Genesis Medical Associates, Inc

Genesis Medical Associates, established in 1995, is the largest, independent, primary-care practice in the North Hills.  As a physician-owned independent practice, Genesis Medical Associates accepts all major insurance plans and is committed to providing the highest quality patient care even as healthcare throughout the Pittsburgh region goes through a transformation.

Keystone Clinical Partners LLC, a joint venture of Genesis Medical Associates, Inc. and Preferred Primary Care Physicians, is the first physician-owned primary care practices in Western Pennsylvania to achieve recognition by Medicare as an Accountable Care Organization (ACO).

What is a physician ACO?  An ACO is a network of doctors and other healthcare providers (hospitals, nursing homes, specialists, home care, etc.) that shares financial and medical responsibility for providing coordinated care to patients towards the goal of limiting unnecessary spending while maintaining optimal care. Both providers and patients stand to gain from the increased emphasis on integration throughout the healthcare system.  The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

At the heart of each patient’s care is a primary care physician (PCP). Genesis physicians  are PCPs who manage their patients’ care across the spectrum of inpatient and post-acute care (PAC).  After hospital cost, PAC is the largest per episode expense per beneficiary.  Aging populations and increasing chronic illnesses points out that the need for PAC will continue to increase. The risk for accountable care organizations, however, is that they may be responsible for costs they don’t directly control.

As more and more providers assume responsibility for managing the care of a population, the cost of post-acute care can be an unknown. The universe of post-acute care providers is broad, and a single patient may receive care in any or all of these care settings, and could be admitted more than once:

  • Long-term care hospital
  • Skilled nursing facility
  • Inpatient rehabilitation facility
  • Hospice
  • Home health

Unfortunately, doctors have little official guidance or objective measurement to help them decide which patients will do best in each setting.  In fact, hospitals tend to refer patients to post-acute providers based on pre-established relationships and availability, as opposed to identifying the highest quality or least cost facilities.

When asked to choose a nursing home, patients have the right to be informed about the average cost of a nursing home stay, the average readmission rate back to the hospital, the amount of

days that a particular nursing home keeps a Medicare patient, or even the average number of times that the nursing home facility transfers a patient back to a hospital emergency room.  In addition, patients should know which post-acute facilities are supporters of new technologies such as telehealth or remote patient monitoring.

Genesis, through the Keystone Clinical Partners ACO, is beginning to review such information and will work to educate its patients so that they, and their loved ones, may make informed choices.  If patients and families better understand their options and how the type of care and cost differs from setting to setting, they can indicate their preference in an informed manner.

Physicians can then work together with hospital discharge teams in making arrangements for post-acute care.

Genesis takes its commitment to accountable patient care very seriously and is continuously looking for ways to monitor patient care in the right setting at the right time.  In fact, Genesis recently hired a Transition Care Nurse who will be monitoring patient hospital discharges to post-acute, and then assisting in the care coordination of nursing home and post nursing home care.

According to Genesis executive director, Mark Kissinger, “Our continued mission is to promote tangible advancements in quality, safety and value and to provide our patients with consistently high value healthcare in the context of a long term, patient-centered relationship.”