The Unexpected Benefits of a Complete Waste of Time

For Clinicians and Organizations.

 

 

 

As my partners and I struggled to integrate our multi-specialty group across the prime/specialist divide, we stumbled on to a great tool—the spillover effect.

 

The workflows required to meet quality targets for specific populations will inevitably “spillover” and cover all patients—with unexpected benefits all round.

 

Years ago, when the NCQA decided to offer a quality certificate for diabetic care, my PCP partners and I went all in.

 

Although most of us were already doing what was required, we went ahead and formally set up systems to prove we were meeting spec, including the yearly foot exams.

 

It didn’t take long to find out that in the fee-for-service world, the NCQA certs turned out to be a total waste for the primes—lots of costs in time, effort and IT to meet documentation requirements, with no additional resources to fund them.

 

The big selling point—the marketable “cachet” of the NCQA designation—was beyond useless.

 

But for some metrics, there were certain unexpected benefits.

 

My partners and I fairly quickly found that we were examining pretty much everyone’s feet during their office visits—diabetic or not.

 

Pathology was identified and morbidity prevented for all, regardless of disease state or payor.

 

For our total-risk patients, this meant lower costs as we managed their pathology ourselves.

 

But we also found plenty of pathology in our fee-for-service patients as well.  As a result of their payment model, those folks wound up in our specialists offices—resulting in more revenue for our specialty colleagues.

 

Everyone benefited.

 

Lessons?

 

Care systems developed for one subset of your patients will “spillover” into all.

 

Those same care systems designed to decrease costs in shared-risk systems will, when applied to a fee-for-service population, actually generate additional demand for your specialists.

 

When introducing a shared-risk payment system for primes, specialist’s fears about reduced revenue from reduced referrals can be allayed by noting this “spillover effect.”

 

For those practices with a good mix of payers, both FFS and shared-risk, the “spillover effect” can a great tool in workforce management.

 

It’ll just take a little empiric evidence and proactive education.

 

 

 

 


 

 

 

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