Maury: Welcome back to Health Matters. Maury Eskenazi and Shannon O'Kelley. Joining us from The Everett Clinic in Snohomish, family practice physician and associate medical director of Care Coordination of The Everett Clinic, it's Dr. Steve Jacobson who joins us.
Shannon: I'm glad you're here because last week we had comments from Rick Larsen on the Accountable Care Act, and I was curious to find out how providers, particularly family physicians, are being affected by this healthcare reform that we are in right now. So, what do you see in your organization at The Everett Clinic?
Dr. Jacobson: The Affordable Care Act is really kind of up in the air what's going to happen. I think the good part that's going to happen, I hope happens, is people who currently don't have healthcare get healthcare. If that happens, I think we will be busier at The Everett Clinic. We need to be busier in our primary care and across the Clinic.
Shannon: As a primary care doc, you're the first line of defense for a lot of patients coming into the system. You know, so many people, are not currently insured, so, particularly in the State of Washington, I think they call it Enhanced Medicaid, and it's a special program for those people at a certain income level, and if that happens are they gonna be able to access the system a lot easier.
Dr. Jacobson: They should be. There's a lot of people now that are uninsured or marginally insured, and healthcare is just a huge issue for them. They might delay seeking appropriate care. Then, if something happened, if they waited too long, had a hospital stay, that is a really expensive issue for them. One of the leading causes of bankruptcies in the country is medical care. Maury: Right. Like some hospitals won't do a test because it's too expensive. Is this going to take care of that?
Dr. Jacobson: I think it will help a lot. We need to be focusing on what does the evidence show is the right thing to be doing for testing. You don't want to be over testing for things, but then, you don't want to be under testing. A big reason for under care would be people who do not have adequate insurance. I'm sure hoping that this helps a lot with that.
Shannon: There are a couple acronyms out there. We hear about the ACA, the Affordable Care Act, and we hear about these ACOs, for Accountable Care Organizations. What do you see in the ACO market?
Dr. Jacobson: ACO is a term that's used nationally. There's a specific Medicare definition for certain types of Accountable Care Organization, and I believe there are about 100 Medicare-defined ACOs across the country. In the broadest sense, it's any organization in healthcare that works together across different parts of the organization, across providers, across hospitals, across different specialties to provide more high-quality care for our patients. So, there is both that kind of a general broad definition, and then, I would say a Medicare-specific definition.
Shannon: So, the ultimate goal of the ACO is essentially to be able to provide a multidisciplinary approach of healthcare, several different specialties under one roof, that the patient ultimately gets the best care.
Dr. Jacobson: Yes, and so would consider The Everett Clinic, although not an official Medicare ACO, is very much an ACO in the true sense. We have a common electronic medical record, we set common practices, best evidence-based medicine for our patients. We collaborate across specialty lines. We provide nurses that are in care management roles. Those are the types of things that an ACO should be providing.
Maury: For someone like me who is not in the medical business, I just want to know if I can just go see my doctor, the same one I am seeing right now. Have you been getting a lot of feedback at The Everett Clinic from patients whether they can continue seeing you or not?
Dr. Jacobson: Yes. I will give you a couple different examples. One would be for our Medicare patients. Every year for patients that are in a Medicare Advantage plan, they have to sign up for the coming year. The open enrollment period happens about the end of October through early December. It changes from year to year. We would like it not to change very much. We would like to have a really stable set of insurers, but, it happens that there might be changes from year to year, and so patients get the letters from the insurers and when they come in to see me, they ask, "Are you going to be signed up with them next year?". And, I try to answer that as best I can.
Shannon: How long is that line of people asking you that question?
Dr. Jacobson: It's pretty long.
Shannon: You often hear family physicians in particular are short in supply, high in demand. Is that currently a problem for any organization out there?
Dr. Jacobson: We have been very fortunate in attracting primary care physicians at The Everett Clinic. We have actually added, this is total, about 80 new providers in the last year or so, which has been good, some really fantastic people we've added to the organization, and a number of those are family medicine, internal medicine, pediatrics, and nurse practitioners that are in primary care. We're still hiring right now. We've got some recruiting going on for both family docs and internal medicine, and so hope to add some more as well.
Maury: That’s great for kids, any kids that are listening right now.
Shannon: Try and go to medical school.
Dr. Jacobson: Absolutely.
Maury: Go study.
Shannon: Actually, from a career standpoint, healthcare has a great future for anybody because the demand is gonna be there.
Shannon: Right now we hear about the hospitalists, internal medicine physicians that are being hired to work in the hospital. Have you seen that in this area happening frequently?
Dr. Jacobson: Yes. Actually Providence and The Everett Clinic work together on a medical hospital team at Providence, and The Everett Clinic has oversight of that and the docs are Clinic docs. We have a group of about 40 internists and nurse practitioners that work at Providence. They do a great job. So, if you were to be admitted with a chronic condition or internal medicine-type condition, pneumonia, congestive heart failure, you name it, that's who will be taking care of you here at the local Providence Everett.
Shannon: The ultimate goal is having that physician in house, who is going to be able to follow that patient through. You don't have to wait to call from an outside source to get the physician there on site, they are there right now. So, they're admitting and taking care of the patient from start to finish, then?
Dr. Jacobson: Yes, they are there 24/7, 365 days a year. I believe the minimum is two on that team at any given time. During a busy day, they probably have about 10 who are seeing patients. If somebody came into the emergency room in the middle of the night, there's going to be a bright alert, awake doctor to take care of you as opposed to somebody getting called in from home.
Maury: That's good to know.
Shannon: (Health care reform.) It's happening. It's here to stay. So, again, you guys have resources for patients to call and/or go to website?
Dr. Jacobson: Yes. Take a look at everettclinic.com. There's information on the website. It's really our goal to take great care of our patients. We have three core values that we live by. Number one is do what's right for each patient. Number two, provide a great workplace. And, number three is provide value, and the equation of service, quality, and cost. That's our mantra. We try to work at it every day.
Maury: Dr. Steve Jacobson, family practice physician at The Everett Clinic in Snohomish. Thanks so much for comin on. I know it's kind of a complicated subject, but you explained it very well. Really appreciate it.