You still see them on Turner Classic Movies: The country doctor working solo, delivering care and charging a simple fee for medical services. Not only has the health care industry changed dramatically since Hollywood’s golden age, but more physician private practices—even those with strong ties to the fee-for-service model—are adjusting to take advantage of the value-based care arrangements that are increasingly available.
Mississippi’s Hattiesburg Clinic opened in 1963, but can trace its roots to 1948 when two local doctors partnered to provide ob-gyn and general surgery services. Since then, it has grown to be the state’s largest privately owned multispecialty clinic, with more than 500 physicians and nonphysician providers. Hattiesburg Clinic is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
The physician-owned and -governed health system’s journey as a value-based care organization started in 2007 and is still evolving, said Hattiesburg Clinic CEO Bryan N. Batson, MD. But he and his colleagues have learned a lot about building a state-of-the-art approach to value-based care.
Dr. Batson said Hattiesburg Clinic began its plan to pursue value-based care with a commitment to remaining an independent practice.
“We wanted to frame a future where we were being mindful of value-based health care delivery and how that intersects with our quadruple aim—something that is important to us as an organization,” he said in an AMA webinar that is part of Private Practice Simple Solutions, which are no-cost, open-access, rapid learning cycles that provide opportunities to implement actionable changes that can quickly increase efficiency in private practices. Learn more.
Watch the full webinar and join the asynchronous discussion board to post your questions for Dr. Batson. Register now for a second webinar on value-based care with Dr. Batson, which takes place tomorrow, April 29, 10:15 a.m. CDT and will include a live Q&A.
Improvements didn’t come overnight
That quadruple aim includes enhancing patient experience, reducing cost, improving population health and improving the work life of physicians and other health professionals.
Hattiesburg Clinic enrolled in its first Medicare Advantage program in 2007, and in 2012 started taking part in the Centers for Medicare & Medicaid Services’ Physician Quality Reporting System with the now retired group practice reporting option (GPRO), which asked practices to report quality measures annually.
“It was really our first glimpse in the mirror as to how we stacked up in a value-based system—and it was not pretty,” said Dr. Batson, who holds the small/medium group seat on the AMA Integrated Physician Practice Section Governing Council.
After extensive infrastructure and training changes, Hattiesburg Clinic had significantly better results in its GPRO data measuring costs and quality by 2018. The organization then had enough experience and results to take another step.
“How do we re-envision how our teams are composed as we look to the future?” he said.
Over the next several years, the organization increased its level of commitment to value-based care with new contracts with various organizations, including a Medicare Accountable Care Organization, and created a quality management department in 2015. The latest step, he said, was a primary care capitation agreement with a commercial payer last year.
“We are still a fee-for-service organization, but the experiences we have gained in value-based care, I think have helped us stay independent,” he said. Quality has improved as measured by various value-based care indicators and EHR tools.
“It makes me very proud that we have been able to deliver better health care, especially in a state that is often known for poor health care outcomes,” he said.
It takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.
Building a “buy-in culture”
Also, as a result, the quality management department has grown from two to 50 nurses, and value-based payments have grown, helping mitigate the cuts to physician fee-for-service revenues, with Hattiesburg Clinic reporting savings to Medicare of more than $66 million.
Dr. Batson emphasized his organization’s “buy-in culture” as he pointed to the development steps of building beyond the basics of value-based care.
“We are still on this journey, and we are still learning,” Dr. Batson said. Having a good understanding of how quality is measured under various contracts and putting in programs designed to meet to excel on those measures is important as an organization’s value-based care evolves, he said.
