How One Pennsylvania Medical Practice Is Easing Volume-to-Value Transition

Develop the Skills to Thrive in Value-Based Delivery Systems

Through a series of six online, on–demand courses and two live workshops, PAMED offers educational programs to ensure physicians have the skills necessary to succeed in the transition from volume to value. The next live workshop is Aug. 7, 2015.

Learn more about online programs and live workshops.

Many Pennsylvania doctors agree: In theory, Medicare payments for value instead of volume make sense. Doctors strive to help their patients stay healthy, and that is the goal driving value-based payments.

However, any transition is bumpy. Adapting successfully requires careful planning, new strategies – and a healthy share of trust that all will go as planned.

“It definitely is a big shift to go from fee-for-service to value-based reimbursements,” said Paul Gausman, DO, family medicine, in Erie. Doctors are “doing a lot more work for a little bit more money with the promise that this is going to be a whole new way of compensating primary care. You have to go a little bit on faith that it’s worth doing all this work, but clearly we are doing it because we think it’s the best for physicians for the future.”

Dr. Gausman’s practice has taken steps and is adopting new strategies to smooth the transition:

  • In recent years, the practice created “patient report cards” detailing gaps in care – such things as whether cholesterol had been checked, vaccines given, or colon and breast cancer screenings performed. Then, electronic records were reconfigured to align with the report cards, and office staff was empowered to arrange missing items or prompt doctors to do them when patients are seen. “It’s a way for patients to get seen and have some of this extra work done,” said Dr. Gausman.
  • The practice actively conducts outreach and tries to bring in patients from lists received from insurance companies. “That’s certainly a different thing than was done 10 years ago,” says Gausman. “If your doctor didn’t go looking for you, you basically came in when you were sick.”
  • Using the report cards and insurance lists, the practice has focused particularly on diabetes “as a strategy beyond just adult well care.”
  • Encouraged by Highmark, the practice is incorporating more Annual Wellness Visits into its workload. “They catch a lot of the details,” Gausman says.
  • The practice is investing in health coaches, giving each doctor one nurse and two medical assistants. The second MA will be the health coach, helping with documentation and much of health-maintenance outreach. The extra help will allow physicians to care for more patients, although “it remains to be seen” if practices can move beyond simply tracking adherence to orders and, instead, reach the point where patients are actually healthier, said Dr. Gausman. “I think health coaches will have a role in that.”

As electronic-records technology improves, physicians will have stronger tools for fine-tuning patient care – identifying those who need more care and developing different strategies for dealing with them. The key to success is “having physicians do physician work and making medical decisions, and having other people do screening and education,” Dr. Gausman said. The “big picture” requires sorting out “which patients and which doctors need time together that brings value.”

“If you can get the systems in place to demonstrate that you’re a better-quality physician, it’s professionally satisfying, and it’s good for patients,” added Dr. Gausman. “I do think there’ll be a reward, but some of that is on faith during the transition period.”