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The Daily Record: Maryland program will bring physicians into all-payer system

Nancy Smit, Partner and Director of the Healthcare Division at RS&F sat down with The Daily Record to discuss the new Maryland Primary Care Program. 

Maryland doctors can expect to be part of the state’s move to cut health care costs under a new program designed to incentivize doctors to help their patients reduce emergency room visits and hospital readmissions.

The Maryland Primary Care Program will take effect Jan. 1 as part of the new all-payer contract Gov. Larry Hogan signed with the federal government Monday. For the first time, doctors will be able to receive incentives to cut costs and improve health outcomes.

“Now doctors are going to be paid to give a higher level of service to Medicare patients and focus on preventative health and make sure you find out what really is wrong with the patient,” Gene Ransom, CEO of MedChi, the state medical society, said. “They are really incentivized to do that.”

Just as the recent all-payer model has provided hospitals incentives to cut costs by improving preventive and population health and increasing management of chronic diseases, the Maryland Primary Care Program encourages doctors to treat Medicare patients more holistically, rather than just treating them when they come into the office for an appointment.

Doctors will be required to treat patients through plans that make sure patients are getting the care they need and doing what they have to do to manage their health, including going to imaging appointments, getting their medications at the pharmacy and learning how to take those medications.

The program will work almost as a Medicare version of the medical home model that private insurers, like CareFirst BlueCross BlueShield in Maryland, have begun to have success with in implementing for their members, especially high-risk members.

Physician practices eligible for the program must have at least 125 Medicare patients and have a certified electronic health records system.

The program will accept applications, but the window for applying is short. It runs from Aug. 1 through Aug. 31.

Physicians that participate in the program should be expected to really commit to the program, but there should not be a downside for them, said Nancy Smit, partner and director of the health care division at business consulting and accounting firm Rosen, Sapperstein & Friedlander. She has been consulting with practices on the program.

Nancy Smit, partner and director of the health care division at Rosen, Sapperstein & Friedlander

Nancy Smit, partner and director of the health care division at Rosen, Sapperstein & Friedlander

“There’s no downside,” she said. “I think it will take a real commitment of the practice. It’s not just the doctor saying, ‘Let’s do it.’ They really need to pull their team together, there needs to be a full commitment and being part of the corporate mission that they are going to help to transform care.”

Part of the program pays physicians on a per-month, per-patient basis. They can receive anywhere from $6 to $100 a month per patient, depending on the difficulty of the patient.

That represents part of the objective of the program.

Whether it is the state or private insurers, all payers are trying to find ways to cut health care costs by improving outcomes.

One of the most targeted segments has been patients with chronic diseases, who tend to take up a vast majority of health care costs. The hope is that helping patients manage these diseases will keep them healthier, in turn keeping them out of the hospital and reducing costs.

“To a practice, the providers and the staff have said to us that they find that the caregiver experience is much more positive and satisfying,” Smit said. “They are relating constantly with the patients, with their referral services. It’s a much more coordinated delivery of care and really more efficient. I would expect that the results of this program would be the same.”

One tool to help doctors will be care transformation organizations. These organizations will help provide support and pull together some other components of the total health picture, including pharmacy and health education.

Practices will also have to be responsible for their patients 24/7. That means they must set up some mechanism for being available to their patients at all times, whether that means an answering service or other method.

The incentives will also help doctors get on board with the hospital shift to encourage value-based service over the traditional fee-for-service payment methods that have permeated health care for decades.

“It does create the incentive for the doctor to treat the patient differently,” Ransom said.

With the new benefits will also come more responsibility, and potentially some risk if the program does not work to cut costs like most are projecting.

“There could be some tension from the hospitals if we don’t see a return on this higher level of care management,” Ransom said. “The key is, we have to remember the focus needs to be the patient and our goal is we need to do what’s right for the patient.”

To view this story on The Daily Record click here