Physician CEO reveals the value of physician-led healthcare teams

When physician leaders at the Hattiesburg Clinic began examining the cost and quality data for the accountable care organization they received from the Centers for Medicare and Medicaid Services (CMS), they did so as a self-evaluation exercise. But what they found has transformed into a national focus in debates over scope of practice and physician-led team care.

Hattiesburg Clinic, the largest private multi-specialty clinic in South Mississippi, took the raw data it received from CMS and learned that non-physician providers were driving up costs by ordering more tests and referring more patients to specialists. Their patients also had more emergency room visits.

“We were very curious to understand internally where our spending was going for our Medicare ACO patients,” said Brian Batson, MD, CEO of the Hattiesburg Clinic, a member of the AMA Health System Program, which provides enterprise solutions to equip leaders , physicians and care teams with resources to help advance the future of medicine.

“More out of curiosity than anything,” Dr. Batson said, Hattiesburg leaders — in their first run through the CMS data — looked around to see which physicians and nonphysicians generated the highest costs among ACO patients. .

2017-2019 CMS cost data for Medicare patients without end-stage renal disease who were not in a nursing home showed that monthly costs per member were $43 higher for patients whose primary care provider is a non-physician, not a physician.

That could lead to $10.3 million more in costs annually if all patients were followed by nonphysicians, the analysis said. When risk was adjusted for patient complexity, the difference was $119 per member per month, or $28.5 million per year.

These findings were included in a study titled “Targeting Value-Based Care with Physician-Led Care Teams,” published in Journal of the Mississippi State Medical Association.

“Naturally, there were a lot of questions and some concern about some of the findings,” Dr. Batson said during an episode of “AMA Update,” in which he discussed the importance of physician-led, team-based care.

“But our goal remains the same,” he added. “We will continue to learn from our own research and hope to continue to improve the way we deliver care.”

Combating scope creep is a critical component of the AMA’s recovery plan for America’s physicians.

Patients deserve care led by physicians—the most educated, trained, and skilled healthcare professionals. The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety.

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Four of the five most expensive professionals in the years studied were non-physicians.

“The only physician who was in that group was a physician who specifically ran a clinic for high-complexity Medicare patients in the geriatric age group and those patients who had the most complex care,” Dr. Batson. “Seeing her in this group was no surprise. But what was a surprise was to see that the other four in this group were all “non-physician clinicians”.

However, Dr. Batson emphasized that nurse practitioners and physician assistants (PAs) are valued members of the Hattiesburg Clinic care team and that their ACO saved Medicare $23 million from 2017 to 2019.

“Our nurses and support professionals are an integral part of our journey,” said Dr. Batson.

That journey included the ACO being ranked first for quality in its cohort in 2016 and 2017, among a total of 471 other participants, and recognized by CMS for providing high-quality care at low cost.

“Team care is critical,” said Dr. Batson. “We have to make sure we use everyone’s skill set in the best possible way.”

Acting on data from CMS, the Hattiesburg Clinic redesigned its care teams so that — effective January 1, 2021 — only a physician leads the patient care team.

The AMA has a policy that defines physician-led, team-based care “as the physician’s consistent use of the leadership knowledge, skills, and experience necessary to identify, engage, and draw from each team member the unique set of necessary training, experience, and qualifications to help patients achieve their care goals and supervise the application of these skills.

The AMA policy also recognizes “nonphysician providers as valuable components of the physician-led health care team.”

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Since the study was published, multiple organizations have contacted the Hattiesburg clinic to compare notes, Dr. Batson said.

In addition to the national attention, state lawmakers sat down with clinic executives to examine the data to determine its applicability to bills introduced each year to allow nonphysicians to practice independently.

This year, the legislation failed to make it out of committee.

“This was local data in a Mississippi health system, and our legislators were willing to take the time to understand what we’ve learned, what they’re telling us, and what we’re doing in response,” said Dr. Batson.

“AMA Update” covers health care topics affecting the lives of doctors and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more – because it’s who’s talking that matters most. You can watch each episode by subscribing to the AMA YouTube channel or the audio-only podcast version, which also includes educational presentations and in-depth discussions.

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