Primary care and mental health

The primary care physician has typically been viewed as someone who sees patients for preventive care, diagnosis, and referrals to specialty providers, all related to physical issues. However, with a growing shortage of psychiatrists and an increase in costs for patients, it is becoming more common for a primary care provider to treat patients for mental health concerns as well. Primary care providers can provide mental health services on a relatively basic level, diagnosing and treating a patient for conditions such as depression or anxiety. Most often, the treatment consists of medication prescriptions but should also include collaborative care, coordinated for more enhanced treatment by a mental health professional. The National Institute of Mental Health (NIMH) states that “Collaborative Care has been found to improve quality of care, satisfaction with care, and both mental and physical health outcomes.” Unfortunately, primary care providers have not traditionally been paid for additional collaborative care efforts. Effective January 1, 2017, however, Medicare began reimbursing providers who collaborate care with mental health providers for those patients with mental or behavioral concerns. The hope is that private insurance companies will follow suit. NIMH also states that, as of December 2016, “it is believed that only about 10% of patients with depression receive appropriate mental health care when visiting their primary health care provider.” Communication with a patient’s specialty providers, including their mental health provider, is a crucial component of quality coordinated care. The patient’s physical medical history can impact mental and behavioral health treatment and vice versa. A patient with depression, anxiety, or addiction issues may be more willing or better able to visit a primary care provider for basic mental health treatment. The primary care provider can then manage that patient’s care, ensuring that a referral to a mental health professional includes information about the patient’s physical health, through shared electronic health records (EHRs), for example. Collaborative care, coordinated between the primary care physician and the mental health provider, helps patients access the care they need and improves patient outcomes.

Nick Dealtry

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What do primary care physicians need to know about precision medicine?

The primary idea behind precision medicine is that every patient is different, with different genetic makeups and living in different environments that may affect how effective a particular treatment will be for each person. Precision medicine hones in on the specific genes and environment to determine which medication and dosage level, for example, will work best for managing each person’s disease or condition. The calculation is more precise and dependent on more factors than the traditional measures of age and weight used to determine dosage. Precision medicine has typically been used when treating an existing condition. Dr. Megan Mahoney, Chief of General Primary Care at Stanford University’s division of Primary Care and Population Health, wants to see precision medicine move “upstream,” to the primary care provider’s office, to help in preventative treatments. Making a change in today’s healthcare crisis, as Dr. Mahoney sees it, would entail a more team-based approach on the part of the primary care physician. Adding staff to the primary care practice will be important as precision medicine moves to preventative care. The physicians can then “practice at the top of their license, focusing on assessment, diagnosis and treatment rather than administrative tasks.” Stanford University plans to “begin a yearlong pilot with 50 to 100 patients from demographically and socioeconomically diverse backgrounds, and will identify ways to reach them to offer preventive care and engagement opportunities based on electronic health records dashboards.” The project team will then identify those patients who may benefit from a precision medicine approach to their preventative care in the primary care provider’s office. The precision medicine approach may also help primary care physicians increase their patient engagement, as they get to know each patient a little better. Taking advantage of technology that enables them to access medical records and visit notes quickly will enable the primary care physician to spend more time with the patient. Understanding the patient’s complete profile can enable the primary care physician to be more effective with the quality of preventative care.

Greg Miller

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How to make primary care more efficient

Everyday inefficiencies plague healthcare - particularly primary care. Big pictures changes cannot happen overnight but that doesn’t mean there aren’t any smaller scale solutions. If you find your practice struggling, here are a couple of strategies that independent primary care physicians can use to make their practices run more efficiently. Creating the “A Team” By training “a teams” consisted of a diverse set of health professionals from physician assistants to therapists, this team has then extended physician capacity. “There are a lot of routine needs that don’t necessarily require a physician,” says Edward Salsberg, MPH, a research instructor at The George Washington School of Nursing. Incorporating health professionals like nutritionists, occupational therapists and social workers into the teams can improve a patient’s health and ability to function while allowing a more efficient delivery of preventive care that helps keep patients healthy and away from the hospital. Using technology to your advantage Investing in an EHR system for independent primary care physicians can give your practice complete flexibility in how you deliver care, help you automate data entry to maintain a more comprehensive and longitudinal patient record and help you drive phenomenal patient outcomes. This technology can aid you in focusing more on your patients than on your screen. Coordinate care efficiently and automatically share updates directly from your Clinical EHR to other providers so they can take action based on the most up-to-date clinical information. Taking this step further to investing in an Interoperable EHR system; meaning that the electronic sharing of patient information between different EHR systems and healthcare providers can happen. Get help for your admin duties According to PwC Health Research, a major source of inefficiency in primary care practices is that physicians have to spend more than a third of their time and significant resources on administration duties. Using an EHR system that is integrated with a practice management software can save your practice time when doing the necessary administrative duties, leaving you with less screen time and more patient facing time. Elation Health’s Clinical First EHR can help you efficiently manage the operations behind your practice and reduce the burden of day-to-day administrative tasks by easily managing appointments, check-ins, and copays; sending and receiving electronic faxes, and tracking your practice’s performance, clinical quality measures, and meaningful use criteria measures all in one place.

Kimmy Hu

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What is community-oriented primary care (COPC)?

Community-oriented primary care (COPC) is a process of improving a community's health by using principles of public health, epidemiology, preventive medicine and primary care that has been shown to have positive health benefits for communities in the United States and worldwide. In 1999 the American Public Health Association gave the following description of COPC: “Community-Oriented Primary Care (COPC) is a systematic process for identifying and addressing the health problems of a defined population. It can be implemented with the resources available in most communities. In COPC, a team of health professionals and community members work in partnership over a long period, diagnosing and treating a community in much the same way as does a primary care physician with an individual patient. Primary care practitioners are not required in every project, and they are usually too busy to lead such an effort, but they must be involved.” Importance of primary care providers COPC offers the possibility of addressing the environmental and social causes of bad health within a community, with the assistance of a primary care physician. The steps that are taken within COPC to diagnose and treat communities follows the same foundations that of a primary care physician. Primary care providers are the “quarterback” of a patient’s healthcare experience, they coordinate care with all of the patient’s specialty physicians in order to keep everyone up-to-date the patient’s health, make sure they have the right tests done without duplicates, among many other responsibilities. The main objective of COPC is heavily based around the functions of primary care physicians. In the transition to value-based physician payment models, community-oriented primary care (COPC) is attracting interest as a care model focused on improving health outcomes on a population level. Click here to learn more about how Elation Health’s Clinical EHR supports innovative care models.

Greg Miller

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The impact of annual wellness checks

Primary care physicians have long emphasized the need for preventive health. Annual wellness checks, or physicals, have been an intrinsic part of the preventive plan for their patients. Most private insurers cover the cost of an annual exam and even Medicare has recently begun paying in full for an annual wellness check for recipients. Some experts, though, believe that the annual wellness check is not necessary, particularly among younger patient populations. Writing in the Harvard Health Blog, Amy Ship, MD, points out that “these annual visits don’t make any difference in health outcomes,” according to a number of large studies. She further explains that an annual wellness check does not necessarily keep a patient from getting sick or even help the patient live longer. However, she also cites the fact that “many doctors and patients perceive the annual visit as a critical opportunity to cement the doctor-patient relationship and a way to ensure that people receive appropriate screenings and preventive care.” That patient-physician relationship can be crucial in impacting the level of care provided during each visit. When a patient feels that the physician is truly listening and has a vested interest in the patient’s well-being, the patient becomes more engaged as well. Ship’s article proposes a separate visit to establish that relationship, rather than relying on the annual wellness check to make that happen. Follow-up communication is another significant element in developing that patient-physician relationship, in addition to having an impact on the quality of care a patient receives throughout the year. The Harvard Health article also suggests that primary care physicians “will need to find a more proactive way to monitor their patients’ attention to preventive care” if the annual physical exam is eliminated. An EHR tool, such as Elation’s Clinical First EHR, enables the primary care physician to quickly identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care.

Kimmy Hu

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How investing in primary care can help us reach the triple aim

Only 6–8% of healthcare dollars are spent on primary care services even though primary care has been shown to help achieve the “triple aim” of improving care and health while reducing costs. The “Triple Aim” includes improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations. The Center for Medicare and Medicaid Innovation’s (CMMI) Comprehensive Primary Care (CPC) initiative and Rhode Island’s statewide payment innovation model provides evidence that additional investment in primary care is expected to assist transformation, improve patient outcomes, and will be cost neutral, or cost saving, overall. Since the start of the CPC initiative in 2011, $371 million was spent in per-member-per-month fees and the amount spent on primary care for the most complex patients doubled. The primary care investment in Rhode Island expanded almost by 40% between the years of 2008 and 2012, where they were mostly investing in medical home transformation. To create new and innovative models for primary care, in order to help the clinical first primary care providers and the healthcare system as a whole; there needs to be fundamental and structural alterations. The CPC initiative states five advances that will improve primary care delivery but that will require investment: 1) improved access and continuity; 2) planned care for chronic conditions, preventive care for high-risk patients, and team-based integration of behavioral health; 3) risk-stratified care management; 4) patient and caregiver engagement, and; 5) coordination of care across the medical neighborhood. All of these advances require all types of health systems to invest vital resources into their primary care framework. Blue Cross and Blue Shield of Rhode Island administered a study with over 100,000 members, these members being practices that had sustained patient-centered medical home transformation. The transformation was done through the CTC and over a 5 year time span this study showed a 5% cut in costs and a savings of $30 million, with comparing this to other primary care practices. Using this model can bring improved patient access and improved care coordination and management as well as avoiding unnecessary hospital admissions. The savings on cost that was presented in this model shows a 250% return on investment in transforming practices into patient-centered medical homes, this being done by having 16% less hospital admissions and 30% less readmissions, compared to other primary care practices. The research from Rhode Island provides evidence that investing in the primary care delivery system can pay off by improving outcomes such as hospital use over time. Federal investments in medical home transformations are following Rhode Island’s footsteps and are mostly being made through increased fee-for-service payments, per-member-per-month fees and a shared savings in ACO models or pay-for-performance quality incentives. Only a few have invested at the same levels as the CPC initiative or in the same CTC practices that were used in Rhode Island. Most of the time payment systems don’t come close to matching the increase in resources that is needed to make an essential investment into primary care. The average 0.5% decrease in spending due to using shared-savings models isn’t enough to to support the base that is needed to transform practices and continue care management. A new payment system needs to be created that will enable primary care to serve as the capable and valued base of a high-functioning health system. The CPC initiative is too constrained by the limits of its investment and its dependance on the fee-for-service payment. The Rhode Island model can give the correct amount of resources needed but can be strained by the use of fee-for-service as the foundational payment structure. As of now, track two of the Comprehensive Primary Care Plus (CPC+) action is offering the decreased fee-for-service payments in exchange for larger payments paid quarterly that will make up for the loss of the fee-for-service revenue, which can have the effect of pushing practices closer to cost. With a dedicated and thorough investment in primary care and the assessment of it, only then will we be able to save our healthcare system and realize how much promise is in the primary care system. [alexraths] © 123RF.com

Kimmy Hu

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MIPS v. APMs

There are two different tracks for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The first, the Quality Payment Program consolidates current fee-for-service Medicare programs (Meaningful Use, Physician Quality Reporting System, and Value-Based Payment Modifier) into a single program called MIPS – Merit-based Incentive Payment System. The second is applied to clinicians who are exempt from participating in MIPS because they are a qualified participant in an APM, which is called the Advanced Alternative Payment Models (APMs). MIPS: MIPS is a performance-based payment system composed of four categories that provide clinicians the flexibility to choose the activities and measures that are most meaningful to their practice. An eligible clinician’s performance in each of the four weighted performance categories is combined to create the MIPS Composite Performance Score, also known as the MIPS Final Score, which is used to determine Medicare Part B payment adjustments in future years. The four performance categories for MIPS are: Quality (measurements like PQRS) Practice Improvement (transforming operational process) Advancing Care Information (rebrand of Meaningful Use) Resource Use or Cost (The Final Rule removed the Resource Use requirement for this year but it will be increased in the following years) Each category is weighted as follows: Quality 60%, Practice Improvement 15%, Advancing Care Information 25%, Resource Use 10% Based on the MIPS Composite Performance Score, physicians will receive +/- or neutral adjustments up to the following percentages: 2019: -4% to 4% 2020: -5% to 5% 2021: -7% to 7% 2022+: -9% to 9% APMs: The Advanced APM path is for providers who take on added risks when treating their patients while delivering high-quality, coordinated, and efficient care. To be an Advanced APM the three criteria must be met: Require participants to use certified electronic health record technology Provide payment for covered professional services based on quality measures similar to those used in the quality performance category of the Merit-based Incentive Payment System (MIPS) and Either: (1) be a Medical Home Model expanded under CMS Innovation Center authority; or (2) require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses. Once physicians are participating in an Advanced APM, they can earn the 5% incentive payment in 2019 for Advanced APM participation in 2017 if: - Physicians receive 25% of their Medicare Part B payments through an Advanced APM or - See 20% of their Medicare patients through an Advanced APM In order to meet Advanced APM Qualifying Participation requirements, you’ll also need to send in the quality data required by your Advanced APM. If a physician decided to leave the Advanced APM in 2017 they should try to meet the Advanced APM requirements for that year to receive the 5% bonus. If they cannot meet these requirements they will need to submit data to be a part of the MIPS program, otherwise, they will be subject to the -4% payment adjustment in 2019. The simple difference between MIPS and APMs is the amount of risk physicians are willing to take on and the amount of the payment adjustment (being positive or negative) they receive for trying to transition to a value-based care model. While participating in an APM you are taking on more risk as a physician or practice and for that you are rewarded with a 5% bonus if you meet those requirements, while being enrolled in MIPS you need to submit your data demonstrating your performance in the transition to value-based care, your reporting data is then scored; a higher score indicates earning payment incentives and a lower or no score indicates a paying a penalty. These tracks are both better suited for larger practices and organizations because they will have more resources to make sure that they can keep up with the requirements for both MIPS and Advanced APMs. However, some independent primary care physicians may be exempt if it’s their first year excepting Medicare payments or if they bill less than $30,000 in Medicare per year or see fewer than 100 Medicare patients. As of 2017, virtual groups (which allow physicians of small or solo practices to pull their resources together so they can participate in the QPP) will not be implemented but CMS is planning on implementing the groups in 2018.

Nick Dealtry

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89% of patients value their relationships with primary care physicians

Access to a primary care physician for patient care has been shown to be effective in improving patient outcomes. Also important to the patient, according to 89% of those polled in a recent survey, is the relationship the patient has with that primary care physician. The survey, conducted by Health is Primary, a campaign from Family Medicine for America’s Health (FMAHealth), asked a national sample of about 22,800 registered voters about a number of aspects of their healthcare. Additional results from the survey include: 88% said it's important to ensure coverage for preventive and wellness care to keep patients healthy 91% said it's important that healthcare is affordable 85% said physicians should be paid based on the value of the care they provide and not on the number of procedures they perform 88% said it should be a priority of the country to ensure access to family and primary care physicians A relationship with a primary care provider is important to patients. Fierce Healthcare reports, however, that a government survey conducted in early 2017 showed that there are still a number of Americans who do not have a primary care physician at all. In fact, the report states that “28% of men and 17% of women don’t have a personal doctor or healthcare provider.” Access to healthcare, particularly to a primary care provider, can make a difference in the quality of a patient’s coordinated care and overall health, particularly for chronically ill patients. At Elation, we believe that the primary care physician can play a significant role in a patient’s healthcare outcomes. We also believe that a positive relationship with a primary care physician includes the ability to communicate directly with the physician. Patients quite often have important questions after their visit and need an advanced technology tool that enables them to get answers securely and seamlessly. Elation Health’s philosophy has always been and will continue to be focused on strengthening the relationship between patients and physicians, and enabling phenomenal care for everyone.

Kimmy Hu

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Primary care compensation goes up according to new report

The healthcare environment is changing, with reimbursement transitioning from fee-for-service to value-based payments. At the same time, healthcare insurance options are in flux, with the Affordable Care Act (ACA) potentially being replaced by a new healthcare law. The value of the primary care physician, however, continues to be paramount in the overall patient health care picture. That value is reflected in the increasing primary care physician’s compensation over the past several years. A 2017 Merritt Hawkins survey and the subsequent report reveals that the average family medicine physician income has increased significantly since the 2012/13 survey year: 2016/17             $231,000 2015/16             $225,000 2014/15             $198,000 2013/14             $199,000 2012/13             $185,000 The 2017 Review of Physician and Advanced Practitioner Recruiting Incentives emphasizes that, even with the current healthcare regulatory environment and with the growing importance of various types of specialty healthcare providers, physicians “continue to be the indispensable caregivers at the heart of the healthcare system.” The Review points out that physicians: Handle over 1.2 billion patient visits a year, in offices, emergency departments and other settings. Control 87% of all personal spending on health care through hospital admissions, test orders, prescriptions, procedures, treatment plans and related activities. Generate $1.6 trillion in economic output collectively. Account for $2.2 million in economic output individually. Support 14 jobs each. Elation Health focuses on helping primary care physicians continue to be effective in providing quality healthcare to their patients and continue to run a financially healthy practice. A significant aspect of the overall financial situation for an independent primary care physician is effective practice management. Elation has always been focused on building a technology platform that physicians actually want to use, that improves patient outcomes, and that will eventually transform the delivery of healthcare itself. Our Clinical First EHR provides all of this and more, so the primary care physician can continue to provide the highest quality healthcare available in a cost-efficient setting. Learn more about how Elation supports independent primary care physicians.

Greg Miller

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What are virtual groups and how can primary care physicians benefit from them?

In an effort to reduce the reporting burden on small and independent primary care practices participating in the Quality Payment Program (QPP) as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Centers for Medicare & Medicaid Services (CMS) has issued a proposed ruling that outlines a number of changes for 2018. One of the most significant aspects of the proposed change is a concept called “virtual groups.” For primary care physicians, the new ruling should alleviate much of the administrative burden of complying with program requirements. With the new proposed rule, says CMS Administrator Seema Verma, the aim is to “improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork.” Virtual groups will be comprised of 10 or fewer eligible physicians, who join together virtually to participate in the Merit-based Incentive Payment System (MIPS) in 2018. Virtual groups ease the burdens on primary care physicians as they will be able to pool their resources and report together. Elation plans to offer functionality to these providers that allows them to dynamically collaborate on patient charts – a key driver of success in the new MACRA reimbursement system. Elation believes that virtual groups can and should be a powerful tool to not only create administrative efficiencies for participating providers, but also to clinically benefit patients and to encourage collaboration that improves the quality of their health care. Independent physicians are already focused on the quality of care they provide to their patients and generally are adept at coordination of services. Virtual group participation should improve the quality of care received by patients of the participating providers by facilitating care coordination and improvement activities. CMS states that “The Quality Payment Program, updated annually as part of MACRA, is meant to promote greater value within the healthcare system.” The new proposed ruling on virtual groups will enable primary care physicians to more actively participate in this program and to continue to contribute to higher quality healthcare delivery.

Nick Dealtry

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Survey reveals national attitudes toward primary care

Independent primary care physicians work hard and face many challenges. The primary care physician focuses on overall patient health, while collaborating with specialty providers and healthcare facilities. Of course, improved patient outcomes are reward enough, but independent primary care physicians may also be wondering, what do Americans think about the state of primary care now? A survey was conducted recently of 22,800 registered voters to determine their attitudes toward primary care. The survey was part of the Health is Primary campaign, out of Family Medicine for America's Health (FMAHealth) which was created in 2013 by the American Academy of Family Physicians (AAFP). The survey participants overwhelmingly agreed that “primary care should be a priority for policy makers.” In addition, 86% of the survey participants stated that “primary care leads to: healthier patients, higher quality health care, and lower costs.” 88% of Americans responding to the survey said it is important to “ensure coverage for preventive and wellness care to keep patients healthy” and an equal number said it is important to “ensure an adequate supply of primary care doctors.” Among the priorities for their own health included in the survey, the highest percentage of respondents, 89%, said “it’s important to have a relationship with a doctor or physician who knows your health background and your family and medical history.” Independent primary care physicians who communicate regularly with their patients are able to develop that relationship that then enables them to provide quality healthcare. In addition, an EHR system that provides all of the patient’s health information in one place, available with one touch, assists the primary care physicians in gathering an overall picture of their patients’ background and medical history. At Elation, we are focused on supporting that physician-patient relationship that has been identified as an important factor in the national attitudes toward primary care.

Kimmy Hu

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Why primary care doctors are trailblazers for Value-Based Care

As healthcare transitions from fee-for-service to value-based reimbursement, primary care physicians are the most well-equipped physicians to lead the transition and have the most to potentially gain from the transition as well. With the cost of healthcare services continuing to rise, patients will start demanding more and more value, while also asking for more transparency and for tools to evaluate if they are receiving the appropriate value of care for what they are paying. Value-based care suggests that we might be able to considerably improve the quality of care provided to patients while reducing the total cost of care. For this to happen we need to enable primary care physicians with the tools, technology, procedures and economic incentives to help them transform the healthcare system. The California regulatory model for fully capitated primary care delivery strongly believes in partnering with independent primary care physicians so that we can provide integrated support, technical systems and framework, and a knowledge of reporting requirements in order to help small practices survive and eventually succeed in the transition to value-based care. If we had this type of support system for physicians transitioning to the value-based care models there would be much less resistance to the change. As stated by the American Academy of Family Physicians, one in three family physicians is already actively pursuing value-based payment models. Primary care physicians goals align with this type of patient care and reimbursement framework, however, physicians have stated that the lack of time and resources to implement the change as being one of the largest difficulties involved in value-based care. Finding new ways to help physicians manage their costs of care, allow for a greater work-life balance and improve the level of care they give to their patients, can be a very valuable service during this time of transition. To learn more about Elation Health’s cloud-based Clinical First EHR solutions and how we can help you succeed in the new value-based care landscape, contact us today!

Nick Dealtry

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