Physician CEOs describe the value of physician-led health care teams

Physician leaders at Hattiesburg Clinic They began examining cost and quality data from the Centers for Medicare and Medicaid Services (CMS) on the Accountable Care Organization, which they did as a self-assessment exercise. But what they found became a national focal point in the debate over practice boundaries and team-based care.

The Hattiesburg Clinic, the largest private multi-specialty clinic in South Mississippi, took raw data from CMS and found that non-physician providers were driving up costs by ordering more tests and referring more patients to specialists. Their patients also had more emergency room visits.

“We are very excited to see where our spending is going for our Medicare ACO patients,” said Hattiesburg Clinic CEO Brian Batson. AMA Health System ProgramIt provides enterprise solutions to equip leadership, physicians and care teams with resources to drive the future of medicine.

“Out of curiosity more than anything else,” Hattiesburg leaders said, Dr. Batson said the first time they took a look at the CMS data — they wanted to see which doctors and non-physician clinics generated the most spending among ACO patients.

The 2017-2019 CMS cost data showed that patients with end-stage renal disease on Medicare who were not in a nursing home had a $43 higher per member, per month cost for patients who had a non-physician primary care provider instead of a physician. .

If not all patients were physicians, this could translate to $10.3 million in additional costs annually, the analysis said. When risk-adjusted for patient complications, the difference was $119 per member per month, or $28.5 million per year.

These findings were included in the study.Targeting value-based care with physician-led care teams” published in Journal of the Mississippi State Medical Association.

“Naturally, there were a lot of questions and some anger around some of the findings,” Dr. Batson said.Update AMA” in him He discussed the importance of physician-led, team-based care..

“But our aim is the same,” he added. “We continue to learn from self-examination and make improvements in the way we deliver care.”

Combat Boundary Creep is a vital part of the transition. AMA Recovery Plan for American Physicians.

Patients should be cared for by physicians – highly educated, trained and skilled health professionals. of AMA strongly defends the practice of medicine with scope-of-practice expansion which endangers the safety of the patient.

Four of the five highest-costing practices in the years under study were non-physician clinics.

“One physician who was in that group was a physician who ran a clinic specifically for Medicare’s most complex patients in the geriatric age group and for patients with high complex care,” Dr. Batson said. “It was no surprise to see her in this group. But what’s surprising is that all four of them in that group are non-physician clinicians.

But Dr. Batson emphasized that nurse practitioners and physician assistants (PAs) are part of Hattiesburg Clinic’s care team and that their ACO saved Medicare $23 million from 2017 to 2019.

“Our nurse practitioners and PAs have been critical to our journey,” said Dr. Batson.

This journey includes being recognized as the ACO ranked first in quality in the group in 2016 and 2017, among a total of 471 other participants, and by CMS for providing high-quality care at low cost.

“Team-based care is critical,” Dr. Batson said. We need to make sure we’re using everyone’s skills to the best of our ability.

Working on CMS data, the Hattiesburg Clinic has restructured its care teams — starting Jan. 1, 2021 — with only a physician leading a patient care team.

The AMA has a policy. It describes physician-led team-based care A physician consistently uses the leadership knowledge, skills, and abilities necessary to identify, engage, and elicit from each team member the unique training, experience, and qualifications needed to achieve patient care goals and manage the application.

Or Policy is recognized “Nonphysician Providers as Important Components of the Physician-Directed Health Care Team.”

Since the study was published, several organizations have reached out to the Hattiesburg clinic to compare notes, Dr. Batson said.

In addition to the national focus, state legislators sit down with clinic leaders to examine the data to determine relevance to annual bills, allowing non-physician clinics to practice independently.

This year, the bill did not make it out of committee.

“This was local information in the health system in Mississippi, and our legislators were willing to take the time to understand what we learned and what it was telling us and what we were going to do to respond to it,” Dr. Batson said.

“Update AMA” covers health care topics that affect the lives of doctors and patients. From physicians and experts in public health, advocacy issues, scope of practice and more – because who’s doing the talking? You can access every episode by subscribing. The AMA YouTube channel or the Audio-only podcast versionIt also features educational presentations and in-depth discussions.