FW: Where we stand

[Guest guest]

Follow the link below to the AAFP proposal for reform. Here is

the response I posted. I encourage other members to do so as well.

Family Medicine is dying quickly and something needs to be done

to save it. If allowed to fail, health care costs will soar and quality will

drop. Such is the value of what we do. But in searching for ways to save FM, we

need to refocus on the most important thing--the doctor-patient relationship.

The further we move from that cornerstone, the less effective and more

expensive our care becomes. Therefore, the focus of the AAFP should be to

reinvigorate FM by doing anything in its power to strengthen this relationship.

Here is what needs to be done: First, we must advocate insurance

for all. This can only be done through a single payor system with defined

benefits. Second, family doctors must be paid in a way which encourages

establishment of a strong relationship with their patients (quality over

quantity). Third, administrative hassles (billing and payment insanities, prior

auths, referrals, etc) have to be removed.

The current AAFP proposal fails in many of these respects.

Having numerous payors will lead to great confusion over who is supposed to be

covering the patient and even more administrative hassles (necessitating more

employees), whereas a single payor with only one set of rules greatly

simplifies this process. Continuing to pay for visits means the continuation of

the insane E & M coding scam which adds to confusion, decreases adoption of

new non-E & M based technologies (ex e-visits, phone visits) and does not

enhance our relationship with ouy patients. I agree with a care coordination

fee, but the NCQA PCMH criteria is a monstrosity of administrative data

collecting which is far more geared to encouraging a technology-centered

medical home than a patient-centered one. Using it will spawn an entire

industry of data collection which will continue to erode precious health care

dollars (and increase the number of employees an office must have). Further, it

has never been shown to actually improve quality, so although it sounds good

superficially, I am frankly surprised the PCMH is being adopted as a baseline

from which we will get paid. Finally, pay for performance initiatives have also

not shown to be worthwhile with many recent studies showing that these result

in higher testing but not better results.

The solution lies in simplifying everything. Wasson et al have

shown that if a patient states " I get exactly the care I want and need

exactly when I need it " on the online health survey " How's Your

Health, " then all measurments of care tend to be good (including diabetic

control, HTN control,ER utilization, hospitalization rates, etc). This one

question is far more powerful of a marker for health quality than anything

found in P4P programs. Also, the data is entered by the patient and no extra

personnel or technology is needed to " mine " the data and report it.

So, by using this simple tool (or a similar one), paying a P4P bonus based on

overall practice results, and combining it with a Care Coordination Fee of a

dollar a day per patient (paid monthly based on the number of patients choosing

the practice as their medical home), the future of Family Medicine would be

assurred. FPs would have pay equity with their specialist colleagues, but there

would also be DECREASED administrative hassles, a strengthening of the

doctor-patient relationship, and a push toward higher quality and cost savings

through a program which can give the accurate and actionable data necessary to

improve our practices. And all this would be done in a way which dramatically

decreases overhead (as we would no longer need billing systems). As with most

things in life, simplifying is the answer.

From: Burke

Sent: Wednesday, April 29, 2009 2:30 AM

To:

Subject: Where we stand

Dear

,

Since

we launched AAFP Connect for Reform more than one month ago, the response

has been terrific. Members are engaged in robust discussions at aafp.org/connect4reform, and we’ve been

listening to your valuable feedback.

As

Congress is preparing to roll out its legislative proposals in the next

month, we want to outline the Academy’s position and measures we’ll support

in these proposals. Click here to read more. Once you’ve read

our position, please take a moment to leave your thoughts and feedback.

Thanks

for your help,

Burke

Director, Government Relations

American Academy of Family Physicians

P.S.

We've added a new feature to bring you even more health care news from

Washington. Check out the new Health Reform Intel section of Connect for

Reform!

To

unsubscribe, visit http://blogs.aafp.org/cfr/connect4reform/entry/join_the_campaign

and choose " I do not want to join the campaign at this time " .

[Guest guest]

I'm gonna be the cynic here...just to play devil's advocate...

Let's say you are the incredibly rich CEO if an insurance company. You live in the lap of luxury. Would you give that up easily? Wouldn't you get together with all the other rich CEOs and not allow a single payer system? They have the control and will not give it up. All the poor and middle class rallying will have no effect on them. Who will force them out? Doctors are, in general, not aggressive, passive and too darn busy to take a stand and fight the beurocracy. It would have to be all of us (OK, ?90%?) at the same time.

I do not see a single payer system happening. No one person has the poewr to make it so.

nancy

To: Sent: Wednesday, April 29, 2009 9:52:16 AMSubject: FW: Where we stand

Follow the link below to the AAFP proposal for reform. Here is the response I posted. I encourage other members to do so as well.

Family Medicine is dying quickly and something needs to be done to save it. If allowed to fail, health care costs will soar and quality will drop. Such is the value of what we do. But in searching for ways to save FM, we need to refocus on the most important thing--the doctor-patient relationship. The further we move from that cornerstone, the less effective and more expensive our care becomes. Therefore, the focus of the AAFP should be to reinvigorate FM by doing anything in its power to strengthen this relationship.

Here is what needs to be done: First, we must advocate insurance for all. This can only be done through a single payor system with defined benefits. Second, family doctors must be paid in a way which encourages establishment of a strong relationship with their patients (quality over quantity). Third, administrative hassles (billing and payment insanities, prior auths, referrals, etc) have to be removed.

The current AAFP proposal fails in many of these respects. Having numerous payors will lead to great confusion over who is supposed to be covering the patient and even more administrative hassles (necessitating more employees), whereas a single payor with only one set of rules greatly simplifies this process. Continuing to pay for visits means the continuation of the insane E & M coding scam which adds to confusion, decreases adoption of new non-E & M based technologies (ex e-visits, phone visits) and does not enhance our relationship with ouy patients. I agree with a care coordination fee, but the NCQA PCMH criteria is a monstrosity of administrative data collecting which is far more geared to encouraging a technology-centered medical home than a patient-centered one. Using it will spawn an entire industry of data collection which will continue to erode precious health care dollars

(and increase the number of employees an office must have). Further, it has never been shown to actually improve quality, so although it sounds good superficially, I am frankly surprised the PCMH is being adopted as a baseline from which we will get paid. Finally, pay for performance initiatives have also not shown to be worthwhile with many recent studies showing that these result in higher testing but not better results.

The solution lies in simplifying everything. Wasson et al have shown that if a patient states "I get exactly the care I want and need exactly when I need it" on the online health survey "How's Your Health," then all measurments of care tend to be good (including diabetic control, HTN control,ER utilization, hospitalization rates, etc). This one question is far more powerful of a marker for health quality than anything found in P4P programs. Also, the data is entered by the patient and no extra personnel or technology is needed to "mine" the data and report it. So, by using this simple tool (or a similar one), paying a P4P bonus based on overall practice results, and combining it with a Care Coordination Fee of a dollar a day per patient (paid monthly based on the number of patients choosing the practice as their medical home), the future of Family Medicine would be assurred. FPs would have

pay equity with their specialist colleagues, but there would also be DECREASED administrative hassles, a strengthening of the doctor-patient relationship, and a push toward higher quality and cost savings through a program which can give the accurate and actionable data necessary to improve our practices. And all this would be done in a way which dramatically decreases overhead (as we would no longer need billing systems). As with most things in life, simplifying is the answer.

From: Burke [mailto:connect4ref ormaafp (DOT) org] Sent: Wednesday, April 29, 2009 2:30 AMTo: Subject: Where we stand

Dear ,

Since we launched AAFP Connect for Reform more than one month ago, the response has been terrific. Members are engaged in robust discussions at aafp.org/connect4re form, and we’ve been listening to your valuable feedback.

As Congress is preparing to roll out its legislative proposals in the next month, we want to outline the Academy’s position and measures we’ll support in these proposals. Click here to read more. Once you’ve read our position, please take a moment to leave your thoughts and feedback.

Thanks for your help,

BurkeDirector, Government RelationsAmerican Academy of Family Physicians

P.S. We've added a new feature to bring you even more health care news from Washington. Check out the new Health Reform Intel section of Connect for Reform!

To unsubscribe, visit http://blogs. aafp.org/ cfr/connect4refo rm/entry/ join_the_ campaignand choose "I do not want to join the campaign at this time".

[Guest guest]

And that is the thought that has been planted in your mind to

keep the system as it is.  Unionize the docs and get the patients behind, no

excuses, and the system can improve.  I uploaded a poll the other day; our

citizens are on our side of this issue.

from Hoboken

From:

[mailto: ] On Behalf Of nancy blake

Sent: Wednesday, April 29, 2009 12:10 PM

To:

Subject: Re: FW: Where we stand

I'm gonna be the cynic here...just to play devil's

advocate...

Let's say you are the incredibly rich CEO if an insurance

company. You live in the lap of luxury. Would you give that up

easily? Wouldn't you get together with all the other rich CEOs and not

allow a single payer system? They have the control and will not give it

up. All the poor and middle class rallying will have no effect on

them. Who will force them out? Doctors are, in general, not

aggressive, passive and too darn busy to take a stand and fight the

beurocracy. It would have to be all of us (OK, ?90%?) at the same time.

I do not see a single payer system happening. No one

person has the poewr to make it so.

nancy

From: Dr. Brady

To:

Sent: Wednesday, April 29, 2009 9:52:16 AM

Subject: FW: Where we stand

Follow the link below to the AAFP

proposal for reform. Here is the response I posted. I encourage other members

to do so as well.

Family Medicine is dying quickly and

something needs to be done to save it. If allowed to fail, health care costs

will soar and quality will drop. Such is the value of what we do. But in

searching for ways to save FM, we need to refocus on the most important

thing--the doctor-patient relationship. The further we move from that

cornerstone, the less effective and more expensive our care becomes. Therefore,

the focus of the AAFP should be to reinvigorate FM by doing anything in its

power to strengthen this relationship.

Here is what needs to be done: First, we

must advocate insurance for all. This can only be done through a single payor

system with defined benefits. Second, family doctors must be paid in a way

which encourages establishment of a strong relationship with their patients

(quality over quantity). Third, administrative hassles (billing and payment

insanities, prior auths, referrals, etc) have to be removed.

The current AAFP proposal fails in many

of these respects. Having numerous payors will lead to great confusion over who

is supposed to be covering the patient and even more administrative hassles

(necessitating more employees), whereas a single payor with only one set of

rules greatly simplifies this process. Continuing to pay for visits means the

continuation of the insane E & M coding scam which adds to confusion,

decreases adoption of new non-E & M based technologies (ex e-visits, phone

visits) and does not enhance our relationship with ouy patients. I agree with a

care coordination fee, but the NCQA PCMH criteria is a monstrosity of

administrative data collecting which is far more geared to encouraging a

technology-centered medical home than a patient-centered one. Using it will

spawn an entire industry of data collection which will continue to erode

precious health care dollars (and increase the number of employees an office

must have). Further, it has never been shown to actually improve quality, so

although it sounds good superficially, I am frankly surprised the PCMH is being

adopted as a baseline from which we will get paid. Finally, pay for performance

initiatives have also not shown to be worthwhile with many recent studies

showing that these result in higher testing but not better results.

The solution lies in simplifying

everything. Wasson et al have shown that if a patient states " I get

exactly the care I want and need exactly when I need it " on the online

health survey " How's Your Health, " then all measurments of care tend

to be good (including diabetic control, HTN control,ER utilization, hospitalization

rates, etc). This one question is far more powerful of a marker for health

quality than anything found in P4P programs. Also, the data is entered by the

patient and no extra personnel or technology is needed to " mine " the

data and report it. So, by using this simple tool (or a similar one), paying a

P4P bonus based on overall practice results, and combining it with a Care

Coordination Fee of a dollar a day per patient (paid monthly based on the

number of patients choosing the practice as their medical home), the future of

Family Medicine would be assurred. FPs would have pay equity with their

specialist colleagues, but there would also be DECREASED administrative

hassles, a strengthening of the doctor-patient relationship, and a push toward higher

quality and cost savings through a program which can give the accurate and

actionable data necessary to improve our practices. And all this would be done

in a way which dramatically decreases overhead (as we would no longer need

billing systems). As with most things in life, simplifying is the answer.

From:

Burke [mailto:connect4ref ormaafp (DOT) org]

Sent: Wednesday, April 29, 2009 2:30 AM

To:

Subject: Where we stand

Dear ,

Since we launched AAFP

Connect for Reform more than one month ago, the response has been terrific.

Members are engaged in robust discussions at aafp.org/connect4re form, and we’ve been

listening to your valuable feedback.

As Congress is preparing to

roll out its legislative proposals in the next month, we want to outline

the Academy’s position and measures we’ll support in these proposals. Click here to read more. Once you’ve read

our position, please take a moment to leave your thoughts and feedback.

Thanks for your help,

Burke

Director, Government Relations

American Academy of Family Physicians

P.S. We've added a new

feature to bring you even more health care news from Washington. Check out

the new Health Reform Intel

section of Connect for Reform!

To

unsubscribe, visit http://blogs. aafp.org/ cfr/connect4refo rm/entry/

join_the_ campaign

and choose " I do not want to join the campaign at this time " .

[Guest guest]

Thanks , we couldn't agree more. Maybe 's right that most docs are too busy/passive to resist, but it wouldn't take all the docs if the patients were mobilized behind/with them.

III had all the power once, until the people who really made things move realized they would have to take up the challenge.

from Appalachia

From: [mailto: ] On Behalf Of José Batlle, MDSent: Wednesday, April 29, 2009 12:14 PMTo: Subject: RE: FW: Where we stand

And that is the thought that has been planted in your mind to keep the system as it is. Unionize the docs and get the patients behind, no excuses, and the system can improve. I uploaded a poll the other day; our citizens are on our side of this issue.

from Hoboken

From: [mailto: ] On Behalf Of nancy blakeSent: Wednesday, April 29, 2009 12:10 PMTo: Subject: Re: FW: Where we stand

I'm gonna be the cynic here...just to play devil's advocate...

Let's say you are the incredibly rich CEO if an insurance company. You live in the lap of luxury. Would you give that up easily? Wouldn't you get together with all the other rich CEOs and not allow a single payer system? They have the control and will not give it up. All the poor and middle class rallying will have no effect on them. Who will force them out? Doctors are, in general, not aggressive, passive and too darn busy to take a stand and fight the beurocracy. It would have to be all of us (OK, ?90%?) at the same time.

I do not see a single payer system happening. No one person has the poewr to make it so.

nancy

From: Dr. Brady <drbradythevillagedoctor (DOT) hrcoxmail.com>To: Sent: Wednesday, April 29, 2009 9:52:16 AMSubject: FW: Where we stand

Follow the link below to the AAFP proposal for reform. Here is the response I posted. I encourage other members to do so as well.

Family Medicine is dying quickly and something needs to be done to save it. If allowed to fail, health care costs will soar and quality will drop. Such is the value of what we do. But in searching for ways to save FM, we need to refocus on the most important thing--the doctor-patient relationship. The further we move from that cornerstone, the less effective and more expensive our care becomes. Therefore, the focus of the AAFP should be to reinvigorate FM by doing anything in its power to strengthen this relationship.

Here is what needs to be done: First, we must advocate insurance for all. This can only be done through a single payor system with defined benefits. Second, family doctors must be paid in a way which encourages establishment of a strong relationship with their patients (quality over quantity). Third, administrative hassles (billing and payment insanities, prior auths, referrals, etc) have to be removed.

The current AAFP proposal fails in many of these respects. Having numerous payors will lead to great confusion over who is supposed to be covering the patient and even more administrative hassles (necessitating more employees), whereas a single payor with only one set of rules greatly simplifies this process. Continuing to pay for visits means the continuation of the insane E & M coding scam which adds to confusion, decreases adoption of new non-E & M based technologies (ex e-visits, phone visits) and does not enhance our relationship with ouy patients. I agree with a care coordination fee, but the NCQA PCMH criteria is a monstrosity of administrative data collecting which is far more geared to encouraging a technology-centered medical home than a patient-centered one. Using it will spawn an entire industry of data collection which will continue to erode precious health care dollars (and increase the number of employees an office must have). Further, it has never been shown to actually improve quality, so although it sounds good superficially, I am frankly surprised the PCMH is being adopted as a baseline from which we will get paid. Finally, pay for performance initiatives have also not shown to be worthwhile with many recent studies showing that these result in higher testing but not better results.

The solution lies in simplifying everything. Wasson et al have shown that if a patient states "I get exactly the care I want and need exactly when I need it" on the online health survey "How's Your Health," then all measurments of care tend to be good (including diabetic control, HTN control,ER utilization, hospitalization rates, etc). This one question is far more powerful of a marker for health quality than anything found in P4P programs. Also, the data is entered by the patient and no extra personnel or technology is needed to "mine" the data and report it. So, by using this simple tool (or a similar one), paying a P4P bonus based on overall practice results, and combining it with a Care Coordination Fee of a dollar a day per patient (paid monthly based on the number of patients choosing the practice as their medical home), the future of Family Medicine would be assurred. FPs would have pay equity with their specialist colleagues, but there would also be DECREASED administrative hassles, a strengthening of the doctor-patient relationship, and a push toward higher quality and cost savings through a program which can give the accurate and actionable data necessary to improve our practices. And all this would be done in a way which dramatically decreases overhead (as we would no longer need billing systems). As with most things in life, simplifying is the answer.

From: Burke [mailto:connect4ref ormaafp (DOT) org] Sent: Wednesday, April 29, 2009 2:30 AMTo: Subject: Where we stand

Dear ,

Since we launched AAFP Connect for Reform more than one month ago, the response has been terrific. Members are engaged in robust discussions at aafp.org/connect4re form, and we’ve been listening to your valuable feedback.

As Congress is preparing to roll out its legislative proposals in the next month, we want to outline the Academy’s position and measures we’ll support in these proposals. Click here to read more. Once you’ve read our position, please take a moment to leave your thoughts and feedback.

Thanks for your help,

BurkeDirector, Government RelationsAmerican Academy of Family Physicians

P.S. We've added a new feature to bring you even more health care news from Washington. Check out the new Health Reform Intel section of Connect for Reform!

To unsubscribe, visit http://blogs. aafp.org/ cfr/connect4refo rm/entry/ join_the_ campaignand choose "I do not want to join the campaign at this time".

[Guest guest]

We are almost getting to a taxation without representation state where our

elected officials say they are listening to us and then doing something else

because they have to make good on promises made by people who funded the

campaign. At least have the decency to say " sorry buddy, you didn't pay us when

it mattered " . All I get is nice 30 something year old admin people telling me to

fill a form out.

The problem we have is we're up against a wall. All of us has debt and many of

us don't organize so the insurance companies can find a " scab " . They know this

and leverage that to create more barriers between us and our money.

Does anybody know if our political action committees use the same tricks the

Pharm and insurance companies use. If they don't, they should start, it seems to

be the only thing working. AAFP can talk and write all they want but politicians

seems to only look for the money. Sad but I think its true.

[Guest guest]

, you give an answer to the question I've been trying to figure out, i.e.

what is the effectiveness measure that a new payment system should be based on:

" by using this simple tool [HYH](or a similar one), paying a P4P bonus based on

overall practice results " . In the real world, how does this work, though? HYH is

a great tool. But when money is attached, the stakes go up, and it seems to me

that there are too many ways to game this system for any payer to agree to use

it.

Haresch

>

> Follow the link below to the AAFP proposal for reform. Here is the response

> I posted. I encourage other members to do so as well.

>

>

>

>

>

>

>

> Family Medicine is dying quickly and something needs to be done to save it.

> If allowed to fail, health care costs will soar and quality will drop. Such

> is the value of what we do. But in searching for ways to save FM, we need to

> refocus on the most important thing--the doctor-patient relationship. The

> further we move from that cornerstone, the less effective and more expensive

> our care becomes. Therefore, the focus of the AAFP should be to reinvigorate

> FM by doing anything in its power to strengthen this relationship.

>

> Here is what needs to be done: First, we must advocate insurance for all.

> This can only be done through a single payor system with defined benefits.

> Second, family doctors must be paid in a way which encourages establishment

> of a strong relationship with their patients (quality over quantity). Third,

> administrative hassles (billing and payment insanities, prior auths,

> referrals, etc) have to be removed.

>

> The current AAFP proposal fails in many of these respects. Having numerous

> payors will lead to great confusion over who is supposed to be covering the

> patient and even more administrative hassles (necessitating more employees),

> whereas a single payor with only one set of rules greatly simplifies this

> process. Continuing to pay for visits means the continuation of the insane

> E & M coding scam which adds to confusion, decreases adoption of new non-E & M

> based technologies (ex e-visits, phone visits) and does not enhance our

> relationship with ouy patients. I agree with a care coordination fee, but

> the NCQA PCMH criteria is a monstrosity of administrative data collecting

> which is far more geared to encouraging a technology-centered medical home

> than a patient-centered one. Using it will spawn an entire industry of data

> collection which will continue to erode precious health care dollars (and

> increase the number of employees an office must have). Further, it has never

> been shown to actually improve quality, so although it sounds good

> superficially, I am frankly surprised the PCMH is being adopted as a

> baseline from which we will get paid. Finally, pay for performance

> initiatives have also not shown to be worthwhile with many recent studies

> showing that these result in higher testing but not better results.

>

> The solution lies in simplifying everything. Wasson et al have shown that if

> a patient states " I get exactly the care I want and need exactly when I need

> it " on the online health survey " How's Your Health, " then all measurments of

> care tend to be good (including diabetic control, HTN control,ER

> utilization, hospitalization rates, etc). This one question is far more

> powerful of a marker for health quality than anything found in P4P programs.

> Also, the data is entered by the patient and no extra personnel or

> technology is needed to " mine " the data and report it. So, by using this

> simple tool (or a similar one), paying a P4P bonus based on overall practice

> results, and combining it with a Care Coordination Fee of a dollar a day per

> patient (paid monthly based on the number of patients choosing the practice

> as their medical home), the future of Family Medicine would be assurred. FPs

> would have pay equity with their specialist colleagues, but there would also

> be DECREASED administrative hassles, a strengthening of the doctor-patient

> relationship, and a push toward higher quality and cost savings through a

> program which can give the accurate and actionable data necessary to improve

> our practices. And all this would be done in a way which dramatically

> decreases overhead (as we would no longer need billing systems). As with

> most things in life, simplifying is the answer.

>

> From: Burke

> Sent: Wednesday, April 29, 2009 2:30 AM

> To:

> Subject: Where we stand

>

>

>

>

> <http://lyris.aafp.org/t/2256348/26754741/734302/0/> Image removed by

> sender. AAFP - Connect for Reform

>

>

>

> Dear ,

>

> Since we launched AAFP Connect for Reform more than one month ago, the

> response has been terrific. Members are engaged in robust discussions at

> <http://lyris.aafp.org/t/2256348/26754741/734302/0/>

> aafp.org/connect4reform, and we've been listening to your valuable feedback.

>

> As Congress is preparing to roll out its legislative proposals in the next

> month, we want to outline the Academy's position and measures we'll support

> in these proposals. <http://lyris.aafp.org/t/2256348/26754741/734302/0/>

> Click here to read more. Once you've read our position, please take a moment

> to leave your thoughts and feedback.

>

>

>

>

>

> Thanks for your help,

>

>

>

> Burke

> Director, Government Relations

> American Academy of Family Physicians

>

> <http://lyris.aafp.org/t/2256348/26754741/734302/0/> Image removed by

> sender. AAFP logo

>

>

> P.S. We've added a new feature to bring you even more health care news from

> Washington. Check out the new

> <http://lyris.aafp.org/t/2256348/26754741/734303/0/> Health Reform Intel

> section of Connect for Reform!

>

>

> To unsubscribe, visit <http://lyris.aafp.org/t/2256348/26754741/733306/0/>

> http://blogs.aafp.org/cfr/connect4reform/entry/join_the_campaign

> and choose " I do not want to join the campaign at this time " .

>

> Image removed by sender.

>

[Guest guest]

Don't talk so well about AARP, they are in bed up their necks with UHC one of the worse offenders in the whole darn business. They are using their better respected name as a champion of the elderly in a prositution like fashion, taking UHC's money (our money whether as under paid medical providers or as consumers) to allow them to sell their worthless carpet bagger Managed Medicare and Medicare Supplement plans that just take more cash out of the system and from the patients for their own profits... I gave up of AARP the moment I put UHC and them together... They need to get a clue. People like UHC are the mortal enemies of those who truly want to improve healthcare.... I know who my corporate master is and UHC is right up there.

To: Sent: Wednesday, April 29, 2009 3:23:06 PMSubject: Re: FW: Where we stand

We are almost getting to a taxation without representation state where our elected officials say they are listening to us and then doing something else because they have to make good on promises made by people who funded the campaign. At least have the decency to say "sorry buddy, you didn't pay us when it mattered". All I get is nice 30 something year old admin people telling me to fill a form out. The problem we have is we're up against a wall. All of us has debt and many of us don't organize so the insurance companies can find a "scab". They know this and leverage that to create more barriers between us and our money. Does anybody know if our political action committees use the same tricks the Pharm and insurance companies use. If they don't, they should start, it seems to be the only thing working. AAFP can talk and write all they want but politicians seems to only look for the money. Sad but I think its true.

[Guest guest]

The way I would see it being used is that you get a percentage

of your patient population to fill it out (say 25-35%) through both your

encouragement and that of the insurance company. After a good sample is

obtained, your practice numbers are compared to the norms that Wasson already

has. If you are above the norm, you get a bigger bonus. If you are below the

norm, you get nothing.

In terms of gaming the system, I would think it would be harder

to do that with this type thing. The patient is filling out the survey and I’m

sure we could (through release forms) send the total practice data to whichever

insurance company wanted it directly from Dartmouth. The only way to game the

system would be to have only the healthy, happy patients do the survey (which

would actually show up on the survey) or having the patients only do the survey

in the office under the watchful eye of a “helpful administrator.”

The data is there as to how effectively HYH can judge the

quality of a practice, and my understanding is that it remains superior and

easier to do than any other method. Of course, Gordon and Wasson can speak

way more intelligently on this than I can.

From:

[mailto: ] On Behalf Of Haresch

Sent: Wednesday, April 29, 2009 4:41 PM

To:

Subject: Re: FW: Where we stand

, you give an answer to the question I've

been trying to figure out, i.e. what is the effectiveness measure that a new

payment system should be based on: " by using this simple tool [HYH](or a

similar one), paying a P4P bonus based on overall practice results " . In

the real world, how does this work, though? HYH is a great tool. But when money

is attached, the stakes go up, and it seems to me that there are too many ways

to game this system for any payer to agree to use it.

Haresch

>

> Follow the link below to the AAFP proposal for reform. Here is the

response

> I posted. I encourage other members to do so as well.

>

>

>

>

>

>

>

> Family Medicine is dying quickly and something needs to be done to save

it.

> If allowed to fail, health care costs will soar and quality will drop.

Such

> is the value of what we do. But in searching for ways to save FM, we need

to

> refocus on the most important thing--the doctor-patient relationship. The

> further we move from that cornerstone, the less effective and more expensive

> our care becomes. Therefore, the focus of the AAFP should be to

reinvigorate

> FM by doing anything in its power to strengthen this relationship.

>

> Here is what needs to be done: First, we must advocate insurance for all.

> This can only be done through a single payor system with defined benefits.

> Second, family doctors must be paid in a way which encourages

establishment

> of a strong relationship with their patients (quality over quantity).

Third,

> administrative hassles (billing and payment insanities, prior auths,

> referrals, etc) have to be removed.

>

> The current AAFP proposal fails in many of these respects. Having numerous

> payors will lead to great confusion over who is supposed to be covering

the

> patient and even more administrative hassles (necessitating more

employees),

> whereas a single payor with only one set of rules greatly simplifies this

> process. Continuing to pay for visits means the continuation of the insane

> E & M coding scam which adds to confusion, decreases adoption of new

non-E & M

> based technologies (ex e-visits, phone visits) and does not enhance our

> relationship with ouy patients. I agree with a care coordination fee, but

> the NCQA PCMH criteria is a monstrosity of administrative data collecting

> which is far more geared to encouraging a technology-centered medical home

> than a patient-centered one. Using it will spawn an entire industry of

data

> collection which will continue to erode precious health care dollars (and

> increase the number of employees an office must have). Further, it has

never

> been shown to actually improve quality, so although it sounds good

> superficially, I am frankly surprised the PCMH is being adopted as a

> baseline from which we will get paid. Finally, pay for performance

> initiatives have also not shown to be worthwhile with many recent studies

> showing that these result in higher testing but not better results.

>

> The solution lies in simplifying everything. Wasson et al have shown that

if

> a patient states " I get exactly the care I want and need exactly when

I need

> it " on the online health survey " How's Your Health, " then

all measurments of

> care tend to be good (including diabetic control, HTN control,ER

> utilization, hospitalization rates, etc). This one question is far more

> powerful of a marker for health quality than anything found in P4P

programs.

> Also, the data is entered by the patient and no extra personnel or

> technology is needed to " mine " the data and report it. So, by

using this

> simple tool (or a similar one), paying a P4P bonus based on overall

practice

> results, and combining it with a Care Coordination Fee of a dollar a day

per

> patient (paid monthly based on the number of patients choosing the

practice

> as their medical home), the future of Family Medicine would be assurred.

FPs

> would have pay equity with their specialist colleagues, but there would

also

> be DECREASED administrative hassles, a strengthening of the doctor-patient

> relationship, and a push toward higher quality and cost savings through a

> program which can give the accurate and actionable data necessary to

improve

> our practices. And all this would be done in a way which dramatically

> decreases overhead (as we would no longer need billing systems). As with

> most things in life, simplifying is the answer.

>

> From: Burke

> Sent: Wednesday, April 29, 2009 2:30 AM

> To:

> Subject: Where we stand

>

>

>

>

> <http://lyris.aafp.org/t/2256348/26754741/734302/0/>

Image removed by

> sender. AAFP - Connect for Reform

>

>

>

> Dear ,

>

> Since we launched AAFP Connect for Reform more than one month ago, the

> response has been terrific. Members are engaged in robust discussions at

> <http://lyris.aafp.org/t/2256348/26754741/734302/0/>

> aafp.org/connect4reform, and we've been listening to your valuable

feedback.

>

> As Congress is preparing to roll out its legislative proposals in the next

> month, we want to outline the Academy's position and measures we'll

support

> in these proposals. <http://lyris.aafp.org/t/2256348/26754741/734302/0/>

> Click here to read more. Once you've read our position, please take a

moment

> to leave your thoughts and feedback.

>

>

>

>

>

> Thanks for your help,

>

>

>

> Burke

> Director, Government Relations

> American Academy of Family Physicians

>

> <http://lyris.aafp.org/t/2256348/26754741/734302/0/>

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> sender. AAFP logo

>

>

> P.S. We've added a new feature to bring you even more health care news

from

> Washington. Check out the new

> <http://lyris.aafp.org/t/2256348/26754741/734303/0/>

Health Reform Intel

> section of Connect for Reform!

>

>

> To unsubscribe, visit <http://lyris.aafp.org/t/2256348/26754741/733306/0/>

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