Protecting the Private Practice of Medicine
Louisiana’s First Physician-Owned Accountable Care Organization: The Inaugural 90 Days
Sabrina L. Noah
New Orleans nephrologist Dr. Joshua Lowentritt, like many physi- cians, has watched the practice of Medicine be overtaken by laborious reporting requirements, eroding re- imbursement rates, and a decreasing ability to spend time providing quality care. In the actual day-to-day care of patients, “physicians are being asked to do more while reimbursements con- tinue to decline,” said Dr. Lowentritt. Like most physicians, Dr. Lowen- tritt and his partners took steps to seek out newmodels of practice that would
to the primary care doctor, which improves quality of care.” Equally as important physicians benefit from this model, because ACOs “create a mechanism to capture payment for the services and the coordination (we) are already provid- ing,” said Dr. Lowentritt. The ACOmodel works by ensuring the entire care team is jointly accountable for the health of their patients by giv- ing them financial incentives to collaborate and rewarding efficiencies. Simply put when an ACO succeeds in both delivering high-quality care and spending healthcare dollars wisely, physicians will share in the savings it achieves for the Medicare program. Since ACOs are operated through collaboration, there is a natural check and balance, ensuring that a physician’s medical decisions are not based on com- mercial interests, but rather professional medical judgment that puts patients’ interests first. Unlike traditional closed networks, ACOs encourage collaboration and allow both patients and physicians to access clinicians in a wide scope and seek out the best and most efficient use of their medical dollar. Dr. Lowentritt emphasized that “we didn’t want to lose our independence as private practitioners.” ACOs allow for independent practices to work collaboratively without sacrificing their autonomy. This rewards physicians who provide high- quality, cost-effective care and benefits patients who can now access a wide population of practitioners. Dr. Lowentritt and his 35 physician partners have now formed The Louisiana Physicians ACO and will begin car- ing for approximately 6,000 patients by spring of this year. This network of multidisciplinary independent physicians will serve patient populations in Hammond, New Orleans, Metairie, and Alexandria and is planning to expand to north Louisiana by the end of next year. We will continue to followDr. Lowentritt and the Loui- siana Physicians ACO throughout the next year and check in on their progress, hopefully gaining valuable insight on this new practice model along the way. **This is the first installment in a new four-part series that will report on emerging trends and new practice models in medicine.
Dr. Joshua Lowentritt
provide physicians with the opportunity to provide the best care possible for the patient, while simultaneously decreasing the growing non-clinical burdens of operating a practice. “I wanted to find an opportunity to preserve the type of medicine that we have been providing in Louisiana,” said Dr. Lowentritt. The Medicare Shared Savings Plan (MSSP), created under the Affordable Care Act, allows physicians to self- manage their Medicare patients under a new program model called an Accountable Care Organization (ACO). The MSSP also allows for waivers of anti-trust laws and Stark regulations allowing physician ownership of the ACO networks. According to the Kaiser Health Foundation “more than half of all ACO’s are physician-owned and operated.” This newmodel offers physicians the unique opportunity to regainmanagerial and financial control of a medical system increasingly dominated by managed care systems. ACOs are built with the primary care provider as the linchpin of a patient-centeredmedical home (PCMH). These entities are comprised of physicians, nurses, and care coor- dinators who share the responsibility of providing quality, financially responsible, coordinated care. Specially trained care coordinators, under the direction of a physician, assist the patient with their treatment plan by providing follow- up care, prescription compliance, and tracking health outcomes. Dr. Lowentritt and his partners believe the ACO model allows for a “refocusing the healthcare system back
J La State Med Soc VOL 166 January/February 2014 35
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