Rural Arkansas clinics use Medicare bonuses to handle influx of patients from Obamacare

While there are fears that physicians can't handle the influx of patients newly insured through federal health reform, especially in rural areas, Medicare and the state of Arkansas may have found a way to accommodate those in need of services. David Pittman of MedPage Today reports the news from El Dorado, Ark., just north of the Louisiana border, where SAMA Health Care Services has become a beacon of success while embracing Obamacare.

The four-physician, primary-care practice, with the help of funds from a Medicare program, "has worked to add more staff and organize care teams to be able to see more patients, increase worker and patient satisfaction, and hopefully generate more revenue for the practice," Pittman writes. "Until a couple of years ago, the practice was a group of physicians and nurses working mostly independently of each other—although all under the same roof. One physician would rotate to be on call that day to take same-day appointments, but patients would complain that they wanted to see 'their doctor.'"

SAMA is one of 69 Arkansas primary-care practices "participating in a Medicare PCMH demonstration project called the Comprehensive Primary Care Initiative," Pittman reports. "Practices in the program receive a per-member-per-month bonus from Medicare, Arkansas Medicaid, Arkansas Blue Cross and Blue Shield, Humana, and QualChoice of Arkansas to better coordinate care for patients with those insurance plans. Providers also receive bonuses if they hit certain quality measures."

To make things easier for employees and patients, "Staff members reorganized themselves into four teams, each with a physician, an advanced-practice nurse, care coordinator and three other nurses. The teams even wear different-colored garb—purple, orange, blue, or red—to let patients know which team is caring for them," Pittman writes. "Under this structure, each team is responsible for a set of patients, whether they are same-day visits or routine check-ups. They have a system where patients just discharged from the hospital will get a phone call within 24 hours and will be seen in the clinic within a week."

The facility, which plans to add a fifth team in May, will have doubled its number of providers since August 2013. Hospital administrator Pete Atkinson told Pittman, "Especially with the Affordable Care Act, we're seeing a ton of patients that never had insurance. The better job we do, the more people that want to come. There was no way we could continue to be the same size and provide proactive services."

Nurse practitioners see patients with more acute illnesses, giving physicians more time to spend with patients with chronic illnesses, Pittman writes. As a result, physicians are seeing about 50 patients each day, up from 25 under the previous system. And even though they are seeing more patients, doctors said they feel they have more quality time to spend with each one. Physician Gary Bevill told Pittman, "What that was telling us—because we're in such an under-served area—that there were more patients of mine that really needed to be seen than could be seen. Work has been more enjoyable because you kind of have an idea everybody is pulling their own weight." (Read more)