Conceptualizing and defining an outcome is not enough for it to come to fruition. To overcome the “inertia” of the business of medicine and accomplish their goals, healthcare innovators must challenge the status quo. Such is the case with 2018 Harwick Innovation Award recipient Alex Binder, MBA, FACMPE, vice president, Advanced Care Institute (ACI), VNA Health Group, Holmdel, N.J.
Binder asserts that “waiting for traditional physicians and conventional hospitals to lead this change [in processes and delivery methods] is impractical.” Instead, healthcare organizations should look to disruptive companies and business models to hasten change.
From the start, Binder and Jon Salisbury, MD — who in 1994 founded Visiting Physician Services, a home-based primary care practice in New Jersey — understood that patient demand would sustain this delivery model and help it flourish. In 1999, Salisbury approached Binder about helping with the operations and finance side of the practice, and they became partners in their new enterprise to care for homebound seniors.
“My vision for Visiting Physician Services was based on demographics, as it was obvious that the number of homebound seniors would only be increasing in the future,” Binder says. “We saw a large potential for home-based primary care. ... homebound patients were delighted and relieved with this delivery model, allowing them to receive medical care and minimize their need for unnecessary hospital visits.”
During the next 15 years, Binder and Salisbury developed a great working partnership that led Visiting Physician Services to become one of the largest house call practices in the United States. The practice has been responsible for the primary care of more than 50,000 patients since 1999.
In 2015, Visiting Physician Services merged with Visiting Nurse Association (VNA) Health Group, the second-largest visiting nurse association in the United States, to form New Jersey’s largest provider of comprehensive home-based primary care. The affiliation would help Visiting Physician Services expand its house call delivery service “both in terms of reach and resources, to care for the tens of thousands of frail and elderly residents throughout New Jersey, who rightly deserve this benefit,” Salisbury noted.
Today, Visiting Physician Services, a division of ACI, has 33 clinicians (physicians, nurse practitioners and physician assistants) who provide medical care and hospice referrals to about 3,400 homebound patients in eight counties in central and northern New Jersey. In the palliative division of ACI, which is separate from the home-based primary care practice, there are six physicians and four nurse practitioners who make approximately 9,000 palliative consultations a year.
The practice’s primary goal “is to address the medical needs of homebound adult and geriatric patients who often have multiple chronic conditions and have difficulty getting to the doctor” by examining, evaluating and diagnosing; developing a comprehensive care plan; providing coordinated home healthcare; utilizing a holistic approach and serving with compassion and dignity.
By offering accessible and convenient house calls, Visiting Physician Services can improve patient outcomes and quality of life. “We take care of this sickest segment of the population in the most cost-effective manner,” Binder says. “These patients have multiple comorbidities, low mobility and therefore incur high healthcare costs.”
According to Binder, accessibility and convenience aren’t the only ways patients benefit. “We also provide value by addressing their end-of-life reality and helping them understand their disease and prognosis, allowing them to appropriately set goals and make plans for their future,” Binder says.
Beyond value to patients, home-based primary care delivers economic value to the healthcare system. “By seeing these unstable patients regularly and taking full ownership of their healthcare, we’re able to minimize unnecessary hospitalizations, diagnostic testing and specialty care,” Binder says. “Understanding that the average cost of a house call is $150, and the average cost of a hospitalization for this patient population is 100 times more, you can start to recognize the value of this model.”
In addition, house calls tie in well with the objectives of the Affordable Care Act in terms of limiting the unnecessary costs mentioned above and with alternative payment models in which high-quality and cost-efficient care are rewarded by Centers for Medicare & Medicaid Services (CMS). As a participant in CPC+ (a Medicare demonstration program), Visiting Physician Services is ahead of the curve as their activities and outcomes are already being reported and monitored by CMS.
Going forward, Binder is excited about helping to lead the movement toward value-based care. He knows it’s not practical to wait for traditional physicians and conventional hospitals to take the reins. “We’ve finally reached a point where … we’re talking about what’s valuable in healthcare, compared to what could be considered redundant and/or wasteful,” Binder says. “The next step is to change our processes and delivery methods to take advantage of these shifting priorities.”
As more palliative care is needed to meet the needs of the aging U.S. population, Binder believes physicians can do their part to bridge the gap between supply and demand. “Frequently the work that our palliative clinicians provide focuses on two central themes: referring patients to hospice and educating patients/families on treatment options for these terminally ill patients (that other physicians have not addressed),” Binder says. “So again, the work that palliative clinicians perform in many respects is not significantly different than what is expected from other physicians.”
Since every patient eventually dies, Binder postulates that more physicians ought to devote more time to palliative care. “End-of-life care should be/could be what most physicians provide, and maybe the success in expanding a palliative culture (over the next decade) would diminish the need for these palliative specialists who are in limited supply,” Binder says.
The home-based primary care environment can be challenging, Binder says, but Visiting Physician Services has forged ahead to treat thousands of patients over the years. “There’s no blueprint for this type of model … sometimes we call it the ‘daily miracle’ that we are able to see all these patients and make it work,” Binder says. “But it’s an honor for me because of working with the people I work with and knowing that they understand the mission of what we’re doing, they believe in what we are doing and that they deliver on that mission hundreds of times each day.”
2018 Lifetime Achievement Award: Rebecca Dean
At MGMA18 | The Annual Conference in Boston, Rebecca Dean, MA, FACMPE, practice administrator, Tanana Valley Clinic Orthopedic and Sportsmedicine Fairbanks, Fairbanks, Alaska, was presented the 2018 MGMA Lifetime Achievement Award. Dean has been involved in healthcare management for more than 30 years and has been an MGMA member since 1989.
From the time she became a member, Dean set out to utilize all the Association’s resources and embrace its goals, standards and objectives. This thirst to acquire expertise in medical practice management has made her an invaluable resource for others, which she takes great pride in.
“I believe we are all knowledge brokers and we must share,” Dean says. “We must know that knowledge is power, but if we withhold it, everyone suffers. As stewards of our professions, it’s our duty to impart knowledge to our colleagues and to leave a legacy of resources and knowledge for those who follow.”
Dean is past president of MGMA Western Section (2003-04) and Alaska MGMA (1994-1996). In addition, she was Chair of the American College of Medical Practice Executives and a member of the MGMA-ACMPE Board of Directors in 2009. In 1994, she became the first Alaskan to attain ACMPE Fellow status.
2018 Legislative Liaison Award: Gerard Filicko
Gerard Filicko, MHA, CMPE, vice president, Virginia Care Partners, a physician-led, clinically integrated network in central Virginia, received the 2018 Legislation Liaison Award at MGMA18 | The Annual Conference. He has 30 years of experience in healthcare operations and practice management and has been an MGMA member since 2003.
As a physician advocate, Filicko espouses the Quadruple Aim of balancing quality care, improving patient experience, reducing cost and enhancing physicians’ quality of life.
Recently, he was instrumental in rallying support and advocating for the passage of HB 139, which requires all insurance carriers to reimburse for care delivered during a provider’s credentialing process, by the Virginia General Assembly. Filicko worked with the Medical Society of Virginia to provide input on draft legislation, coordinated MGMA representation at crucial committee hearings, organized and held grassroots calls for action and helped elicit more than 600 calls and emails to support the bill. The law went into effect in July and will help physician practices in Virginia avoid losing revenue.
Filicko’s passion for advocacy has helped him make a difference in Virginia and beyond. “Through education, communication, collaboration, I set the conditions for our membership to influence change in Virginia,” he says. “And that’s what advocacy is all about: Magnifying a voice to transform the business of healthcare.”
Filicko has been a legislative liaison for Virginia MGMA since 2011, a member of the MGMA Government Affairs Council since 2014 and served as president of the Richmond MGMA chapter in 2010-2011.
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