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Small Practices Forging Ahead in Value-Based Care : Page 2 of 5

Small Practices Forging Ahead in Value-Based Care : Page 2 of 5

Family Medical Specialists

Located in Plant City, Fla., where the snowbirds fly in the winter, it's not surprising that family medicine physician Michael Paul Gimness' practice has a patient panel composed of nearly 53 percent Medicare patients. As such, Gimness, who is a solo doctor with a nurse practitioner on staff, has gotten on board with value-based care. Any cut into his Medicare reimbursement would do significant damage to his practice's bottom line.

"I saw the way healthcare was going," says Gimness. "If you are not looking [ahead] to [MACRA], in 2019, 2020, 2021, there is a 9-percent decrease in reimbursement for the bottom 12 percent [of practices] … I can't afford to take that kind of cut because my staff will take that cut. Any decrease in pay comes out of my bottom line. In order to stay in practice and in medicine, I have to embrace this. Any physician who doesn't embrace this, they will be financially struggling in the next couple of years."

Gimness is using CPT code 99490 to manage care for his population of patients with two or more chronic health conditions. Using an IT system from CareSync, the practice extracts data from its EHR to facilitate chronic care management (CCM) for eligible patients. For those patients with two chronic conditions, the CCM code, as of Jan. 1, 2015, has paid Medicare providers to check the boxes for various proactive face-to-face, electronic, and phone-care coordination services (preventive care measures, medication reconciliation, discharge follow up, and much more), with the ultimate goal of decreasing hospitalizations, improve outcomes, and lower costs.

For its efforts, Gimness' practice makes $45 per patient (minus what he pays in contracted rates to CareSync). The biggest challenge, he says, is constantly being hands-on with patients to ensure they are being compliant with their care and staying out of the hospital. At the end of the day though, he is a firm believer in population health management, "This is beneficial for my patients, it's beneficial for my practice. It's a win-win."


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