The Evolving Landscape of Independent Primary Care

Posted by Christian Kratsas on 4/13/17 12:26 PM

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Independent primary and speciality care practices have challenging years ahead. MACRA, MIPS, APMs, and the ACA are posing uncertain regulations and complicated payment models.

Despite this uncertainty, there is one thing that’s clear: independent practices must prepare to take on risk in order to stay profitable.

We sat down with Mark Kissinger, executive director of Genesis Medical Associates, to get the inside scoop on the challenges a large independent primary care practice faces in a value-based care and regulatory-driven world.

Primary care will need to adapt to new [MACRA] incentives and requirements rolling out in 2017. Doctors...will face a new era of documentation, reporting, and performance measurement.

- Physician’s Practice, 8 Issues for Physicians to Keep Top of Mind in 2017

In our Executive Interview series, Mark Kissinger explains the mammoth changes he’s witnessed during his experience in multiple practice management roles. He demonstrates the relevance of several quality initiatives throughout his practice, Genesis Medical Associates. Notably, their joint venture in forming the first Medicare ACO in their region, implementing an electronic referral network, and standardizing their referral processes across all locations.

[DOWNLOAD] Get the full interview: A Primary Care Leader's Journey to Value-Based Care

Major Changes in Operating a Large Independent Primary Care Practice

The role of practice leadership is evolving at a breakneck pace. Each year, another measure of improvement, cost, quality and utilization is factored into the way practices manage the care of their patient population.

Coupled with regulatory changes in reimbursement, this new stage of evolution is particularly challenging for practice management.

 Q: Due to these challenges, how has your life as an executive director changed in the last 5 years of running a large practice? When did you begin to witness the rise of value-based care initiatives?

AFFORDABLE CARE ACT

“We really saw it ramp up with the Affordable Care Act (ACA) implementation and the introduction of Meaningful Use,” Mark Kissinger, executive director of Genesis Medical, said when we visited his offices for an interview. “All of the large healthcare payors established their own set of quality criteria and measurements, but value-based initiatives weren’t pushed mainstream until the ACA was enacted.”

MEANINGFUL USE STAGE 2

These new initiatives were the catalyst that brought Treatspace and Genesis Medical together.

“Meaningful Use Stage 2 was the springboard into our relationship with Treatspace because of the measure that required Direct messaging back to the specialist for referrals including the transition of care documents,” Kissinger recalls.

PCMH LEVEL 3

Additionally, as Genesis Medical was in the process of receiving certification for Patient Centered Medical Home (PCMH) Level 3 by the NCQA, they discovered that they “needed to fulfill an additional step, which was closing the referral loop,” Mark explained.

“Treatspace enabled our care coordinators to send a referral to a specialist electronically. In return, the specialist treats the patient and responds back to the primary care physician with a consult report or communication that there was a closed-loop of treatment for the patient.”

- Mark Kissinger, Genesis Medical Associates

BETTER HEALTH IT SYSTEMS

Mark Kissinger asserts that “in order to innovate in patient care coordination, you need technology that EHRs can’t provide… with the ability to manage quality and clinical care on a
real-time basis.”

“We have to respond in real-time and recognize that that's the only way that we’ll win in the new population health management world, accountable care organization world, or the gainshare world,” Kissinger explains. “We are all moving toward risk share, gain share, capitations, and bundled payments. But without the ability to communicate with your specialists, we’re all cooked!”

The executive director of Genesis Medical Associates continues to formulate his strategy for propelling his practice into a value-based world. Mark constructs his background in forming an ACO and strategically partering with specialists to close the loop on referrals. Get the entire interview here or download by clicking the image below.

[DOWNLOAD EBOOK] A Primary Care Leader's Journey to Value-Based CarePrimary Care Leader Journey Value Based Care

Topics: Care Coordination, Coordinated Care, Referral Network, Closed-Loop Referral Management, Value-Based Care