How geriatric practices can bend the cost curve and succeed with

The Centers for Medicare & Medicaid Services (CMS), have updated their compensation rules. This has put increased pressure on long-term/postacute care providers (LTPAC) to adopt value-based care models. These pressures and the COVID-19 pandemic challenges have increased the need for geriatric practices to adapt their business practices and technology in order to facilitate collaboration and coordination between payers, healthcare systems, and care facilities.

Two successful geriatric practices presented their strategies for building and maintaining a value-based infrastructure in LTPAC settings. Genevieve is a geriatric care management and medical practice based in Minnesota. Amanda Tufano MHA, FACHE. CMPE is the chief executive officer. Multiple value-based payer contracts are held by the organization for dual-eligible patients.

Michelle Coffey ACNS-BC RN, MSN is the chief clinical officer of Austin Geriatric Specialists. It is central Texas’ largest geriatric-focused medical office. This organization cares for thousands of patients and follows them throughout the continuum from hospitalization to skilled nursing facilities to assisted living facilities to a successful transition home.

The presentation was focused on three areas of focus:

• Value-based care models are encouraged
• A company culture that discourages burnout
• Capitated payment models can be supported with the right technology.

Value-based care models are encouraged

Genevive sought better alignment with payers, provider partners and providers on financial and clinical goals. Genevive aimed to build closer partnerships with payers and providers, as Tufano pointed out that facilities require more than just “guests” in their buildings. Two new Institutional Special Needs Plans were developed (I-SNPs). These plans are designed to strengthen ties with facilities and create the infrastructure for financial and clinical incentives. Evaluation of existing networks. Explored ways to offer innovative care and encourage more facilities and people to join Genevive

Facilities share metrics and goals

Diversified ownership allows for the creation of additional value-driven contracts. Austin Geriatrics introduced value-based care in 2018 and Coffey says it is the largest area for continued growth. Participated in capitated models and risk sharing pools to encourage growth in assisted living, homecare and hospital-based settings.

Austin Geriatrics’ care goals include deprescribing and reducing invasive testing, holistic health care, family involvement, advanced care planning, and family involvement. To support financial diversification for the practice, and to provide better care for patients, continue building relationships with value-based partners.

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Prevention of burnout and company culture

Genevive’s Tufano said that the requirement for providers to see a certain number of patients per day can make providers view their profession negatively. Instead of helping patients, they feel pressured to meet quotas in return for their money. Genevive’s model can be customized to suit the preferences of providers in order to keep incentives and values aligned.

Providers are paid based on how many patients they can manage on a given panel size. If the practice is performing well, owners and the entire practice share in a performance incentive pool. Genevive believes that capitation should be treated with greater ethics and the model places emphasis upon quality of care. Austin Geriatrics is proactive in reducing burnout and staff turnover. It also focuses on hiring providers who share its mission.

Employees are provided with extensive training, which includes practice to their highest licensure level. To ease the pressure on team members and to reduce time constraints, create a dedicated team for after-hours on-call. Providers can receive free counseling and are encouraged to explore ways to increase flexibility in scheduling to improve work/life harmony.

Technology and process strategy

• Genevive moved to mobile technology in 2019, after major disruptions to client services caused by a winter snowstorm. These upgrades helped Genevive to be ready for the COVID-19 pandemic.
• Installed a new phone system compatible with iPad Wi Fi calls
• Changed to GEHRIMED. An electronic health record (EHR), designed to work with iOS and iPads, was created specifically for mobile practitioners
• Genevive was able to quickly bill and provide services for telehealth, virtual care, and other related services when CMS issued new rules for practitioners in 2020.
• Austin Geriatrics added third-party solutions to its EHR to reduce the amount of documentation time. Coffey said that managing multiple vendors was inefficient.
• Austin Geriatrics has switched to GEHRIMED because of the features and processes that support how geriatricians work.
• Clinicians are supported by built-in functionality, including standardized reports, advanced searches function, and CPT code protection
• Dashboards that send out alert notifications about quality measures are a support for value-based care models.
• Integrity features allow practitioners to stay in touch with office support services and on-call services.

Value-based care models and risk-sharing payments agreements will continue to be more common. CMS will continue making changes to its compensation rules. LTPAC providers must look ahead to ensure financial stability and adapt to new technology and processes. This will result in stronger collaboration with other providers, enhanced quality of care and financial stability. You can watch the entire webinar here.