Colorado practice increases reimbursement with Medicare Advantage

Doc and patient

Thomas Jeffers, M.D., a family physician at Colorado’s largest primary care practice, has increased his salary by 15 percent and sees less patients per day.

That is because of his practice’s switch from traditional Medicare to the Medicare Advantage program in 1999, Jeffers said in an article for AAFP News. By dropping traditional Medicare in favor of Medicare Advantage, Denver-based New West Physicians has not only increased reimbursement, but has fewer administrative woes and improved health outcomes for patients, according to the report.

Jeffers is one of 70 physicians at New West, which includes 100 primary care health professionals who care for about 200,000 patients. The practice now accepts Medicare Advantage and fee-for-service commercial health insurance.

The practice decided to drop Medicare after receivables were running 90 days behind and reimbursement was too low, Jeffers told the publication. The practice gave patients a year’s notice that it was switching to Medicare Advantage and about 85 percent of the practice’s Medicare patients made the switch with no additional premium, according to the report. Other patients who did not want to change their insurance designation were referred to other doctors.

Medicare Advantage now accounts for 30 percent of patient visits and 55 percent of the practice’s revenue. New West is under contract with insurers in an accountable care organization payment model and receives more than $25 in per-member, per-month payments, Jeffers said. The practice has the same responsibility as an insurer to control costs, he said.

"In medicine, if you do the right thing for the patient the first time and follow the latest standards of care, then the patient gets better care, the physician gets paid more, and the insurance company makes more money," he told the publication.

Physician assistants and nurse practitioner see patients with routine problems, so physicians can spend more time with patients with complex needs. Jeffers said his salary has increased, while he now sees about 16 patients a day, compared with about 25 patients before the switch.

To succeed under Medicare Advantage, Jeffers said a practice needs to have enough infrastructure. New West has taken steps to control patients’ hospital stays and the use of specialists. It has its own team of hospitalists that provide coverage in five area hospitals and monitors patients when they leave the hospital to prevent readmissions, cutting its 30-day readmission rate to 6.1 percent, far below the 18 percent national rate for Medicare patients.

Nationally, Medicare Advantage enrollment has continued to increase, with 17.6 million people accounting for nearly one-third of all Medicare beneficiaries. Last year, overall medical costs within Medicare Advantage plans were 6 percent lower than traditional Medicare.

- read the article