the abcs of practice models: from concierge to acos and everything in between

The ABCs of Practice ModelsFrom Concierge to ACOs and Everything in BetweenPresented by Lea ChathamMarch 23, 2016

webinar

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• Welcome & Introductions• ABCs of Practice Models • How Kareo Can Help• Your Questions

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Speakers

Lea Chatham• Content Marketing Manager at Kareo• Editor of Getting Paid blog• Over 5 years in practice marketing • Over 15 years developing educational

content for leading practice management and EHR companies such Kareo, Emdeon and Sage Software.

• Published in leading journals including Physicians Practice, Medical Economics, & Medical Practice Insider.

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Models

• Direct Primary Care (DPC)• Concierge• Independent Physician Associations (IPAs)• Accountable Care Organizations (ACOs)• Telemedicine/Virtual Practice

Direct Primary Care & Concierge46% of providers considering one of these

models

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Direct Primary Care

• Patients “purchase” care direct from provider

• Can be membership paid monthly, quarterly, annually

• Can be a la carte paid service by service

• Good for patients with high deductible plans or no coverage

• Sometimes through employer contracts

• Focus on preventive care/urgent care

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Concierge

• Patients pay retainer/membership $2,000 - $20,000 per year

• In return may get 24/7 access, personalized care, house calls

• May also bill insurance for covered services (80% function as hybrid)

• Geared towards high end market, busy executives, etc.

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Direct Pay & Concierge

• For physicians:- Smaller patient panel (less than 1000)- Longer patient visits (30-60 minutes)- Less administrative work (5 fewer hours per

week)- Work fewer hours overall- Lower overhead/smaller staff- Increased revenue (more than double when

done right)

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• For patients:- Improved access and service- Longer patient visits (30-60 minutes)- Focus on prevention and keeping patients out of ER- May include wellness component- More engaged relationship with the physician- May be able to use HSA for direct care

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• Legal & Regulatory Issues- May be viewed as providing insurance- Can trigger fee-splitting laws, self-referral laws, and

anti-kickback regulations- Can’t charge membership fee and bill Medicare for

covered services (double billing)- Rules around opting of Medicare (follow them!)- Some states have discrimination laws that can be

triggered by concierge- May violate hold harmless clause in HMO contracts

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• Other considerations- Smaller patient panel means bigger impact when

patients come and go- Bigger focus on patient experience and patient-centric

solutions• Patient portal• Online scheduling• Text communications

- Marketing and growing the practice can be harder- Technology can play a bigger role

Telemedicine/Virtual Practice72% of patients willing to do telehealth visits

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Telemedicine/Virtual Practice

• Potential benefits:- Improved access & convenience for

patients- Better management of chronic conditions- Fill open appointments- Lower overhead

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• Potential Drawbacks- Equipment (cost, reliability, etc.)- Confidentiality/Security- Licensure- Varying payer rules and reimbursement- Malpractice and liability

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• Patients are interested• Many willing to do self-pay• Payers are starting to cover services• You can go all in or add as a service• You can work for an established service

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• A note about patient collections:- If doing self-pay telemedicine, patient

collections is critical- Set up credit card on file- Offer electronic statements and online

billpay

Independent Physician Associations

More than 70% of independent physicians say they don’t want to sell their practice

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• Group of independent providers• IPA often takes on contract

negotiations, disburses payments, and manages administration

• Can reduce some risk and management• Often on a capitation or modified fee-

for-service structure• You may still be able to have other

contracts as well

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• Things to ask about:- What is the organizational structure- Sound fiscal management?- Is the management style a match for

you?- What technology do they use? Will you

have to switch? What is the cost?

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• Not sure, consider outsourcing instead:- Is billing your biggest issue?- Are you struggling to keep qualified

staff?- Are you uncomfortable giving up

administration?- Would you prefer to stay on your

own?

Accountable Care OrganizationsOver 600 ACOs in the US today

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Accountable Care Organizations

• About 600 ACOs in US• Value-based care model • Most on Medicare Shared Savings

program• About half are hospital led and half are

physician led• Requires EHR and HIE to track metrics

and outcomes• When certain measures are achieved

participants share in the savings

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• Payment influenced by quality and patient satisfaction scores

• There can be direct costs for software, indirect costs for care coordination and data entry/tracking

• May not be able to have any separate contracts from the ACO

• Assumes financial risk for poor outcomes, so providers need to have ability to manage this risk

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• Note about Virtual ACOs- More flexible, often groups of

independent providers- Participate but also maintain

independence- Can keep other contracts and software- May be direct costs to join- Still more work and indirect costs to

track data, report measures- Still have same financial incentives

Final Thoughts

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In Conclusion

• You have lots of options to be an Agile Medical Practice• Evaluate your practice, your patient panel, and your community• Look at ways to test models in your practice (i.e., DPC, virtual

ACO, etc.)• If unsure about model change, consider options like outsourcing

to help your practice• Take advantage of technology and all the benefits it offers

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Awards

Cloud-based Billing, Scheduling & Practice Management Electronic Health Records Medical Billing Services Practice Marketing & Patient Engagement Free Education, Training, & Support Ranked #1 by Black Book 3 Years

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Discover Kareo’s Role

DoctorBase Practice Marketing & Patient Engagement• Appointment reminders• Recalls• Email & text

communications• Patient surveys• Website & SEO• Online reviews• Provider directory• And more

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Kareo Practice Management

• Fee schedule updates• End-to-end claim

management• Task Management• ICD-10 Ready• Patient collections

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Kareo EHR

• Fully-mobile EHR• 2014 Edition Certified

for MU• ICD-10 ready• Flexible documentation• Specialty templates• Electronic Superbill• Patient Portal

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Kareo Medical Billing: Web, Mobile & Messaging!

• Web and Mobile Software

• Calendar & Patient Check-in

• IBM & MAC Enabled• Secure Messaging• Revenue Cycle

Performance for Visibility

• Kareo Success Team

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the abcs of practice models: from concierge to acos and everything in between

Health & Medicine