Scarcely a week goes by without another news story about problems in health care. As the largest independent medical group in the state, serving 250,000 patients, The Everett Clinic is well aware of the challenges. But we see progress in patient care that can help point the way toward solutions to some of the major issues affecting our health care system.
The Everett Clinic is participating in a national Medicare-sponsored demonstration project to look at how we can deliver health care to seniors more effectively and efficiently. We are one of only 10 physician groups across the country selected by the Centers for Medicare and Medicaid (CMS) to take part in this program.
Results just released by CMS show excellent outcomes. The Everett Clinic scored 96 percent for management of diabetes, coronary artery disease and congestive heart failure based on national standards.
We also saved CMS and Medicare patients $1.6 million in the second year of the demonstration project and $400,000 in the first year.
An overriding focus for us in this study, and everything we do at The Everett Clinic, is to provide added value to patients and employers by delivering quality care efficiently. The CMS study illustrates how we can improve care and reduce costs through well managed care of chronic diseases such as diabetes and heart disease.
For example, we put in place systems to help our medical team improve the management of our diabetic patients and achieved a blood sugar control rate of 88 percent compared to the national average of 76 percent. We increased the percentage of our diabetic patients receiving routine annual eye and foot exams. By keeping sugar in control and avoiding complications such as blindness and foot ulcers, our seniors with diabetes are living better lives. This approach to diabetes care helps doctors spot and treat health issues before they become major problems for the patient that also add to the cost of medical care. This is an example of the value of well managed, preventive care.
Improving care does not need to be complicated. For example, we have a nursing “coach” visit Medicare patients in the hospital to answer their questions and tell them what to expect when they are released. The goal is to anticipate patient needs prior to their leaving the hospital, including having a follow-up appointment already scheduled with their doctor.
Electronic medical records are a fundamental part of effective, efficient health care. We have fully integrated the use of electronic medical records throughout The Everett Clinic to make medical information instantly accessible. Contrast that with a recent national survey reported in the New England Journal of Medicine that indicated less than 20 percent of doctors nationwide use electronic medical records.
Managing care effectively means making sure all physicians involved in a patient’s care, including the primary care physician and specialists, understand and regularly consult with each other on the patient’s condition, diagnosis, treatment and medications. It helps ensure patients receive the right treatment at the right time.
The improvements resulting from the Medicare study are gratifying. However, we experienced a $7.6 million loss last year caring for Medicare patients. That kind of loss hurts because it makes it difficult to serve all the new Medicare patients that will be needing care in the future.
Evidence from the CMS study shows we don’t have to radically change our health care system to make major improvements. One day, hopefully very soon, the best practices we are helping pioneer, from intensified chronic disease management and well managed care, to technological improvements such as electronic medical records and electronic prescribing, will become standard for all medical practices.
The Everett Clinic and other physician groups in the CMS study are helping to identify care innovations that can be spread across the health care system. Policymakers need to do their part by supporting these innovations and finding ways to fund high quality care that meets the health needs of seniors, and all patients, without shifting costs onto others.
James Lee, M.D., is an internal medicine physician with The Everett Clinic and director of the clinic’s CMS Medicare Demonstration Project.
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