call these patients and conduct a screening similar to what would occur within the four walls of the doctor’s office. Because it’s done remotely, the patient does not have to travel to the office, which is especially helpful for elderly patients who may be reluctant to seek help, or simply unable to. Further, any information that is collected during this interaction goes directly into the practice’s EMR, allowing for all parties involved in care coordination to have a complete idea of the patient’s situation.

Essentially, if there’s a problem, the practice’s representative will make sure that it’s fixed and that the patient has everything they need – whether it’s a new medication, a refurbished wheelchair, or a step-by-step walkthrough of a set of complicated instructions.

The end goal of CCM is simple: prevent unnecessary ED visits for patients with chronic conditions and keep them from being readmitted to the hospital. Essentially, Medicare has gone on record saying, “Docs, if you can do this, we’ll reward you for the extra effort.”

It’s estimated that a “typical” practice with about 2,000 Medicare patients could generate more than $75,000 net revenue per full-time physician if half of their eligible patients enrolled in chronic-care management. Considering these numbers, it’s no stretch to say that practices that successfully participate in CCM are going to find a new revenue stream, and possibly one that could prove the difference between a thriving financial year and having to consolidate with the hospital down the road.

Moving forward

As CCM and CPT 99490 demonstrate, CMS must continue to reward physicians who go above and beyond to provide effective and timely care to their patients. The traditional business model of the primary care physician is still invaluable, but augmenting these services with technologies like telehealth and remote monitoring tools will only help to improve outcomes and financial success.

The message from CMS is clear: If we are truly going to improve the care of at-risk patients who most need it, the healthcare industry must dedicate themselves to participating in programs like CCM, and further, pay physicians who effectively use them to improve outcomes. The idea of providing care like Dr. Welby should never go out of style; it just might be that this call comes through your iPhone instead.