The Affordable Care Act authorized the creation of the Medicare Shared Savings Program, which in turn allows Medicare to contract with accountable care organizations. ACOs, in turn, will be motivated to reduce discretionary office visits.
As the Centers for Medicare and Medicaid Services explains, the MSSP "promotes accountability for a patient population, coordinates items and services under part A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery."
Dr. Jon O. Ebbert
Some of us believe that the Medicare fee-for-service payment model will remain on the table in the future but that it will become de-incentivized relative to an ACO model. Many challenges remain, however. At its core, an ACO model of care is designed to promote high-quality clinical care and cost controls by providing incentives for care coordination, improved patient experiences and safety, and preventive health.
To control costs, the low-hanging fruit may be office visits. Office visits require staff, and we all know that some patient complaints could be handled differently. To this end, it is important to understand why people visit health care providers in primary care.
Our research group at the Mayo Clinic analyzed data from the Rochester Epidemiology Project (REP) to determine the most common nonacute clinical diagnoses in a well-defined population (Mayo Clin. Proc. 2013;88:56-67). The REP records linkage system includes the medical records of patients residing in Olmsted County, Minn., who receive the vast majority of their medical care through the Mayo Clinic, Olmsted Medical Center, and the Rochester Family Medicine Clinic.
For this study, we searched the REP electronically to extract the ICD-9 codes in the medical records of members assigned by any health care institution from Jan. 1, 2005, through Dec. 31, 2009. Diagnoses were assigned based upon clinical visit assessments and subsequent assigned and billed diagnoses.
Among 142,377 patients, skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most prevalent diagnoses.
If we have an understanding of the resources needed to address the most common issues, we can creatively explore how to accomplish the same amount of work while streamlining care and reducing costs.
Is teledermatology ready for prime time in the United States? Perhaps not, but embedding orthopedic specialty colleagues in the primary care practice, as we have done at our institution, may reduce downstream utilization and has an evidence base to support it. Addressing all lipid disorders telephonically with nurse protocols certainly seems like fertile ground for exploration. Enhanced phone triage for respiratory tract conditions also may decrease visits.
If we are planning on bravely surviving into the future of medicine, knowing why patients visit us is the first step in developing care models to alleviate the need to do so.