Value-based care - Rerouting of Patients Based on Value-Based Purchasing

A new approach to health care is in the works and in the wind, and you should be aware of it. It’s important in that it may reroute patients away from you before they have the chance to see you. It may make data the criteria for seeing you rather than their relationship to you. It represents a new form of intensive managed care.


It started with Medicare this summer. It’s called PQRI, for Physician Quality Reporting Initiative, and it’s now spilling over into the private sector into health plans and corporate worksite clinics. Under the initiative Medicare will pay doctors a 1.5% bonus incentive for recording and reporting quality measures, and doctors will be required to measure quality of service.


Ultimately, PQRI will probably require doctors to install software so they can comply with “best practices” and electronically record how they measure up in meeting various quality measures, of which there are already more than 500 for more than 200 clinical conditions.


What are the clinical implications of PQRI? It will require either an EHR or online software to implement best practices and to measure quality. It may give doctors incentives to treat healthier patients with better outcomes. It may cause many doctors, wary and weary of bureaucracy and paperwork, to no longer accept new Medicare patients. It will be an added practice expense. It may force doctors into larger groups so they can afford the information infrastructure they need. It may improve care and outcomes. And lastly, in the name of equality and cost savings, it may reroute patients to other care settings and other doctors before they have the opportunity to see you.


Now let’s examine how value-based reporting might work outside the Medicare setting. Today a new wave of corporate worksite clinics is opening, driven by employers’ desperation to reduce health insurance premiums by taking care of workers before they need to see outside doctors.


More than 100 of the nation’s 1,000 largest employers now offer on-site primary care or preventive health services — forecast to exceed 250 by the end of 2007. Companies opening or expanding these clinics include Toyota, Sprint Nextel, Florida Power and Light, Credit Suisse and Pepsi Bottling, and a small company in Florida called MycareTLC, which plans to franchise these clinics across multiple corporate settings.


According to MycareTLC, these clinics are projected to save as much as 45% to 50% inhealth care expenses for employers. How? Well, it’s claimed company doctors onsite can conveniently assess the situation, prescribe generic drugs on site, follow best practice guidelines, and refer to pre-selected specialists, judged by data mining to be the best performers, the most quality oriented, and the most economical. Furthermore, employees need not travel to see a doctor for routine care, pay no co-pay, receive generics at cost, and they and their families can be coached on healthy living and preventive care.


The clinics have an EHR integrated with an online editing and publishing service containing best practice information and evidence-based data on 200 clinical conditions, updated daily. In addition, the clinic and its doctors have access to information from a data-mining company which identifies high risk individuals, high performance physicians to whom to refer, and offers clinical advice and strategies to employers, purchasers, and patients.


The concept of a company doctor at worksite clinics isn’t new. Companies have had doctors on site for decades, and Kaiser Permanente turned the concept into the largest medical empire in the land. But the idea franchising medical onsite clinics across multiple corporations is relatively new and may be something for physicians to watch for and know about.





.