By Donald Collins, MD
In March of 2019 I was trying to decide how my solo Internal Medicine practice near downtown Orlando was going to continue. I had considered concierge and direct primary care practice models, but I worried about my many patients who would not be able to afford to continue seeing me.
The Army had paid for my medical school education, and after my Internal Medicine residency and an additional four years in practice repaying my service obligation in Army hospitals, I was convinced I could do a better job for my patients by running my own medical practice. Still, something was going to have to change.
After 18 years in private practice, my staff and I were working as hard as we could. I had learned you can only increase the number of patients you see up to a point trying to compensate for declining reimbursements. Each passing year we were working harder to maintain our income.
I had heard about value-based care referred to as “the future of health care,” but I didn’t really understand what that meant. I felt my staff and I had always provided value-based care. We treat our patients as if they are part of our family, and I feel an obligation to care for their medical needs as economically as possible. I routinely explain to patients how the cost of their diagnostic test or procedure can vary dramatically depending upon the facility in which it is performed. I know that working a patient into my schedule over lunch and diagnosing and treating a condition which spares the patient (and their insurance company) the cost of an emergency department visit adds value to their healthcare. Still, I worried I was doing what I had always done, while healthcare was continuing to change around me.
My office manager came to me and told me about a company that helps groups of physicians form Accountable Care Organizations, that had approached my office about participating. I was concerned that joining an ACO meant losing control of my practice, but I agreed to meet with them when she told me, “The company wants to keep independent practices independent.” Joining an ACO was the best decision I could have made.
When I met with the Florida ACO administrator, he showed me things I could do to improve my patients’ health. Performing more annual wellness visits, for example, would likely uncover and correct problems before they became crises. I learned I was not always coding the discussions I was having with my patients about their alcohol and tobacco use. Implementing these changes improved both the care I delivered to my patients and my reimbursement for their care. And, instead of spending countless hours on the phone with my EMR company’s MIPS consultant to receive a 1% increase in my annual Medicare FFS reimbursements, when I joined an ACO I received a 5% increase.
I saw an immediate improvement in my practice revenue. Because of the information my ACO was providing me daily, I was now able to see which of my patients had been in the hospital or ED and to schedule timely follow-up appointments to try to avoid readmissions. I was likewise able to see which patients needed annual wellness visits, helping me identify and treat problems before they caused a hospitalization.
Prior to my joining an ACO, I thought I could provide value-based care to my patients. I was wrong. My ACO provides me with resources I simply wouldn’t have without them. My ACO also shows me which codes are “weighted” and used by Medicare to determine how much it “should” cost to care for a patient annually. My advice to anyone considering joining an ACO would be to find a partner committed to helping your practice succeed, not just their bottom line. Ultimately, what is good for your patients and your practice will be good for your ACO.
ACOs are getting results – especially physician-led ACOs. In September, CMS Administrator Seema Verma released the 2019 results for all ACOs in Medicare’s Shared Savings Program. “Low-revenue” ACOs run by independent physicians saved Medicare and
taxpayers $201 per Medicare beneficiary. “High-revenue” ACOs run by health systems and hospitals only saved $80 per beneficiary. These savings will be shared among Medicare, the physician practices, and the ACO, resulting in additional income to practices for taking better care of patients.
I would heartily encourage more independent physicians to consider value-based care models. It has made all the difference for my practice.
Dr. Donald Collins is a third-generation physician practicing Internal Medicine in Orlando, FL. He has been a member of the Aledade Florida 2016 ACO since 2019. His medical practice is located at 1109 S. Lucerne Terrace, Orlando. Prior to his present position, Dr. Collins was a Major in the US Army Medical Corps stationed in Landstuhl, Germany. Visit Aledade at https://www.aledade.com/ or email firstname.lastname@example.org