There is a part of the Affordable Care Act (ACA) that is helping primary care physicians transform how we deliver care to our population of patients, and it is actually kind of exciting.
One of the biggest flaws of the fee-for-service system in general (is that doctors) get paid the same to see someone with an ear infection as to see someone with high blood pressure, high cholesterol, or diabetes. As you can imagine, an ear infection or sore throat requires a LOT less work than managing more chronic problems, what with medications, lab tests, monitoring tests, etc.
…(T)he fee-for-service environment does not really incentivize doctors to focus their efforts on chronic disease management: If you make the same amount per patient, and can see 30 patients with ear infections or 15 diabetic/hypertensive/hyperlipidemic patients, which would you choose? The thinking is that it probably evens out in the long run. But better control of diabetes, blood pressure, cholesterol, COPD, asthma, or heart failure will save lots and lots of money in the long run because complications of all those diseases are more expensive.
The ACA provides funding and guidance for a new way to approach health care. The Comprehensive Primary Care Initiative (CPCI) is a program that involves about 500 practices across the country (including 63 in New Jersey)…Basically CPCI…provides additional monies…(via) the Center for Medicare and Medicaid Services (CMS) for practices to use as they see fit in order to help improve the care for their patients, particularly (although not exclusively) those with higher risk chronic illnesses…
Instead of saying, “Hey, if we pay you more, you’ll do a better job, right?”, CMS is saying, “We will give you money to use (within the structure of our program and its milestones) to improve patient care — which should improve outcomes, decrease severe complication rates, improve patient satisfaction, and eventually decrease overall costs through an investment up front.”
I am a family practice physician in a multi-specialty group of about 60 doctors, mostly primary care…(W)e have used the money to hire more staff, including registered nurses who can reach out to patients before, during and after appointments…We try to have labs drawn before appointments so we can have already reviewed the results…Now we will be able to offer diabetes education free of charge to all of our patients, which means someone doesn’t have to have a stroke, end up with a metastatic cancer, go blind or lose a foot to their diabetes.
The doctors get more help, the patients get more individualized attention and care, and the outcomes improve. The result is more efficient care — and saving money.
…(T)he idea is that CPCI will help to transform how we provide care, therefore leading to a sea change in primary care across the country. If you get better outcomes, improve patient satisfaction AND save money while practicing a certain way, every practice is going to want to adopt these methods.