To get started, just get started
Plunge in, doctor advises
Every medical practice is stumbling over patients need to be better managed, says Jerry Maliot, MD, MS, medical director of the Lahey Clinic Community Practice Network with headquarters in Danvers, MA.
His advice to other practices that want to cut costs for their Medicare risk population: "Don’t get hung up on trying to come up with the perfect case methodology. Just get started.
"Getting started in small ways isn’t really that difficult," Maliot says.
If you’re a small practice and don’t have to hire a case manager you can train a nurse to manage the program for a few hours a week. Or, if you’re a bigger practice, Maliot suggests starting with a small group of doctors, then expanding your program.
Here are some other tips for getting started:
• Create a profile of patients who are at high risk. It may be a Medicare patient with two or three emergency room visits in the past year who is taking 12 or more medications. Look at pharmacy claims, billing data, and insurance claims data, or work with your insurance plans to find the highest-risk patients.
• Create some kind of documentation system so you can track your results.
• Use community resources and disease management programs from your payers.
• Take advantage of materials from pharmaceutical companies on managing high-risk patients.
Try to set realistic goals so you can know that you are managing the patients well. For instance, if a patient is admitted to the hospital seven times in a year and has six emergency room visits, if you can cut it back to four admits and two emergency room visits, that’s success.
Plan on making an initial investment in the program with the expectation that it will pay off. "Spend a nickel to save a dollar," Maliot says.
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