Task Force on Independent Practice
INDEPENDENCE AT HOME
Jack Resnick, MD
501 Main St.
Roosevelt Island, NY 10044
Internists in independent practice are uniquely positioned to benefit from the movement to value based payment to physicians.
- We often have closer relationships with our patients than our employed physician colleagues.
- Our personal availability is usually better than that provided by physicians who work for institutions.
- We can refer freely to specialists and institutions in our community without concern for their organizational affiliations.
- These factors contribute to higher quality and lower cost.
There is strong data to support these statements from the Obamacare demonstration projects.
Gain-sharing relationships with our patients’ insurers – commercial or governmental – can produce significant increases in our revenues.
Pilot for a Statewide IPA for Dual Eligibles
A proposal for the Independent Practice Committee of the NY ACP
Dual Eligibles (individuals covered by both Medicare and Medicaid) are the sickest and costliest to care for. A Federal/State program initiated earlier this year – Fully Integrated Duals Advantage (FIDA) – to address these beneficiaries failed miserably across the country. We have been working with senior administrators in Albany and Washington on this issue.
FIDA failed because it relied on insurance companies and their restrictive networks to provide health care. Beneficiaries with multiple comorbidities and long-term relationships with their doctors opted out of the FIDA plans – and appropriately so. These are the last people who should be forced to break continuity.
Almost simultaneously, another CMS program – Independence at Home (IAH) – finished its three-year demonstration with resounding success. Ten thousand Medicare beneficiaries in 17 sites spread around the country scored high on clinical and satisfaction metrics and saved more money than any other Obamacare project. It has been renewed by Congress and the President for another two years.
IAH is a very simple program.
- There are no networks.
- There is no prior approval for services.
- Patients stay in traditional Medicare, and physicians are paid in the usual fee-for-service process.
- Every IAH patient has a personal physician whom they can reach 24/7.
- Physicians are incentivized by gain sharing. If Medicare costs come in below projections, Medicare gets the first 5%of the savings, and physicians get 80% of the rest.
- There is no down-side risk.
- The ideal physician organization to form an IAH is an independent practice association (IPA).
Combining IAH with a managed-long-term-care plan would provide the infrastructure to keep these vulnerable people out of institutions and care for them at home. It also saves enormous amounts of money.