Practice Management Update: FFS

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Practice Management Update FFS IAHTrends,
Near Term Survival Strategies, Technology,
Managing under IAH related programs

• Kevin Jackson MD
• Geriatric Solutions House Calls
• Washington DC, AAHCP Annual Conference
• April 29, 2008

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OVERVIEW

• Summary of topics to be discussed
• Integrating IAH or IAH-like care for your
  practice
• Dealing with Medicare cuts
• Identifying strategic partners
• Integrating technology
• Leveraging the demographic shifts to your
  advantage
• Optimizing revenue change the house call
  paradigm
• Reasons for optimism

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Preparing for the next future

• It was the best of times

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Dealing with Medicare cuts

• Anticipated revenue cuts
• 40 reduction in Medicare by 2012
• Growth of entitlement programs
• Increasing costs of SS, Medicare Medicaid
• Increasing proportion of budget and of debt
• Potential crisis for Primary Care
• Dissatisfaction will cause PCPs to retire
• FFS care increasingly unsatisfactory for
  Providers Patients
• Increasing costs for practices with decline in
  revenue

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INDEPENDENCE AT HOME

• Change focus of care from acute, problem oriented
  care to Chronic Illness Management (CIM)
• Aligning objectives
• Pay for what you want to happen
• Clearly define goals

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Adapting your practice

• Transition from LTC in the home (private, AL,
  Group)
• 24/7 coverage-necessary or just desirable?
• Strategies to facilitate
• Partnering
• HHAs
• Urgent care or ER groups
• Creation of a larger call group with like minded
  Providers
• Joining or creating a medium to large group
• Adding a parallel urgent care group to an
  existing group with 1099 Providers
• Referral only or Urgent Care type practices
• May be able to partner with groups to act as
  Urgent Care or prn visit group

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Putting IAH into practice

• Telephone vs. On-site visit
• Communicate
• Visit frequencies? Unknown but likely 1.3-1.5
  Provider visits (physician vs NP vs PA) but may
  replace or add additional SW, RD, Caregiver, RN
  visits or 1099 Urgent/ER visits
• More ill the mix, the more frequent the contact
• Creating your team team (MD, NP, PA)? so
  variable that it is situation dependent on the
  skill set of your team your area
• Can you do this solo (MD, NP, PA)? NO!!
• Technology
• Computerized records although not necessarily an
  EMR
• Other Access to lab draws, X-ray, US, EKG, CLIA
  waved tests

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IAH Decision Making

• Specialty services to keep people out of
  hospitals how far to go in wound care?
• Nutritional issues such as dehydration? Other? IV
  therapies, Laser therapy (for wound care, pain,
  peripheral neuropathy, small skin excisions),
  sleep oximetry, ambulatory BP monitoring, Holter
  monitors, change of tracheostomy tubes or PEG
  tubes
• Ancillary testing alternatives what provisions
  must be made to keep people out of ERs and
  inpatient settings.
• Labs, X-rays ability for urgent assessment by
  phone and in person as necessary
• Care coordination what is it? What services must
  be provided and how soon?
• Evidenced-based protocols for clinical care
• Disease management protocols fail miserably with
  even 2 significant illnesses

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Opportunities for partnering

• New payment system(s)/Incentives
• PACE, opting out, P4P, HMOs
• Integrative and Anti-aging Medicine
• Independence at Home
• Medical Home
• Actions and stake holders
• AAHCP
• AMDA
• AAFP
• ACP
• Many others both government and private
  enterprise

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Identifying strategic partners

• Hospice
• Home Health Agencies
• Hospitals hospital systems
• Health Plans
• Multi-specialty medical groups
• Hospitalists
• Be wary of what incentives hospitals have in
  working with groups

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Working with health plans

• Speaking the CEO language
• Know the financial reasons
• Present a cogent argument without emotion
• Quality is assumed and is NOT an important part
  of your presentation
• Understand the metrics better than the health
  plan does

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Integrating technology

• EMR
• Disease and illness management
• Architecture matters
• CCHIT
• Telehealth
• Gerotechnologies
• Monitoring systems, Robots, Epogenetics

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Leveraging the demographic shifts to your
advantage

• Point of care our strength as home care
  providers is flexibility
• Pushes for a different care system
• Baby boomer health consumerism
• Quality of life
• New forms of LTC
• LTC without walls
• Village of NY micro nursing homes
• Spa type adult day care
• PACE programs
• Re-inventing the nursing home
• Adult Day care and Adult day spas

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Optimizing revenue change the house call paradigm

• Variety of models of care
• Primary care
• Urgent care
• Boutique
• Private pay
• University based
• Hospital based
• Government funded
• Other
• Subscription models
• Complementary medicine
• Patients pay for your EMR

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Reasons for optimism

• The baby boomer wave
• Flexibility
• Technology and freedom from bricks and mortar
• Medicare has little choice but to embrace new
  models

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QUESTIONS/COMMENTS

• Questions or comments?