It's common to have complex patients who you frequently see attributed to you. But what about a complex patient who sees multiple specialists but sees you infrequently, and only for simple acute problems? Such patients, and all their associated quality gaps and specialty costs, are also being attributed to you.
Without having any opportunity to help manage their care, you are left to rely on specialists to provide a coordinated clinical experience and document quality and risk codes. Just as important is the healthy patient who has limited contact with the healthcare system. This patient may find himself unattributed, even though he or she believes you are their physician.
It sounds simple but the key to attribution is seeing your patients, both the sick and the healthy.
At my practice, Village Family Practice (VFP) in Houston, Texas we use the annual wellness visit (AWV), a high-intensity visit that focuses on precise coding to capture an accurate acuity level, screening tests to close gaps in care, and preventative services, as the visit that helps drive attribution. The AWVs on our most complex patients are conducted by physicians; those patients with less complex problems are scheduled with our nurse practitioners, physician assistants, and clinical pharmacists.
Acuity: Physicians have an average practice panel of 1,500 patients, with 20 percent (or 300) of those patients typically consuming the majority of health care resources in your practice. Can you name your 300 patients?
Knowing the acuity level of patients helps providers prioritize patients, making sure the most complex patients are seen more frequently and have access to the resources they need. Acuity levels are determined by risk acuity scores. The score is determined by a patient''s ICD-10 diagnosis, the more complex the diagnosis the higher the score and the higher the acuity.
Utilization: To successfully manage a complex patient population, you have to know how patients are utilizing the healthcare system--when, where, and why patients have been seen, across the system, including primary care, specialty care, emergency department (ED) visits, and most importantly hospital admissions.
Claims data can provide a historical look back, but are often too old to be useful. Most of us get notifications of ED admits, hospital admissions, and specialty consults from our physician colleagues. Finding a way to make a note in your electronic medical record (EMR) of very simple utilization data such as ED visits can greatly improve identifying patients who need more attention.
Utilization and quality are most accurately measured by combining EMR and claims data. Doing so allows you to view utilization both inside and outside of your practice. Once only available to large groups, this data is now available through independent physician associations, management services organizations, health information exchanges, and practice management companies.
Dr. Clive Fields is president of the Village Family Practice and co-founder/chief medical officer at VillageMD.