Changes to insurance have been getting all the headlines, but the Affordable Care Act aims to change the way doctors operate as well.
The federal law offers incentives for health providers to work together to keep Medicare patients healthy in hopes of saving money. Whether this approach can actually create savings is still unclear, and many doctors remain skeptical. But in Kansas City, a few doctors are teaming up.
In a backroom of the Clay Platte Family Medicine Clinic, a giant phlebotomy machine spins tiny vials of blood while lab assistants scurry around. Blood work is pretty common for a big clinic, but in the past year, the doctors at the clinic have been doing a lot of work that’s hasn't always been so common – work beyond treating illness.
“We’re gonna screen that patient for depression,” explains Dr. Nathan Granger. “We screen for fall risk. We make sure they get their immunizations - those are our measures. We see how all these doctors are doing with their flu vaccines.”
Preventive medicine, like the screenings Granger talks about, is a key part of being an Accountable Care Organization. One year ago, Granger and his clinic joined with 11 other practices to start the first local Accountable Care Organization. It’s called the Kansas City Metropolitan Physician Association and serves around 12,000 Medicare recipients. Granger says not all of those Medicare patients were thrilled about the idea of being treated under the new system.
“They automatically assumed that anything that had to do with the Affordable Care Act was bad, and they didn’t want to be part of it,” Granger says.
The idea behind Accountable Care Organizations is this: going to the hospital costs a lot, and Medicare patients often spend a lot of time in hospitals. Those inpatient hospital services cost over a quarter of Medicare’s total spending in 2012. To reduce that spending, the Affordable Care Act encourages doctors to form these groups to track patient health and do preventive care so that patients stay out of the hospital. The money the approach saves is then split 50/50 between Medicare and the doctor’s groups.
Jill Watson, CEO of the Kansas City Metropolitan Physicians Association, says this is a big shift from the standard healthcare business.
“The way healthcare works is that physicians get paid for the services they provide. [There’s] not a lot of payment for keeping people healthy,” says Watson.
At the start of this year, two new local groups became Accountable Care Organizations. The Physicians Collaborative of Kansas City is made up of doctors from Kansas City Internal Medicine and Encompass Medical Group. And doctors connected with KU Hospital formed Kansas Primary Care Alliance. Together, these new groups will serve close to 12,000 Medicare patients.
KU Med’s Carrie Jordan says their doctors had already been moving toward accountable care.
“I think it’s just step in a lot of other quality initiative we’ve undertaken to real focus on quality outcomes. It’s not a volume-driven model anymore,” explains Jordan.
The Accountable Care approach requires doctors’ offices to do a lot more behind the scenes than they’re used to. They need to bring on care coordinators to manage complicated patient situations. They’ll send updates and reminders to patients as well as report data to the federal government. Patients evaluate their doctor’s work as well. This all requires doctors to use standardized, digital records. For many practices, all the requirements are too much to take on.
“I think generally there’s been a reluctance unless the provider or hospital has been a trailblazer in coordinating care or managing the health of a population,” says Heather Punke, who tracks the growth of these doctors’ groups for Becker’s Hospital Review
There are currently over 360 Medicare Accountable Care Organizations nationwide, with 13 serving Kansas and Missouri. But Punke describes the early performance of Accountable Care Organizations as a “mixed bag.”
In a pilot program of 32 groups that started in 2012, just about half showed significant money savings in the first year and nine dropped out. With few successful models, only half of the country’s hospital executives say they’re currently interested in signing on with an Accountable Care Organization.
“They change the way people provide medicine, which can be scary,” says Punke.
Jean Hansen of Kansas City Internal Medicine says that, looking over the data, she’s doubtful about any quick payoffs for Accountable Care.
“We don’t feel like there’s going to be much shared savings, and we didn’t really do it for this,” Jean Hansen says. “This is quite the investment. We’re doing it because we think this is the way practice should be.”
At the Clay Platte clinic, Jill Watson says she’s happy with the first year as Kansas City’s first Accountable Care Organization. But what about saving money?
“We don’t know yet. Medicare will reconcile those numbers, and we should know that sometime in the summer,” explains Watson.
Watson says the Accountable Care Organization members are still working to get the system operating as they’d like. Some have patients opted out and one practice left the group.
However, the KC Metropolitan Physicians Association is already considering expanding the approach beyond Medicare patients. And some private insurers have already begun setting up Accountable Care Organizations for non-Medicare patients.