Story was updated Sept. 15, 2017.
Dr. Katherine Clark was tired of the fee-for-service status quo. Every day, she would go through the same motions: see patients, treat their ailment and not see them again until they had a new health issue. But those patients weren't getting better in the long run, and she wanted the cycle to end.
That required a change in how she and other members in her practice were paid.
"The way reimbursement has been structured for years was that in order to make ends meet, there was pressure to see patients as rapidly as possible," said Clark, a family medicine doctor who practices at the Integrated Medical Group in Beavercreek, Ohio. The practice is part of the Kettering Physician Network, which has 135 primary-care physicians in 37 practices in the Dayton, Ohio, area.
In 2012, Clark and her practice began their journey to transform how practitioners delivered care. When the practice was accepted into the CMS' Comprehensive Primary Care Initiative, it moved from the standard care pattern to one that put more emphasis on preventive screenings and follow-ups. Not only did she notice an overall improvement in quality of care, her practice also achieved notable savings under the model.
Clark's practice reduced average monthly patient costs by about 40%, from more than $1,200 a month to $725 by the time the initiative ended in 2016. The practice also had marked reductions in emergency department utilization and hospitalizations for chronic illnesses. And the program helped them decrease costs associated with congestive heart failure by almost 50%.
Providers are hopeful that success stories like Clark's will spur the CMS to pursue more multipayer models like the Comprehensive Primary Care Initiative. Introducing more models that only target Medicare beneficiaries, especially now that the agency wants to make participation in value-based pay arrangements voluntary, may not be enough to get doctors out of the fee-for-service mindset, physicians say.
