Going insurance free and Quality Studies WAS=>a few quick questions about your plans for pcmh

[Guest guest]

H and all,

 

I am glad you asked that question, , about " what mounting pressures. "   I have had a couple of days to think about it as I am now recovering from the stomach flu, shared so kindly with me by my children. 

 

The mounting pressures I guess have been in my mind.  I keep reading all this " prove your worth and we might pay you someday " rhetoric, and I sometimes start to buy into it. I have been working for over a year now with a grant program here in Colorado called CCGC, which, in my current slightly dehydrated state, I can not remember what all the letters stand for. 

 

I was very " gung ho " in the beginning, as they seemed to really been interested in helping me organize my practice more efficiently and help care for my patients.  What has actually ended up happening, is I have taught them an awful lot about running an efficient practice, as well as understanding the relentless pursuit of the doctor-patient relationship.  Getting data into their system has been an ongoing nightmare.  Double entry is stupid, a waste of time and gets in the way of me caring for my patients...I am frustrated.  They keep trying to make me conform to their system and I keep saying " but you are here to help me.  This system should make it easier for me, not harder. "   They finally are sort of getting that concept, but slowly. 

 

I have also been trying to get them to integrate How's Your Health data as well, so their A1C data, etc will actually mean something, but that too has been mind numbingly slow---but might be happening sometime before I retire at age 80.  (Gordon, I am still trying, I promise). 

 

Some good news with this program is now one of our GI docs and I are using the " Reach My Doctor " interface to exchange patient information with each other.  IT IS INCREDIBLE!  I send him an email with a question like " I have amazingly healthy 92 year old who swallowed multivitamin pill 10 days ago, still having some pain with swallowing, but eating fine.  Co-mobidities of well controlled 's, thyroiditis on methimazole and asthma, stable.  Should I be worried/do anything/continue to watch?  Yours truly, MEL. "  I upload his medication list and BINGO.  Within 2 hours he has written me back with advice on when to refer and what to do.  NO MORE STUPID PHONE TAG!  Yeah!  So maybe something good is coming out of this.  (How darn hard/expensive would it be to hook each little community up with secure email system like this--I mean come on really?  The money it would save...  The GI docs now do not loose my referrals, 'cause when they do, they get on the Internet and down load it again from RMD.  But the only reason Reach My Doctor is free to both of us is because I am participating in the grant program.)  But, I digress...

 

To echo tac (aka Crowley), I have loved every minute of being out of the insurance world.  I can choose who I give free care to, as opposed to the insurance cartel deciding this for me.  I no longer feel resentful.  I no longer sweat at the end of a visit trying to figure out what codes to use so I might get paid someday.  Instead of trying to figure out what ICD9 code to use for loss of balance, I simply write in my note " loss of balance. "   Cool.  Very freeing.   For my folks with insurance, I put in the codes for the visit that I know and do not sweat the small stuff. 

 

As I have said many times in the past, there is a large group of individuals who have opted out of the western medicine " system, " not because they believe homeopathy and naturopathic medicine are necessarily better, but because they have recognized that the current allopathic/osteopathic non system does not have their best interests in mind, especially for those interested in health, not seeking out treatment for illness.

 

As the economy has worsened, more of these folks are coming out of the woodwork and are joining my practice.  I am astonished.  I have 3 new patients this week and more next week.  Word of mouth is amazing.  I am not nearly as gloomy as I was when I posted my heartfelt commentary some weeks ago.   

 

The more I try to work " from within the system, " the more frustrated I become.  I will still participate to some extent in projects that might someday head in the right direction.  I am really pushing HYH with my patients because I feel this information is worthwhile to me.  Still having some kinks with patients not quite completing the whole process, but I hope to have some data soon that will help me improve my care further. 

 

Rambled a bit, so if something is not clear, do not hesitate to ask questions. 

 

www.mountainviewmd.com

Durango, CO

john, i'll answer because i am all cash, and loving my job more every day.  those people (the all too time consuming for the $88 allowable) either leave, and take their neediness to a doc that doesn't mind the low pay and poor working conditions (like your current self), or they stay, and pay me what i am worth, and suddenly i don't resent them. 

even more theraputic is when they leave, go to the doc down the street, realize how good they had it, and come back.

again, before i am pegged as selfish and only catering to the rich, i know this is not the best way, but for me, it's all i can do.  i do feel with every passing day that the farther i am from organized health insurance, the less injured i will be when it all comes crashing down.  I will be glad to be here and ready for my patients when it all falls apart.

tac

 

, I'm interested in what " mounting pressures " you're feeling.On days like today, I have a hard time visualizing making your leap. While I have grateful self-pay patients for whom I offer significant discounts, then I have the patient today who writes the note on her 4-month-past-due bill about how my $145 charge was too much and threatening to leave (yes!). Nevermind the fact that she has Medicare and only $88 was allowed. Nevermind that she had to pay only half of that as her deductible. Nevermind that I spent 40 minutes plus significant follow up time dealing with her 6 chronic problems and associated meds. Nevermind that she regularly calls requesting that I diagnose her acute problems with tests ordered over the phone. Nevermind that I did 2 long med prior auths for her in the past 2 months. Nevermind that I take home $14/hr for putting up with her.

, did these folks disappear from your new practice, or do you have to keep dealing with them? Haresch > >> >> This is a very important issue.> >>> >> We have to step back and ask the question: What are we trying to> >> accomplish?

> >>> >> What I hope is that the NJAFP is trying to help its membership> >> practitioners remain vital contributors to their communities by providing> >> excellent health care for reasonable compensation.

> >>> >>> >>> >> The question " will PCMH get us there? " is the next most important> >> question.> >>> >> Brady, Egly, & Antonucci respond very well to this.

> >>> >> When we step back and look at the goal of improved population health,> >> improved experience of care, reduced per-capita cost of health care, we will> >> likely agree that a system achieving these meaningful goals is doing a good

> >> job – it is in the words of the Commonwealth Fund a " high performing health> >> system. " > >>> >> Such systems are founded on comprehensive primary care.> >>

> >>> >>> >> Comprehensive primary care has certain cardinal features:> >>> >> First point of contact = " I have no problem getting care when I need it "

> >>> >> Relationship over time = " My primary care practitioner knows me as a> >> person " > >>> >> Broad array of services = " My PCP takes care of the bulk of my health care

> >> needs " > >>> >> Coordination of care = " My PCP coordinate any care I need from the health> >> system " > >>> >>> >>

> >> Bob Berenson (who has authored and co-authored some very important> >> articles on health policy lately and headed up the PCMH review work for ACP)> >> tells an interesting story when he describes what it was like going around

> >> the country assessing practices as " medical homes. " > >>> >> He visited several that met all the NCQA criteria and had all the> >> electronic bells & whistles. Then he visited one that didn't have the bells

> >> & whistles but was a very small practice with superb access, superb> >> continuity, and exemplified the core values of comprehensive primary care.> >> Bob said that the latter practice didn't cut it as an NCQA " medical home "

> >> but would be where he would send his parents.> >>> >>> >>> >> Folks, the NCQA model not only doesn't effectively get at the core of what> >> defines high performing health systems, it also diverts our time, energy and

> >> money into things that have very little to do with quality, care, and the> >> compassion that is the essence of what we do for our patients. As far as I> >> can tell, achieving " Level 3 recognition " is an expensive diversion down the

> >> wrong road and will lead to self congratulatory delusion that somehow we've> >> created a better health care delivery system.> >>> >> Gordon> >>> >>

> >>> >>> >> ------------------------------> >>> >> *From:* [mailto:

> >> ] *On Behalf Of * Crowley> >> *Sent:* Friday, March 06, 2009 9:13 AM> >> *To:* practiceimprovement1

> >> *Subject:* a few quick questions about your plans> >> for pcmh> >>> >>> >>> >> I have a state afp board meeting coming up, and i always feel very much

> >> the minority when i question the validity or feasiblity of the MedicalHome,> >> so to arm myself (since I am often told I am alone in my feelings, and that> >> there is no other way), if you have a few seconds to provide me with the

> >> following data:> >>> >>> >>> >> what is your specialty?> >>> >>> >>> >> what state do you practice in? (in what state do you practice?)

> >>> >>> >>> >> do you plan to attempt ncqa certification for a patient centered medical> >> home?> >>> >>> >>> >> and, if you feel like answering, why or why not?

> >>> >>> >>> >> i hope this is not a violation of list protocol, it is helpful for me so> >> that, if nothing else, i don't feel like a complete lunatic when i am

> >> surrounded by the rest of the board. I would like to change the name of the> >> group to NJAPSPCMH (new jersey academy of practitioners supporting a> >> patient centered medical home), but i guess that wouldn't fit on the shirt

> >> logos...> >>> >>> >>> >> thanks, and happy friday.> >>> >> tac> >>> >> --> >> Crowley, MD

> >> Family Medicine> >> Cape May Courthouse NJ> >> > >> Patients, please allow up to 48 hours for response. If you are having an> >> urgent problem please go to the emergency department or call 911. If you

> >> have a problem or question that can't wait 48 hours, or you have not> >> received a timely response, just call the office at 465-0882.> >>> >> >> >

> > --> > If you are a patient please allow up to 24 hours for a reply by email/> > please note the new email address.> > Remember that e-mail may not be entirely secure/> > MD

> > > > > > ph fax > > impcenter.org> >> > > >

>

--

Crowley, MDFamily MedicineCape May Courthouse NJPatients, please allow up to 48 hours for response. If you are having an urgent problem please go to the emergency department or call 911.  If you have a problem or question that can't wait 48 hours, or you have not received a timely response, just call the office at 465-0882.