In Colorado, a primary care practice has stopped using traditional Medicare and adopted Medicare Advantage, resulting in more reimbursement, fewer administrative concerns and better health outcomes.
The facility, New West Physicians, is the biggest primary care practice based in Colorado. It is established in Denver and employs 100 primary health professionals. Seventy of these professionals are physicians; they provide care for approximately 200,000 patients in the area.
In 1999, New West Physicians left Medicare to use Medicare Advantage as well as fee-for-service commercial insurance. Until that point, Medicare receivables were 90 days behind, and the Medicare reimbursement rate was low. The switch to Medicare Advantage was inspired by the heavy burden of current Medicare billing.
With this change, approximately 85 percent of the patients changed to Medicare Advantage -- without any additional premium. Today, 30 percent of visiting patients and 55 percent of the facility’s revenue are established in Medicare Advantage.
"Despite the lack of formal clinical integration with hospitals and medical specialists, New West has substantial control over hospital stays and the use of specialty practices," according to a report from the American Hospital Association about the practice. "Additionally, New West does not suffer a loss of income as care practices are streamlined and hospital and specialist costs are reduced."
