Can Primary Care Providers still Thrive?


As CMS continues to find ways to move away from a fee-for-service payment model it is becoming increasingly difficult to keep up with all of the acronyms in which data is reported: MIPS, MACRA, ACO, PQRS, PCMH, etc. However, one thing is certain. Fee-for-service, in some form or fashion, is going away and we are moving towards a value-based payment model.

What does this mean for you? Glad you asked. This means that as a primary care provider you must begin finding ways to close the gaps in care, report data timely and accurately and probably most importantly, find new ways to diversify your revenue streams.

What do I need to know to be able survive? You need to understand how to operate in this new world of outcome-based care. CMS measures your success based on the total healthcare spend of your patient base. I know what you are thinking.

"John Doe shouldn't be my patient, I have only seen him one time in the last two years."

In theory we agree, however, CMS determines your patient base by "plurality of claims". In other words, who saw the patient the most over the last 12 months. Since John Doe only saw you, he is now your patient. What does this mean for me? This means that you must take action on your attributed CMS lives today. I know, I know, how do you know which patients are attributed to your clinic or you as a provider? If you are part of an ACO or MSSP than this step is easy, because CMS gives you this information. However, if you are an independent primary care provider/practice don't waste time on trying to figure out the formula for attribution, instead, let's start by taking action on the whole of your Medicare population. How do I get started? There are many things a clinic/provider can do to try and capture data and close gaps in care. In fact, clinics sometimes get so caught up in this cycle they lose focus and heart.

The two most important things any clinic can do is 1) create a baseline for your patient population and 2) begin to put practices in place to manage their chronic conditions. We know that 80% of the total healthcare cost comes out of 20% of the total patient base. (High risk population) How do I create a baseline? The best and most efficient way to create this baseline is through the Medicare Annual Wellness Visit. There are a few key factors to this visit that make it a great starting point:

1) It is 100% free to the patient

2) It can be done by medical staff other than the provider

3) Done right it can start to close those gaps in care

4) It produces new revenue for the practice immediately How do I manage those chronic conditions? Managing chronic conditions in geriatric patients can be tricky. The key to success is an increase in patient touchpoints. You as the PCP do a fantastic job of taking care of your patients when they are in front of you. However, it is very difficult to manage what happens to them the rest of the time. The best line of defense we have for this is utilizing the chronic care management (CCM) services. There are a few key factors to this visit that make it great at managing those conditions:

1) Low cost, if any, to patient

2) Monthly telephone check up on patient

3) Preventive actions taken on patient's behalf All this sounds great, how do we get started? Many clinics will try to do the Annual Wellness Visit on their own, however, with the daily chaos that happens within a clinic they are often not very successful. Luckily, we have a solution for you. Pro Care Innovations is a company that specializes in Annual Wellness Visits and chronic care management services. We provide an all-inclusive solution at no up-front cost to your practice, by utilizing wellness program experts to schedule AWVs and see these patients for the visits. We also provide chronic care management services that result in higher patient reach and greater patient interaction and satisfaction. Pro Care Innovations would love to discuss with you today how we can help you transition from fee-for-service to value- based payment. For more information or to schedule a demo with a Pro Care Innovations account executive call today :

833.313.CARE or email support@procareinnovations.com


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