Rate hike planned for primary docs

Officials at Empire BlueCross this year plan to raise reimbursements to primary care doctors in in an effort to lower the costs and improve the quality of patients”™ health care.

The insurer said it would begin its patient-centered strategy this summer and offer primary care doctors reimbursement hikes estimated at 10 percent. Additional payments are likely to increase by as much as 50 percent, Empire said.

The insurer also would provide resources to enhance information-sharing and provide clinical care management support to physicians.
Empire officials estimated the program could reduce overall medical costs by as much as 20 percent by 2015.
“We know that the physician-patient relationship is the most important one in promoting health and wellness. As such, primary care is critical,” Ethel Graber, Empire BlueCross vice president and general manager, said in a press release. “Our initiative aims to strengthen the relationship between doctors and their patients, while compensating primary care physicians more for making quality and cost effectiveness an everyday practice. We believe this will fundamentally change our relationship with primary care physicians.”
The new program will incorporate best practices from the patient-centered medical home pilot projects that Empire began rolling out in 2010. In the insurer”™s downstate New York pilot program, acute inpatient hospital admissions decreased by 12 percent to 23 percent and total emergency room visits declined by 11 percent.
“National data shows that primary care physicians, which include pediatricians, internists, general practitioners and family practice physicians, have income levels significantly lower than specialists, yet they are the glue in the medical system that ensures improved health outcomes and cost reduction associated with inconsistent, duplicative and fragmented care,” said John Caby, Empire vice president for provider engagement and network management at Empire.  “This new program will help give primary care physicians new resources and the financial incentive to invest more time with our members and help develop a more comprehensive plan to live healthier lives. Ultimately, this will help lower overall health care costs.”
Physicians participating in the new Empire program will earn additional revenue these ways:

• General increase to the regular fees paid to physician practices for specific services.
• Payment for “non-visit” services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
• Shared-saving payments from Empire for quality outcomes and reduced medical costs.