WASHINGTON – Many Buffalo-area medical practices will receive a big financial boost – and patients likely will get easier access to health care – thanks to the region's selection for a new Medicare pilot program that eventually could help cure the area's physician shortage.
Insurance executives who pushed for the program said Wednesday that the pilot program is likely to pump hundreds of millions of dollars in federal funding into local medical practices that choose to take part. Those would be practices that serve the region's 90,000 or so people on the traditional fee-for-service Medicare program, not the popular, HMO-like Medicare Advantage plans.
What's more, insurers and doctors said the initiative to improve Medicare – the hugely influential government health insurance program for seniors – could have ramifications throughout the local health care system.
Insurers and physicians said the new initiative could even boost the number of primary care physicians in an area seeing a greater need of them, while lowering costs and making for better health care for all patients.
"The good news is this is all money that is flowing directly to primary care practices," said Dr. Michael W. Cropp, president and CEO of Independent Health, which teamed with BlueCross BlueShield of Western New York to push for the federal designation for the five-year experimental program.
"This will help some physicians to stay on in practice a little longer," Cropp said.
While the new payment system is designed to improve Medicare, insurers and doctors familiar with the program say it will make local medical practices so much more efficient that even non-Medicare patients will notice a difference.
"This is very exciting, not only for the physicians, but also for the patients," said Dr. Fuad Sheriff, a partner in Amherst Medical Group, a practice with five physicians. "The idea is to get comprehensive care in one trusted environment, the physician's office, with a physician who knows the patient well and knows the need of the patients and tries to coordinate and collaborate with the patient and also with other entities who would take care of the patient."
Experts think the program may result in new practices opening to serve the area's huge population of Medicare recipients. That is because the program will give Buffalo physicians a guaranteed income for the Medicare patients they see.
"I do think it will be attractive in drawing physicians into Western New York to practice here," said Dr. Thomas Schenk, senior vice president and chief medical officer for BlueCross BlueShield.
The federal Centers for Medicare and Medicaid Services announced that it had chosen the Buffalo area, along with the states of Louisiana, Nebraska and North Dakota, for its second round of designations in its new "Comprehensive Primary Care Plus Initiative."
The effort, taking place under bipartisan federal legislation passed in 2015, aims to lower medical costs for Medicare patients by changing how physicians are paid while simultaneously improving health care.
The program "rewards value and quality by offering an innovative payment structure to support primary care practices to improve quality, access, and efficiency," the federal agency said in announcing that the program is coming to the Buffalo area.
First and foremost, the program aims to push the medical system away from the traditional "fee for service" payment model, in which doctors get paid for every patient visit. Critics have long cited that model as one of the reasons why medical care is so costly and inefficient,because it encourages physicians to schedule unnecessary patient appointments.
Independent Health and BlueCross BlueShield already have moved patients away from the fee-for-service model, and the federal agency that runs Medicare chose to bring the experiment to the Buffalo area just because area physicians already are getting used to a "value-based" payment system, local health insurance executives said.
Under the new initiative, the federal Medicare program would pay physicians based on the number of Medicare patients they see and the quality of care they provide, instead of based on the number of services they provide.
The new system will be appealing for physicians because it will give them a guaranteed income from the federal government for the Medicare patients they see while allowing them to design their practices to operate better.
"Now we won't have to be worried about overhead," said Dr. Sheriff, whose Amherst practice plans to apply for the new federal program.
Instead of calling Medicare patients in for visits again and again, doctors will work with other medical providers to develop a comprehensive care plan for each patient. For example, Dr. Sheriff said a diabetic's medical team might include not only a doctor, but also a nutritionist and a pharmacist.
That's a big improvement, said Schenk, of BlueCross BlueShield.
"These are models that give the primary care physician the opportunity to practice the way they want to practice," he said.
Patients will notice a difference, too.
A Medicare patient with a minor question might be able to get an answer from his or her doctor via email rather than having to schedule an unnecessary office visit, said Cropp, of Independent Health.
"How you interact with a practice may change dramatically," Cropp said.
Irene Snow, medical director for Buffalo Medical Group -- with 140 physicians, the city's largest -- said that change may extend into patients' homes.
The new program "will allow our group to continue to put medical equipment in people's homes to monitor patients at home and keep those patients out of hospitals, emergency rooms and physicians' offices," she said.
Primary care practices will have to apply for the new program, which starts next January. Practices that serve more than 125 traditional Medicare patients will be eligible to apply.
CMS, the agency that manages Medicare, said it expects 1,000 medical practices to qualify in metro Buffalo and the three states that won the designation.
This is the agency's second round of awards in its Comprehensive Primary Care Plus program. Fourteen regions, including the Albany area, were chosen to take part in the program last year, and 2,891 medical practices in those 14 regions are already operating under the new payment model.
Since it was authorized under a separate law rather than Obamacare, the program would continue even if Congress and President Trump were to agree on a plan to repeal and replace the Affordable Care Act, Schenk said.
The program is the federal government's effort to push health care away from the traditional fee-for-service model, Cropp said.
"This represents a major investment by the federal government to accelerate the transition so that care for patients is much more patient-centered and delivered according to what a patient's unique needs are," he said.