Making value-based care work for the small practice
Family Medicine Partners of Santa Fe, New Mexico, is bucking the trend. While many small practices are being gobbled up by hospital chains and larger consortiums, Dr. Julia Martinez and her physician partner, Dr. Patrick Samora, broke away from a larger practice to form their own office.
The move required having the right team in place, being sincerely interested in caring for patients, and having the right tools.
“Fortunately, we have the tools we need,” Dr. Martinez said, “and those tools are the Greenway Health EHR and Greenway Revenue Services. They give me the luxury of thinking about how to make healthcare better for seniors instead of, ‘Oh, my gosh, we’re not going to make the bills this month,’ or ‘The payroll’s going to be tough.’ Thanks to Greenway, I’ve never even thought that.”
Dr. Martinez credits the success she and Dr. Samora have achieved to being employed physicians in lots of different settings. “We started out in a community health center for several years, then a critical access hospital,” she said. “We joined a large, multi-specialty practice for a few years, and then, ahead of branching out on our own, we were employed in a small practice.”
Clearly satisfied with the care they received from Martinez and Samora, a group of patients had followed the pair from practice to practice. The doctors came to know these patients very well and grew familiar with their healthcare needs. They realized how important and valuable such healthcare intimacy could be to improving patient outcomes. Their last stint as employed physicians also happened as the focus was shifting to quality-based payment models. They saw an opportunity.
“I was feeling empowered to make changes to the way we were seeing patients and providing care, and I was able to make some of them,” Dr. Martinez said. “However, it really became clear that if you want to prioritize the quality you provide as an individual physician or the culture in which you want to provide this care, you have to be in control of it.
“When my partner and I decided to open our own practice in 2014, we had gained knowledge from all of these experiences, but I think we were really empowered by a new focus on quality care. I don’t have an MBA or know a whole lot about business, but I do know how to provide quality care. That’s right up my alley.”
The culture at Family Medicine Partners focuses on quality of care and sustainability. They strive for a practice that neither overworks nor underworks physicians, while ensuring that all patients get standard care with respect to all preventive services, that chronic care needs are met, and that acute illnesses are treated. However, to design a system that works in this way, independence is necessary. “If you want those things,” Dr. Martinez said, ”you sometimes have to design the system yourself. That was our motivation.”
Unlike practices that fear value-based care, Family Medicine Partners was ready for it.
“We embraced it because we are family practice doctors, and this is what we do,” Dr. Martinez said. “For the first time, we are potentially going to be paid for the care we’ve always known that we do best. That was empowering, and fortunately, it has worked out for us. We know Greenway Revenue Services has helped make that happen.”
“For the first time, we are potentially going to be paid for the care we’ve always known that we do best. That was empowering, and fortunately, it has worked out for us. We know Greenway Revenue Services has helped make that happen.”
Dr. Julia Martinez, Family Medicine Partners of Santa Fe
Dr. Martinez acknowledges that her small practice is the outlier. “I think a lot has to do with expectations and motivations,” she said. “We were motivated to do a good job, make a fair living, and give service to the community. We were new, and I don’t think we expected things to be a certain way. We were very open to new ways of doing things.”
Primary care has long had its importance minimized and its remuneration sub-par. Martinez and Samora see value-based payment as a remedy to that. “I’m pleased that there’s an opportunity to be recognized for providing excellent primary care,” Dr. Martinez said. “This is different from a specialist’s viewpoint. They didn’t have to see a paradigm shift to feel valued because they were always valued.”
Dr. Martinez sees value-based care as the medical community finally acknowledging that preventive and primary care are critical to improving health outcomes — the fulcrum of patient well-being. This is a far cry from many physicians and practices who see it as an unwelcome intrusion.
“For example, we do Medicare annual wellness visits,” Dr. Martinez said. “Last year, 82% of our Medicare patients got them. I put that out there on a message board since I had seen so many people asking how to get your numbers up. As it turned out, a man from CMS called me and I didn’t know if I was in trouble or not, but he wanted to know how we did it and what our process was.”
This type of practice may demand more from physicians, but with Greenway EHR and Greenway Revenue Services, the “more” is simply better, more proactive care — once again, right up Dr. Martinez’s alley.
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