http://www.palmbeachpost.com/business/content/business/epaper/2009/08/09/a1b_ibmhealth_0810.html
Can a new medical practice style lower Florida’s notoriously high employee costs?
By STACEY SINGER
Palm Beach Post Staff Writer
Sunday, August 09, 2009
BOCA RATON – Of all IBM’s offices in the United States, none has employee medical costs as high as South Florida.
So on a recent visit to Boca Raton, IBM executive Dr. Paul Grundy of Hopewell Junction, N.Y., pulled in to a cardiologist’s office to test a theory.
“Chest pain,” he said to the receptionist. “I need to see a doctor right away. I have chest pain.”
He was led in to an examining room. Grundy offered a textbook list of symptoms to the doctor which described costochondritis – sore ribs. Treatment? Advil.
Grundy said the doctor wanted an immediate CAT scan of his chest. Grundy objected, saying he’d just had one, and it showed his arteries were in great condition. In that case, the physician said, he needed an immediate cardiac catheterization to find the source of the pain. It’s a hospital-based procedure that involves snaking a probe through veins into the heart.
“I was just an opportunity to make a Mercedes-Benz payment,” Grundy said. “I’m sorry to say that, but it’s true.”
Grundy is IBM’s director of global health care transformation, and he’s on a mission to lower Big Blue’s employee health costs. But more than that, Grundy wants to lead a revolution in how health care is delivered everywhere.
Washington is listening.
Today, Grundy is speaking with President Obama and the director of the White House Office of Health Reform, Nancy-Ann DeParle, about a concept called the patient-centered medical practice.
The latest version of the House health reform bill includes $1.6 billion to advance the patient-centered medical practice concept.
It combines the ideal of the old-fashioned doctor-patient relationship with modern, data-based, electronic patient-management tools. The goal is to get away from “doctors getting paid to do stuff,” Grundy said, and return to a time when doctors knew their patients’ every vice and virtue.
Doctor: System is broken
In the patient-centered model, Grundy’s doctor should know him and his cholesterol so well that Grundy’s chest pain complaint would first raise the possibility that he had over-exerted himself.
The managed care era has divorced doctors and patients to the point where, studies show, most hospitalized patients cannot name their physician. The system is fundamentally broken, he said.
“We’ve discovered the enemy, and it is us; it is me, the employer. It’s how I buy my care,” Grundy said.
Under the patient-centered model, the patient’s primary care doctor becomes the quarterback of their health care team, calling the plays, making sure they’re executed properly.
Grundy insists it’s not managed care as most people experienced during the shift to health management organizations, HMOs.
Patient-centered medical practice pilot projects are under way in the Philadelphia and Denver metropolitan areas, the Mid-Hudson Valley, New York and Rhode Island.
Dr. Dennis Saver, a family practice physician in Vero Beach, wants one in Florida. And soon.
“The incentives in the American medical system are that you get paid for what you do and that’s all,” said Saver, who is a past president of the Florida Academy of Family Physicians.
“So if you do a stress test, or you do an X-ray, or you do a surgery, then you are paid,” he said.
“If you talk to people you get paid a little,” he added. “If you think about what’s going to help your patient be well over the next five years, you get paid nothing at all.”
Under the pilot programs, insurer Aetna is paying primary care doctors between $35,000 and $90,000 each above their normal fees to make the shift. UnitedHealthcare is paying an extra $3 per member per month in an Arizona pilot project, and in other pilots, it’s paying extra for doctors to hire care coordinators, said Eric Sullivan, UnitedHealthcare’s national director for medical home initiatives.
Participation carries cost
Participation in the pilot requires an investment from the doctors: They must be credentialed by the National Committee for Quality Assurance, and they’re urged to adopt an electronic patient record system, which can be a significant investment.
Doctors are coached to use accepted standards to manage disease.
They must demonstrate they’re easily accessible to their patients, whether it’s taking e-mails or allowing walk-in visits.
And they are encouraged to use electronic systems to write and send prescriptions, track tests, and see that patients follow through on referrals and keep up with hospital release advice.
Saver said his electronic record-keeping system cost more than $175,000.
“That major change in technology comes with a price tag, and right now that price tag comes out of your hide as a doctor,” Saver said.
Dr. Donald Liss, who is heading up Aetna’s patient-centered medical practice initiatives, said physicians are making major changes in how they run their practices.
“It’s not good enough to deal with patients when they show up. You have to have a system in place to follow them,” Liss said. “If you send them to a cardiologist, you have to confirm that the meeting happened and find out the outcome. When you prescribe medications, you make sure that’s what the patient is taking.”
Grundy said he began pushing for such a system “literally the day after the Clinton initiative failed.”
Most of the pilot projects are so new that data is still inconclusive on whether they save money.
While there’s an up-front cost for insurance companies, Grundy is convinced that time will show that patient-centered medical practices save money by improving patient behavior, eliminating duplication, and reducing hospitalizations and readmissions.
Liss, at Aetna, is not entirely convinced that patient-centered medical practice will provide less costly care, because they may wind up sending patients to the doctor more frequently. But the concept may well prove it’s providing more effective care and more satisfying care, he said.
“If it results in better health care and doesn’t cost more money, that’s not a bad outcome either,” Liss said.