More collaboration, less expense
DR. JORGE NIEVA, oncologist, Billings Clinic: Care here is very patient-centered. Patients get brought here, and we try to arrange for them to see everybody that they need to see in a very rapid period of time. It's a collaborative model. It's a model where I can always call up the doctor down the hall or walk across the hall and get him to see somebody the same day, if they need to be seen that day for a serious illness or diagnosis.
BETTY ANN BOWSER: Nieva and his colleagues routinely talk to each other about how to best treat patients.
DR. PAUL GRMOLJEZ, general, thoracic and vascular surgeon, Billings Clinic: Can he have additional radiation therapy after excision of the lesion, if there's any suspicion of margins in that area there, Chris?
DOCTOR: I guess I wouldn't recommend anything beyond what he's already had.
DOCTOR: Brock had suggested trying chemo again, but I don't think that that's going to fly with him.
BETTY ANN BOWSER: And avoid repeating expensive tests, which often are unnecessary. And while, nationwide, Medicare spends an average of $8,304 a year on each patient, in Billings, Montana, that number is $6,332, among the lowest in the country.
The Billings Clinic is 1 of 10 physician group practices nationwide taking part in a Medicare demonstration project. It's designed to see if better coordinated care for chronically ill patients can save the government money and improve patient outcomes.
Two years into the project, the answer was yes. The cost savings at Billings came from 500 congestive heart failure patients monitored in a disease management program. Dr. Doug Carr is the medical director of Billings and headed the study.
DR. DOUG CARR, medical director, Billings Clinic: We were able to reduce hospitalizations for them over the long haul over 40 percent. That's about 500,000, or half a million, per year, but we were able to save somewhere between 1 million and 1.5 million in avoided hospitalizations.
BETTY ANN BOWSER: Hospitalizations are the single most expensive item on America's health care tab, but staying out of the hospital is exactly what Clare Frees wants to do.
CLARE FREES: I was going to the hospital approximately once a week.
BETTY ANN BOWSER: That was before she enrolled in the Billings program of all-inclusive care for the elderly, or PACE. For an annual fee paid by Medicare or Medicaid, all health care services are coordinated by a team of medical and social service providers.
DOCTOR: And she wants to just check another thyroid level.
BETTY ANN BOWSER: PACE also provides its members with transportation to doctors appointments and a day center. With consistent access to care, Frees and the other PACE members are able to continue living on their own, instead of ending up in a nursing home, which is much more expensive.
But when Billings officials talk about the key to keeping medical costs down, the one thing they always point to is the way they pay their doctors.
DR. DOUG CARR: Physicians are paid a competitive salary, but it is not based on whether they see patients -- Medicare patients, Medicaid patients, commercial patients, whatever. And they're not paid -- they're paid for doing things for patients, and they're not paid for tests that they order or where they do their surgeries.
BETTY ANN BOWSER: Dr. Pat Coon is a geriatric specialist at Billings.
DR. PAT COON, geriatrician, Billings Clinic: I get no reimbursement based on how many X-rays I order, how many EKGs I order, stress tests, or laboratory tests that I order. What I'm looking at is, what is the best way to manage that patient and what do I need to do that?