Physician Personals: Specialty group seeks primary-care practice

The single life may prove troublesome for specialty group practices under MACRA.

David Fitzgerald, CEO of Proliance Surgeons in suburban Seattle, said specialty practices are in the dark about their fate under the new physician reimbursement system.

Things are clearer for primary-care practices in determining costs and quality involving care for Medicare patients, he said. But specialty practices like his, which has 420 providers and generates $400 million annually in revenue, will have to wait until the CMS releases its final regulations in November.

The uncertainty could forge greater alliances between the two worlds.

Proliance, where 25% of its patients and 17% of its revenue come from Medicare, has had some experience with Medicare's Bundled Payments for Care Improvement initiative, which required the group to put some revenue at risk. Starting about a year ago, Proliance opted in for diagnostic-related groups for orthopedic surgery and ignored those for general surgery, where it has small volume.

It's worked out well so far, Fitzgerald said. In the first quarter, Proliance saved Medicare about $400,000, yielding a $22,000 bonus. “It isn't a needle mover for us yet. We're hoping MACRA moves the needle more for us,” he said.

He said that specialty groups and primary-care groups will need to improve care coordination with hospitals and skilled-nursing facilities because of MACRA. In the past, Proliance didn't know total costs of care for an episode and didn't necessarily know if a patient had been re-admitted later.

Fitzgerald said a major issue facing specialty groups is coordinating information with primary-care groups, which use a raft of electronic health record management systems that don't talk to each other. “MACRA is forcing us to focus on the patient, which is the right way to be, but right now we are operating nine different electronic health records,” he said.

He said his group is contemplating “a data warehouse approach” that will enable it to deal with multiple medical record systems to compile data it needs for MACRA on costs and quality.

Fitzgerald said his group aims to be in the better-compensated Alternative Payment Model groups under MACRA. He noted, however, that a specialty group almost by definition cannot manage populations like an accountable care organization.

Proliance's strategy is to team up with primary-care groups to manage populations. “MACRA has helped us open those doors,” he said.