For the last 2 years, her practice, comprised of herself and two nurse practitioners, participated in a patient-centered medical home pilot program with Arkansas Blue Cross Blue Shield. It is ending in December. No additional payments were given for doing things like creating a patient portal and offering consultations by phone after hours. And not all of her 5,800 patients were covered by the pilot.
The current initiative, with four participating payers in Arkansas – Blue Cross Blue Shield, QualChoice, Humana, and Medicare – will cover 92% of her patients. It’s not clear yet what the monthly payment will be from Medicare or those insurers, but payments are due to start Oct. 1, Dr. Zimmerman said.
The additional funds will let her invest in areas that she couldn’t before, like diabetes education, and to perhaps hire a care coordinator. It also eill help her maintain her EHR and improve her patient portal. Only about a third of patients are using it – to make appointments, request prescription refills, and access lab results or e-mail Dr. Zimmerman. She uses it to send patients a visit summary and lab results and to share educational materials.
The portal makes her work a lot easier, she said. For instance, the system tracks whether a patient has accessed those educational materials or lab results and notifies the physician that the materials have been – or have not been – read. It also allows relatives – say a daughter of an elderly patient – to see medical records and communicate directly with her. That’s especially important if the daughter lives elsewhere.
She also uses her website and a clinic Facebook page to stay in touch with patients. In rural Arkansas, a large number of people have smartphones because so many use Facebook as entertainment, said Dr. Zimmerman. "I would rather them get on my Facebook page and read about something I posted from the Mayo Clinic than surf the web and look up something that’s not good educational information," she said.
Dr. Reicks also says that his patients have been enthusiastic about his patient portal, though only about a third have signed up for access. Initially, the practice’s providers – three physicians, a nurse practitioner, and a physician assistant – were worried that inviting patients to e-mail would open up a flood that would take away from actual practice time.
But uptake has been slow, and "we’ve found it to be convenient and effective," saving time, money on postage, and miscommunications, Dr. Reicks said.
His practice has had an EHR since 2007, and it participated in the Colorado Beacon Consortium, a CMS-funded practice-improvement program in western Colorado. Though the practice underwent a huge transformation, it was looking to move to the next level, said Dr. Reicks.
The per patient/per month fee under the primary care initiative will help the practice "pull in additional human resources," he said. That would include case managers, health coaches, and behavioral health specialists. The idea is to offer truly comprehensive care, Dr. Reicks said.
About 4,500 of the practice’s 10,000 patients will be covered under the initiative, including some 3,000 Medicare patients and 800 Medicaid patients. The practice anticipates an average $10 per patient monthly fee, but it could be more after Medicare payment is risk-adjusted. Like Dr. Zimmerman, Dr. Reicks is waiting on getting word from the private payers – which include Rocky Mountain Health Plans, Anthem Blue Cross Blue Shield, UnitedHealthcare and Cigna – on their monthly payment. But at least one payer – Rocky Mountain Health Plans – has suggested that it will offer in-kind resources such as health coaches instead of an actual payment, Dr. Reicks said.
The uncertainty over the revenue stream is a familiar, but vexing problem, he said. CMS is requiring the participating practices to submit a plan detailing how the monthly fees will be spent. "And we don’t know how much will be coming in," Dr. Reicks said.
It begs the question of why a practice would seek out participation in this initiative.
Besides improving patient satisfaction and health outcomes, "we’re hoping this will somehow restore the joy of practicing medicine again," he said.