Hi there. Uh, this is the Pennsylvania Clinical Network Podcast where we feature our network's, talent, resources, and the positive outcomes that yield at every day at the PACN. I'm Dr. John Pagan, chair and CEO of the PACN and your host. It's my pleasure to welcome back Dr. James Galasso of Galasso Family Practice in Schweers in northeast Pennsylvania.
Speaker 2: Good morning.
Speaker: Welcome back, Dr. Glasser, to the show. Uh, we had learned, uh, about your lifelong, uh, dedication to your community and to independent practice, uh, in Schwar Ville during our last podcast, but we didn't have enough time. So we're gonna continue now and, and learn a little bit more about what, what features of the PA clinical network you find, uh, most helpful as well as your prior experience in, uh, shared savings and quality programs.
Um, that are so important, [00:01:00] go going forward. Dr. Galasso is also one of our, um, valuable members of our, um, PA clinical network, a CO oversight board. And, uh, your previous work with, uh, in that area really helps the board and gives direction. Um, can you give us, uh, a little bit more of your experience and your perspective about ACOs, uh, given your prior experience?
Speaker 2: Yes. Um, uh, the, when Governor Rendell was in office, he had a pilot program. It was actually a study that they were doing. It was called the Governor's Chronic Care Initiative. And they, uh, picked practices throughout the state of Pennsylvania and they broke us up into regions. And the goal was to work with, um, one of the, we actually worked with Blue Cross at the time, um, to see if we can.
Uh, pick out our patients who had certain diagnoses. And the big diagnosis that we worked [00:02:00] with initially was our diabetic patients. If we can work with these patients, dial them in, bring them in, and try to control their outcomes and improve their diabetes to see if we can save money. Um, it actually was a lot of fun because we get to meet practices from all over the state and we all.
We're kind of competing to see what we can do and we learned from each other what worked in each practice. Um, we also took one of our nurses in our offices and made them a care manager called patients that, that weren't coming in and saying, Hey, you know, you haven't been in a while. We need to do blood work.
We need to do check your A one Cs, make this Sure. So we did a lot of quality stuff that way. Um, the big thing that came out of that whole study is that it did work. In my first year, I received a check from Blue Cross over a hundred thousand dollars just from my practice, [00:03:00] and it didn't, it wasn't that hard to do Once you, once you found out who your patients were and looked at the ones that were uncontrolled and brought them in and really worked on them and, and hit all the different guidelines that they recommend.
Their numbers correct it and when you correct the diabetic numbers, a lot of the different things, the hospitalizations went down. So we were able to save a lot of money just with a little bit of work. Now, with the, the nice thing about the PA clinical network is I have a lot more resources. Then I had, when I was in that office with one nurse doing the information, you know, we work as a team.
Everybody in the office worked on it. But I had, I had three staff members. Now I have a whole bunch of people that are behind the scenes looking in my charts, scrubbing the numbers. I'm getting reports and saying, Hey, you know, this one fell outta here and this one's here. [00:04:00] Um, and it really has made it a lot easier for me compared to when I was with the Governor's chronic Care Initiative.
Speaker: Yeah. No, it, it is great. And, and that's exactly what the PA Clinical Network is about, is, is being behind the scenes, giving the support, uh, and helping practices. And as you said in your prior podcast, it's not necessarily easy to be independent. You know that there are staffing limitations and, and competitive limitations with the large systems around you.
So again, our, our job at the PA Clinical Network is to help you get recognition for that great care that you give to every one of your patients there. Um, you know, and again, your experience with the chronic care initiative, you know, really helped you and was one of the things that also the network looked at.
So within the PA clinical network. There is a PA clinical network, a CO. Um, many of our practices in the network also belong to the A CO, but not all of them. [00:05:00] Um, there. And that a CO is designed to do the same thing as the governor's initiative is to access shared savings by the great care that our docs are giving.
They were reducing hospitalizations, they're reducing emergency room visits, and they're getting savings for the, um, American people and Medicare. We know that in our first year of participation in 2022, we saved a significant amount of money. We're waiting to see right now whether we get to share in that savings, because if you don't save on dollar one, Medicare has a threshold as to what to do with.
So we know we're on the right track in our very first year, um, and doing some of the key things that you talked about will assure us of that savings in in future years. One of the things we, we look at and, and we call it the big five in the a CO, you're familiar with it, you, you help conceive of it on, on the board is the key touch points in patients' lives that really need to be captured Well.
We know that [00:06:00] your practices are doing it and glass of family practice in particular is doing it, but capturing it and making sure that Medicare knows about it is where we can benefit from the savings. So the annual wellness visit. Um, uh, which, uh, often includes advanced care planning for those latter stages in life.
Uh, chronic care management or the multiple complex conditions, transitional care coming in and out of the hospital and, and nursing home, as well as behavioral health, which is so prevalent, uh, uh, an issue to many patients with one or more chronic conditions. And actually many patients right now, especially in this atmosphere, behavioral health is almost a crisis.
I doubt there's any family practice that that doesn't deal with that significantly as well. Um, the annual wellness visit in particular, maybe one of the, the biggest parts of it. Any tips that you have for our docs and, and fellow docs on how to have a successful annual wellness visit?
Speaker 2: I mean, that's, that's something [00:07:00] that every one of my patients, it's, they're on the list.
Um, and what's nice about the network is they'll also give you a heads up on who's due. Um, but our, my staff, when somebody checks in, they're already looking to see if they had it and if they didn't have one, that they're brought in that way. And they're, they're already trained to do the mini mental status exams and to do the depression screenings and the diabetic foot exams.
There's a whole bunch of things that you're doing anyway. You might as well get in with this. The, uh, annual wellness. And the nice thing about the annual wellness is you're also getting paid for it. Plus you also get, you can use the modifier and you're getting paid for a regular visit. You're what you're doing also, so you're doing both things at the same time and you capture all of your chronic diagnoses because you need to report those every year.
To the carrier so that they know that that's, that puts 'em at a higher risk. If they have multiple diagnoses. The more diagnoses they have, [00:08:00] the higher your risk. They're, they're, they give them more money towards that patient with those diagnoses so that you're not s. Spending as much money because they know that you have a sicker patient.
If you just put down a basic diagnosis and your patient's going to the hospital, all these different things, they're spending more money than what they're allotting them because they don't realize that they're as ill as they are. So in that visit, that's when you catch all these things. These things. The nice, the nice thing about the behind the scenes is your staff, um.
They're, they're bringing to my attention. They'll say, you know, what do you think about this? Or what do you think about that? And there's some things that specialists will put in a note that I may not catch really quick, but they'll pop up that diagnosis for em and they'll say, Hey, can we put this in there?
And I use that and it expands our, our chronic care, um, illnesses and, and, and the diagnoses that we need to put down. But, um, it really [00:09:00] has helped to have. Those people in the background. Um, my, my, I use med end, which is my medical record system, and I actually have a flag that pops up on my chart. It's a big red diamond that comes up.
I click on that before I go in the room. I already know what I need to do. That helps with your pre-visit planning. You know, what, what's going on, you know, what you need to address. And my patients have bought into it. They, they all know every year I'm getting a Medicare wellness exam. They come in, they actually look forward now that we've been doing it so many years about, oh, let's check my brain, make sure my mini middle status is good.
And, and it's nice and, and my staff is all bought into it. Um, and now I have more help. So it really, it's really worked well.
Speaker: That's, that's, that's great. And, and again, the, that willingness says it's so important, the coding and the capturing of, you know, the [00:10:00] complete patient there. And again, those conditions.
As long as you know, you, you note in your note somewhere that they're being addressed and how you're addressing them, um, certainly those, those risk factors do make a difference because again, not only for your practice, but for the whole network, then the complexity of the population is recognized, be it by Medicare or any of the payers.
Then the great care that you're giving in sharing savings, uh, gets to be recognized even further.
Speaker 2: That's correct. So
Speaker: I mean, it, it,
Speaker 2: the other, the other big one that I really, we really honed in on is transition of care. That's where a lot of things, bad things happen. Somebody gets out of the hospital, they come in soon as somebody's, as soon as I find out somebody's discharged within the week, we get them in the office sooner the better because there's.
That's where all your medication errors are gonna happen. Um, and, and you address some of the new diagnoses that they have and, and discuss that with the patient so they understand it [00:11:00] more. A lot of times the patients come outta the hospital because of the hospitalists. Now they don't understand. They don't understand what, what happened.
So you can sit down with them and say, okay, this is why you were there. This is what happened. You review all their information, go over their meds, and sometimes you'll catch, you'll catch where somebody was given. They've been on Lisinopril their whole life, and then they go to the hospital and Ville is their formulary drug and they come home and now they're on Lisinopril and Pril and they both do the same thing.
So these people are overmedicated and you catch it because sometimes the hospitals, it's not their, you know, it's not it. It's just the way the system works. At the end of the hospitalization, whoever's discharging them looks at the med list. Print their scripts out and didn't pay attention to what they came in with.
There's a lot of those errors that you catch, and if you can catch 'em, you can prevent other problems. And then you follow up on studies that need to be followed up on, make sure they're getting their rehab, home health, [00:12:00] um, and, and, and that's where you save your money.
Speaker: I, I think what you're, you know, the other thing that's evident is that, you know, that continuity of care that you talked about in the first podcast, you know the patients so well.
Speaker 2: Yes.
Speaker: You know, that really, that is an advantage, uh, there and making sure that the balance of the medicines they're on and seeing them through every stage of their life, um, you have a perception and, uh, and ano uh, historical knowledge about a patient and a family. Their support structure that goes beyond any transactional, you know, admission or discharge that may occur in a larger institution.
Um, and transition of care as well as annual wellness visits. So important there. Um, you know, the time flies with today's podcast, I'm sure we're gonna have you back to talk about some of the other Big five Behavioral health annual. Uh, advanced care planning, um, and the chronic care management, uh, there, uh, in the future.[00:13:00]
But that wraps about that, about wraps up our conversation for today's show. Um, we really appreciate your time, Dr. Glasso and the, the strong work that your practice does and all our PAC physicians do. Around the state. Uh, once again, I'm Dr. John Pagan, CEO, and the host of the PACN podcast. Thank you for tuning into the latest installment, and be sure to look to our other interesting podcasts in the series, including the one that, uh, we just had with Dr.
Galasso, introducing him and his practice. Any parting words, Dr. Glasson.
Speaker 2: Thanks for having me. I look forward to, to, uh, working with you again and, um, you know, if anybody has any questions out there and wants to talk to us, how we do things, I'm, I'm always available and I'm not afraid to share the different things that we went through to make it easier for you.
Speaker: Thanks so much. We really appreciate that and, and it, and it shows with the great care you give your individual and collective patients. [00:14:00] Alright everyone, good day.
