Tuesday, October 1, 2013
ANDREW KITCHENMAN | OCTOBER 1, 2013
Pilot programs illustrate how collaborative approach pays off for patients and doctors
Healthcare delivery reform has been a buzz phrase in New Jersey for several years. Care providers got a chance yesterday at a meeting of the Assembly Health and Senior Services Committee to highlight ways they have turned those words in action.
Providers reported making progress in their efforts to rein in runaway healthcare costs, while still improving the quality of care, by coordinating efforts by all providers a patient sees.
For example, Summit Medical Group – a large doctor-owned practice with 382 practitioners – has instituted a patient-centered medical home model for providing care to many of its patients. This model, launched as a pilot program with Horizon Blue Cross Blue Shield of New Jersey, pays for providers to coordinate care more closely.
The results are impressive: The cost of care for Summit’s pilot program was $336 per patient per month, compared with a statewide cost of $433 for patients who are not in patient-centered medical homes.
Lower costs are just one half of the equation. Another measure of the quality of the patients’ healthcare also was positive: Summit patients in the pilot program were admitted to a hospital at a rate of 49 per 1,000 patients, compared with a statewide rate of 85 per 1,000.
“The patient-centered medical home had a major impact on cost of care, quality of care,” said Dr. Robert W. Brenner, Summit Medical Group’s chief medical officer.
A related approach known as an accountable care organization (ACO) also has paid off for Summit. In ACOs, providers share in savings that result from increasing care coordination. In another Horizon-Summit pilot program, an ACO resulted in lower costs in direct correlation to how much patients stayed within Summit Medical Group.
Patients who had 75 percent of their visits with Summit providers had the cost of their care lowered by 20 percent; those who had 50 percent of visits with Summit providers had their costs lowered by 10 percent; and those who had at least one visit with Summit providers but without enough visits to increase care coordination actually saw their costs increase by 7 percent.
“What that says is, the more we can do comprehensive, integrated care, the more that we have the ability to lower the costs of care and improve the quality,” Brenner said.
Brenner urged lawmakers to consider ways to provide incentives for providers across the state to have teams of healthcare providers manage every patient “transition,” such as when patients go from their homes to a hospital, or when they move from a hospital to a nursing home.
These transitions have traditionally been a source of problems as care is interrupted – for example, a patient might not receive or pick up prescriptions after leaving a hospital.
Both patient-centered medical homes and ACOs are alternatives to the traditional system in which providers are paid for each service they provide to patients.
Summit has started having geriatricians, rehabilitation doctors and advanced practice nurses visit patients who recently arrived in nursing homes from hospitals. The early evidence shows that the program has reduced the hospital readmission rate for these by patients by one-sixth, Brenner said. I
In addition, Summit Medical Group operates an urgent care center for patients who require immediate attention but whose needs fall short of a trip to a hospital emergency room.
The overall savings from these efforts to reduce hospital visits was more than $49 million over three years, Brenner said.
In addition to Brenner, the committee heard testimony from representatives of southern New Jersey healthcare system Virtua; Meridian Health, which is focused in Ocean and Monmouth counties; Geisinger Health Plan, an insurer working with Meridian to manage the care of Medicare patients; and Lifeline Medical Associates LLC, a Parsippany-based Ob/Gyn practice.
Committee chairman Assemblyman Herb Conaway Jr. (D-Burlington), a primary care doctor, said the testimony showed the importance of encouraging care teams. He said this undermines the case for legislation that would allow advanced practice nurses to operate their own practices without agreements with doctors, since this could reduce opportunities for coordination.
Assemblywoman Nancy F. Munoz (R-Morris, Somerset and Union), an advanced practice nurse, reached the opposite conclusion from the testimony. She said the use of APNs by practices like Summit Medical Group showed the increasing importance of APNs in providing care.
BY JAY WEAVER
The “Rock Doc” stood in Miami federal court Monday sporting an all-black look of T-shirt, pants and sneakers but some not-so-hip accessories – shackles on his wrists and ankles. His grayish-blond hair, once worn in punk-style spikes, was disheveled.
Christopher Gregory Wayne, dubbed the “Rock Doc,’’ had been arrested at Larkin Community Hospital earlier in the day on a dozen charges of Medicare fraud. The longtime Miami Beach resident, 53, was accused of falsely billing the taxpayer-funded program for physical therapy procedures, such as massages and electrical stimulation, that were not necessary or in some instances had been provided at his prior medical practice in Miami.
Wayne, a state-licensed osteopathic physician, seemed utterly disoriented in court.
He had just been arrested, his defense lawyer was absent and prosecutors sought to detain him permanently, calling him a flight risk. “I don’t understand what we’re talking about,” Wayne told Magistrate Judge Barry Garber. “So, even if my lawyer comes tomorrow, I can’t be released tomorrow?”
“No, sir,” responded Garber.
Garber set Wayne’s arraignment for Tuesday and scheduled a bond hearing on Thursday.
His defense lawyer, Michael Grieco, said he will seek Wayne’s release from the Miami Federal Detention Center, scoffing at the allegation his client might flee. “I don’t think there’s anything to back that up,” Grieco said. “He’s a longtime resident of Miami-Dade County.”
Wayne, who has sported the punkish hair along with chains, bangles and leather bracelets in the past, has been in the public eye before as a focus of a Wall Street Journal profile in December 2010. According to the profile, he has used his Pine Tree Island home as a production studio for Playboy photo spreads and has posed with celebrities such as Paris Hilton and Aerosmith’s Steven Tyler.
In 2008, he took in more than $1.2 million from Medicare -- the government program for the elderly and disabled -- mainly by billing for physical therapy that involves heat packs and electrical stimulation, according to the Journal profile.
An indictment, filed by the U.S. Attorney’s Office, charged him with 12 counts of Medicare fraud, by submitting “false claims” for therapeutic treatments, such as a 15-minute massages ($25), electrical stimulations ($20) and ultrasounds ($15).
The indictment accuses him of “falsely and fraudulently representing that these treatments and services were medically necessary and had been provided to Medicare beneficiaries” between December 2007 and August 2009. The indictment further alleges that he disbursed the Medicare payments to himself and others.
Wayne once operated a lucrative medical practice in Miami ’s Design District. He told the Journal that he expanded physical therapy at his clinic because his patients needed it.
Medicare regulations require that physical therapists billing under a physician must have completed an accredited physical-therapy education program, the Journal reported. But Wayne said he trained his “office girls” to do the work, in part because hiring full-fledged physical therapists was too expensive.
Wayne acknowledged grossing $1.1 million or $1.2 million from Medicare in 2008, and estimated his take-home that year from his clinic was about $400,000. His gross payments were more than 24 times the Medicare income of the average family doctor, according to the Journal’s analysis of Medicare-claims data.
All together, Wayne’s medical practice received more than $2.6 million from Medicare between 2007 and 2009, according to the Journal’s analysis.
In the story, Wayne denied abusing the system, saying he had not been accused of wrongdoing by authorities. He said his regimen “does wonders” if used correctly. He added that he gave physical therapy to “patients who needed it, with appropriate diagnoses, and I should get paid for it.”
But Medicare administrators grew suspicious of Wayne’s voluminous billing activity for physical therapy services and began heavily scrutinizing his bills in 2009. That increased oversight forced him to sell his business.
Wayne, who obtained his osteopathic license in 1990, went to work for a pain clinic, Park Place Medical Group, in Fort Lauderdale in 2011-12, according to state records.
But he got into trouble dispensing pain killers and other prescription drugs. In September 2012, the state Department of Health banned him from owning, operating or working in a pain management clinic and from dispensing prescription drugs, such as Oxycodone, Xanax and Flexeril.
His Facebook page says Wayne is now working in the emergency room at Larkin Community Hospital, where he was arrested Monday by agents with the FBI and Department of Health and Human Services-Office of Inspector General.
Read more here: http://www.miamiherald.com/2013/09/30/3660611/miami-beachs-rock-doc-busted-on.html#storylink=cpy