GloucesterTimes.com, Gloucester, MA

January 18, 2013

Lahey signs on for federal cost program

By Paul Leighton
Staff Writer

---- — Lahey Health is the latest organization to sign on to a new way of delivering health care to Medicare patients.

The federal government has selected the Lahey Clinical Performance Network as one of 106 new accountable care organizations for Medicare. The designation means that, if the Lahey network — which includes Gloucester’s Addison Gilbert Hospital — can stay under a spending target set by the government while meeting standards for quality of care, it will keep a percentage of the savings.

The ACOs, as they are called, were created under the Affordable Care Act and are designed to move health care away from the fee-for-service model that critics say encourages doctors and hospitals to spend more on patients without necessarily improving their health.

With its designation, the Lahey Clinical Performance Network becomes one of more than 250 ACOs in the country for Medicare patients.

The organization has about 190 primary care doctors and 600 specialists and treats approximately 35,000 Medicare patients throughout the North Shore and Cape Ann, said Dr. Gregory Bazylewicz, chief development officer for Lahey Health.

Bazylewicz said ACOs can cut costs by better coordinating a patient’s care throughout the system.

“Increasing the efficiency of care ultimately improves the quality of care,” he said. “There can be duplication of X-ray testing, duplication of lab tests, extra visits to multiple specialists because no one coordinates what the patient actually needs. By pulling that together, we think we’ll take some of the inefficiencies out of the system.”

Bazylewicz gave the example of a patient who is moving through the system from a doctor’s office to a hospital to a rehab facility to home. If all of the providers at each location are communicating, it could prevent a costly hospital readmission for the patient, he said.

Some critics have said doctors might be reluctant to order certain tests or administer other forms of care in order to stay under the government’s spending target. But Bazylewicz said there is often more danger for patients if they are over-tested or overtreated.

“Someone who has multiple CAT scans is exposed to unnecessary radiation,” he said. “It’s not at all a focus on restricting access to care. But if appropriate care can be given in a lower-cost setting, then that is where you would want to have it done.”

Medicare patients using ACOs can still choose doctors outside the network, although Bazylewicz said the coordinated care concept will work better if patients stay within the Lahey system.

Bazylewicz said Lahey Health is “moving toward the ultimate goal” of establishing a large electronic system so that doctors throughout Lahey can access a patient’s medical records.

Lahey will notify by mail the Medicare patients who are affected by the change, a spokesman said. There will also be posters and brochures in the offices of primary care doctors.

Staff writer Paul Leighton can be reached at 978-338-2675 or via email at pleighton@gloucestertimes.com.