RE: transformed's medical home network -- can it really work for a solo

[Guest guest]

RE Does Transformed apply to small practice environment?

Gordon -- is the PCMH as TransforMed envision it REALLY useful to me as a solo doc on a limited budget?

Or does it only apply to bigger outfits so they can, pardon me, BEG for more money to do what WE ALREADY DO?

In case you haven't noticed, for every successfully started IMP in this list, a number are either doing additional, NONprimary care work, or LEAVING!

To "reengineer" my practice to a CORPORATE standard, without GUARANTEE of financial payoff is, "foolish".

This is now, not later.

There will not be a later.

There will only be several docs running "teams" of NP/PAs, some, I'm sure, good, but others undereducated.

I'll keep my solo going as long as I can, as I don't see the advantage of moving away from where I am, or trying to join ANOTHER group working for a large hospital conglomerate who can COMPLAIN ABOUT ME NOT SEEING ENOUGH PTs, or force me to manage an unmanageable group of pts.

I just got done reading the NEJM article at

http://content.nejm.org/cgi/content/full/358/6/549Market-Based Failure — A Second Opinion on U.S. Health Care Costs

Kuttner

Sorry, it's very very hard for me to participate in a TransforMed demonstration for a solo low volume without FUNDING!!!!!

Respectfully, but hard to keep my cool on this,

Matt in Western PA

RE: transformed's medical home network

I have to agree with Ramona

I had the pleasure of spending the day with Terry McGeeney MD, the CEO of Transformed this past weekend.

The Transformed folks have done a lot of heavy lifting to figure out what it takes to survive and thrive in the current environment and provide better care and prove it.

I see the work that they are doing as being very complementary with what we are doing.

We need real and substantive change in the way health care is paid for in the US. We need major policy shifts and new rules. This will create an environment in which we can deliver superb care and thrive. Political reality teaches us that this kind of transformation rarely happens quickly. Transformed shows the way to make it work right now. It favors a larger team model with a high flow practice. This is not for everyone, but it does work very well for those who like to work in this model and are willing to go through the significant practice redesigns to get there.

Gordon

From: [mailto: ] On Behalf Of RGMSSent: Sunday, January 25, 2009 3:38 PMTo: Subject: RE: transformed's medical home network

Let me see if I can find out the cost from those I know at TransforMed.

Despite the doubts with regards to the TransforMed process, I have found the community to be extremely supportive and helpful. It is good to remember that there are other groups of physicians “out there” who have their values in the right place, care for their patients well, and are looking to improve primary health care in this country, just like the members of this listserve are. Of late, the Touchstone group has put together a document related to the definition of the PCMH. It is clear to me (as it is to those other physicians in the TransforMed demonstration project) that the NCQA standards are insufficient to define the medical home. The personal relationship that patients have with their doctors and the patients’ input are pretty much absent in the definition as stated by NCQA. Whether doing care with “team-based” practice of “IMP” style, the core values are the same. See the core value set (in blue box) in this link:http://www.transformed.com/transformed.cfm

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

NOTE NEW ADDRESS AND PHONE NUMBER:

269 Peninsula Farm RoadSuite F

Arnold, MD 21012

410 518-9808

From: [mailto: ] On Behalf Of EadsSent: Friday, January 23, 2009 9:49 AMTo: Subject: transformed's medical home network

Anyone know how much this costs? I couldn’t find it on their website. It seems to have some good components that would be neat if we could offer them, but that would require a cost, as they have implemented (webinars, tools, etc).

http://www.transformed.com/MedicalHomeNetwork/

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

[Guest guest]

Transformed solves the problem using today’s

standards. They don’t work on the premise of any promised guarantee.

Ramona is a solo IMP doc and she was part of Transformed, so yes, they work with

solo docs, but their model is a larger team model and their solutions include

really nailing work flow, coding, billing, collections, using a team to achieve

high quality and high flow.

Like I said, this is not for everyone, but

no solution works for all.

Yes, I am aware of a number of IMPs that

have not survived. This is a marker most often of the toxic environment but is

also adding to our knowledge of what pitfalls to avoid. The sad truth is that

one can nail every aspect, do it all perfectly, and still end up being poisoned

by the environment.

What you’re asking for Matt is only

reasonable. If America

is ever to have a high performing health system it needs to throw a lifeline to

primary care right now. We need to be rescued from almost certain death in the

current policy climate, we need to create models of payment not poisoned by

those working to maintain the status quo, we need real reform of the outrageous

burden of work that comes from billing and dealing with unfunded administrative

trivia. Bring us back from the bring and then give us the resources we need

to deliver on the full promise of effective primary care.

If on average every person

in America

had a voucher for care that paid $2 per person per day for primary care this

would still count for less than 10% of current health care spending. I’m

not stipulating on where a voucher comes from, I’m not making a hidden

case for government run health care, I’m just saying that if the average PCP

had 1500 patients @ $2/per person per day, we would finally have the resources

we need to purchase the inter-operable HIT, hire or engage with a virtual team

to provide superb population care, have the time to address a broad array of

needs our patients bring, and coordinate care across the continuum.

Gordon

From: [mailto: ] On Behalf Of Dr Levin

Sent: Sunday, January 25, 2009

7:14 PM

To:

Subject: Re:

transformed's medical home network -- can it really work

for a solo

RE Does Transformed apply to small practice environment?

Gordon -- is the PCMH as TransforMed envision it REALLY

useful to me as a solo doc on a limited budget?

Or does it only apply to bigger outfits so they can, pardon

me, BEG for more money to do what WE ALREADY DO?

In case you haven't noticed, for every successfully started

IMP in this list, a number are either doing additional, NONprimary care work,

or LEAVING!

To " reengineer " my practice to a CORPORATE

standard, without GUARANTEE of financial payoff is, " foolish " .

This is now, not later.

There will not be a later.

There will only be several docs running " teams " of

NP/PAs, some, I'm sure, good, but others undereducated.

I'll keep my solo going as long as I can, as I don't see the

advantage of moving away from where I am, or trying to join ANOTHER group

working for a large hospital conglomerate who can COMPLAIN ABOUT ME NOT SEEING

ENOUGH PTs, or force me to manage an unmanageable group of pts.

I just got done reading the NEJM article at

http://content.nejm.org/cgi/content/full/358/6/549

Market-Based Failure — A

Second Opinion on U.S.

Health Care Costs

Kuttner

Sorry, it's very very hard for me to participate in a

TransforMed demonstration for a solo low volume without FUNDING!!!!!

Respectfully, but hard to keep my cool on this,

Matt in Western PA

transformed's medical home network

Anyone know

how much this costs? I couldn’t find it on their website. It

seems to have some good components that would be neat if we could offer them,

but that would require a cost, as they have implemented (webinars, tools, etc).

http://www.transformed.com/MedicalHomeNetwork/

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

[Guest guest]

So where's MY $2/day?

All I'M asking the system is to APPLY EVIDENCE BASED MEDICINE NOW!

1) Review ALL cardiac cases to PREVENT UNWARRANTED and NEEDLESS invasive testing AND angioplasty/stenting. REDISTRIBUTE this "savings" to current primary care so WE can "pay our way" as the primary care docs in ENGLAND have.

2) REVIEW all ORTHOPEDIC elective procedures for STANDARD necessary and needful arthroscopy based on the STANDARDS already STATED by the Orthopedic Medical Society.

3) REVIEW ALL GI procedures so that STANDARD follow up is given, NOT increased frequency.

4) Pay ALL MANDATED VACCINES at market + $5% plus admin fee.

These are early solutions that could be done within 6 months going forward.

Instituting MORE SURVEILLANCE of primary care practices to make sure that policies for followup are done in triplicate will NOT NOT NOT "save" primary care, will NOT NOT NOT encourage others to be in it, will NOT NOT NOT allow me in ANY ANY WAY to institute ANY of the "mandated" goals of Medicare.

Look, MAKE A MANDATE THAT ANY TESTING PAID FOR BY MEDICARE is put into a STANDARD DATABASE and that DUPLICATES will not be PAID to the labs.

More STANDARDS for primary care to "jump through" to SHOW HOW GOOD WE ARE is NOT working to encourage more primary care.

But should I personally care? Right now the insurers are paying me. I'm at about 75% of my goal after 5 years of solo. I finished residency in 1988 in Family Medicine. Half of the primaries in my area work for hospitals, and these places burn people out so fast, OR decide they "want other docs there" that I should be able to fill, slowly but surely, over the next 2-3 years. I "think" I have additional moonlighting/parttime work to keep some semblance of a normal life for my family, baring unforeseen needs, but it's GETTING TOUGH OUT HERE NOW!

Time is running out. NOW!

Make it budget neutral, by all means, but primary care is in trouble, NOW! I can decide what I can do cost effectively and leave others (hospital practices) to see the other folks. That's a tough choice, but that's what will happen, more and more.

Pass this on to the TransforMed folks, see if they can give those of us "in the trenches" a "quick path" to certification, sort of like a "grandfather in" path, to be certified, NO cost (we've already paid for it!) and THEN I'll feel comfortable supporting the agenda.

Pass this onto the TransforMed folks at AAFP (or Dr McGeeney himself if he's interested-- I applied to participate and didn't even get an email back), I'm a member! MAKE ME BELIEVE IT, I haven't seen it YET!

Matt Levin, MD

dr-levin@...

Admin is matlev@...

RE: transformed's medical home network

I have to agree with Ramona

I had the pleasure of spending the day with Terry McGeeney MD, the CEO of Transformed this past weekend.

The Transformed folks have done a lot of heavy lifting to figure out what it takes to survive and thrive in the current environment and provide better care and prove it.

I see the work that they are doing as being very complementary with what we are doing.

We need real and substantive change in the way health care is paid for in the US. We need major policy shifts and new rules. This will create an environment in which we can deliver superb care and thrive. Political reality teaches us that this kind of transformation rarely happens quickly. Transformed shows the way to make it work right now. It favors a larger team model with a high flow practice. This is not for everyone, but it does work very well for those who like to work in this model and are willing to go through the significant practice redesigns to get there.

Gordon

From: [mailto: ] On Behalf Of RGMSSent: Sunday, January 25, 2009 3:38 PMTo: Subject: RE: transformed's medical home network

Let me see if I can find out the cost from those I know at TransforMed.

Despite the doubts with regards to the TransforMed process, I have found the community to be extremely supportive and helpful. It is good to remember that there are other groups of physicians “out there” who have their values in the right place, care for their patients well, and are looking to improve primary health care in this country, just like the members of this listserve are. Of late, the Touchstone group has put together a document related to the definition of the PCMH. It is clear to me (as it is to those other physicians in the TransforMed demonstration project) that the NCQA standards are insufficient to define the medical home. The personal relationship that patients have with their doctors and the patients’ input are pretty much absent in the definition as stated by NCQA. Whether doing care with “team-based” practice of “IMP” style, the core values are the same. See the core value set (in blue box) in this link:http://www.transformed.com/transformed.cfm

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

NOTE NEW ADDRESS AND PHONE NUMBER:

269 Peninsula Farm RoadSuite F

Arnold, MD 21012

410 518-9808

size=2 width="100%" align=center tabIndex=-1>

From: [mailto: ] On Behalf Of EadsSent: Friday, January 23, 2009 9:49 AMTo: Subject: transformed's medical home network

Anyone know how much this costs? I couldn’t find it on their website. It seems to have some good components that would be neat if we could offer them, but that would require a cost, as they have implemented (webinars, tools, etc).

http://www.transformed.com/MedicalHomeNetwork/

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

[Guest guest]

The TransforMed group certainly appears to operate

from the perspective that solo and small group

practice is already dead-Just like the corporate

clients they're trying to cater to.

Their model is corporate group practice. I've seen

nothing from them that encourages me that AAFP has a

survival plan for the 2/3 of the membership that works

solo or in small groups.

They might as well be intellectually honest about it

and tell the AAFP rank and file " Save your dues, we

don't have the time, resources or inclination to work

on small practice survival- you're hosed. Go

elsewhere, go broke or join a big group. "

Within the next 2-4 years, I think we'll know whether

Family Medicine as a specialty lives or dies.

The " survivors " will be back on the treadmill at Mega

Health Inc., supervising a fleet of extenders or

changing careers. We'll finally be Transformed, just

not in the way we'd like.

Ben Brewer M.D.

[Guest guest]

Since Gordon has the "ear" of the prinicipal of TransforMed, I'd like to hear what he can find out for us.

What I know is, I've worked for staff model HMO, I've worked for hospital owned group.

NEITHER is worth it for me; goals are ALWAYS not primarily mine -- I see that as the goal of big business, as we all know from the recent financial/wall street crew how "benign" that influence is.

Why do we mostly feel that corporate LARGE SIZE is better in this country? Devaluation of the individual in favor of security?

Ben -- I thought you were the voice of small group/solo to the world?

Matt, solo-lite FP in Western PA

RE: transformed's medical home network -- can it really work for a solo

The TransforMed group certainly appears to operatefrom the perspective that solo and small grouppractice is already dead-Just like the corporateclients they're trying to cater to. Their model is corporate group practice. I've seennothing from them that encourages me that AAFP has asurvival plan for the 2/3 of the membership that workssolo or in small groups. They might as well be intellectually honest about itand tell the AAFP rank and file "Save your dues, wedon't have the time, resources or inclination to workon small practice survival- you're hosed. Goelsewhere, go broke or join a big group."Within the next 2-4 years, I think we'll know whetherFamily Medicine as a specialty lives or dies.The "survivors" will be back on the treadmill at MegaHealth Inc., supervising a fleet of extenders orchanging careers. We'll finally be Transformed, justnot in the way we'd like.Ben Brewer M.D.

[Guest guest]

I agree

with Ben and I have to add my two cents—well really more like $8 million.

My issue with Transformed is that it cost $8 million to come up with some cool

slides about which we kind of already know (transforming a practice into a

medical home is very difficult and sometimes impossible. It takes great

communication among all members. It takes commitment. Etc). Much of the money

went into consultants pockets and now that the well is dry at the AAFP, it has

been spun off into its own consulting group so it can continue to make money

transforming practices nationally (with the complete blessing of the AAFP). Of

course, paying consultants costs money which increases overhead, which means

you have to run patients through faster, which means quality might drop a bit—but

at least the practice is transformed.

I don’t doubt that there are really

good people at Transformed. I am certain there are wonderful docs who

participated. But it bothers me a bit to have my dues pay to start up a

consulting firm which generally feels bigger is better and has produced (as far

as I have seen) mediocre results at best.

RE:

transformed's medical home network -- can it really work

for a solo

The TransforMed group certainly appears to operate

from the perspective that solo and small group

practice is already dead-Just like the corporate

clients they're trying to cater to.

Their model is corporate group practice. I've seen

nothing from them that encourages me that AAFP has a

survival plan for the 2/3 of the membership that works

solo or in small groups.

They might as well be intellectually honest about it

and tell the AAFP rank and file " Save your dues, we

don't have the time, resources or inclination to work

on small practice survival- you're hosed. Go

elsewhere, go broke or join a big group. "

Within the next 2-4 years, I think we'll know whether

Family Medicine as a specialty lives or dies.

The " survivors " will be back on the treadmill at Mega

Health Inc., supervising a fleet of extenders or

changing careers. We'll finally be Transformed, just

not in the way we'd like.

Ben Brewer M.D.

[Guest guest]

Matt,we can add Cadillac chemotherapy to that listesp. in view that physician delivered pharma was included in as physician payment when they prepared SGR formula based cuts Medicare may not be unsustainable and [hysician cut may not be required if they do their maths again, with pharma cost excluded

[Guest guest]

That's hilarious! I have about 500 Medicaid part of our "medical home" model in Illinois Medicaid (given a the catchy name of "Illinois Health Connect" although they repeatedly faill to connect my pediatric patients with specialty care) pays me $2 PER MONTH per patient. $2 even WEEKLY sounds better-$2/day!!!! Wow, that would be like winning the lottery!Maybe Medicaid can pay me more, but our governor who I believe started this IHC program is currently being impeached (as I type this email), so there MIGHT be some delays in that process. Subject: Re: transformed's medical home

network -- can it really work for a soloTo: Date: Sunday, January 25, 2009, 10:21 PM

So where's MY $2/day?

All I'M asking the system is to APPLY EVIDENCE BASED MEDICINE NOW!

1) Review ALL cardiac cases to PREVENT UNWARRANTED and NEEDLESS invasive testing AND angioplasty/ stenting. REDISTRIBUTE this "savings" to current primary care so WE can "pay our way" as the primary care docs in ENGLAND have.

2) REVIEW all ORTHOPEDIC elective procedures for STANDARD necessary and needful arthroscopy based on the STANDARDS already STATED by the Orthopedic Medical Society.

3) REVIEW ALL GI procedures so that STANDARD follow up is given, NOT increased frequency.

4) Pay ALL MANDATED VACCINES at market + $5% plus admin fee.

These are early solutions that could be done within 6 months going forward.

Instituting MORE SURVEILLANCE of primary care practices to make sure that policies for followup are done in triplicate will NOT NOT NOT "save" primary care, will NOT NOT NOT encourage others to be in it, will NOT NOT NOT allow me in ANY ANY WAY to institute ANY of the "mandated" goals of Medicare.

Look, MAKE A MANDATE THAT ANY TESTING PAID FOR BY MEDICARE is put into a STANDARD DATABASE and that DUPLICATES will not be PAID to the labs.

More STANDARDS for primary care to "jump through" to SHOW HOW GOOD WE ARE is NOT working to encourage more primary care.

But should I personally care? Right now the insurers are paying me. I'm at about 75% of my goal after 5 years of solo. I finished residency in 1988 in Family Medicine. Half of the primaries in my area work for hospitals, and these places burn people out so fast, OR decide they "want other docs there" that I should be able to fill, slowly but surely, over the next 2-3 years. I "think" I have additional moonlighting/ parttime work to keep some semblance of a normal life for my family, baring unforeseen needs, but it's GETTING TOUGH OUT HERE NOW!

Time is running out. NOW!

Make it budget neutral, by all means, but primary care is in trouble, NOW! I can decide what I can do cost effectively and leave others (hospital practices) to see the other folks. That's a tough choice, but that's what will happen, more and more.

Pass this on to the TransforMed folks, see if they can give those of us "in the trenches" a "quick path" to certification, sort of like a "grandfather in" path, to be certified, NO cost (we've already paid for it!) and THEN I'll feel comfortable supporting the agenda.

Pass this onto the TransforMed folks at AAFP (or Dr McGeeney himself if he's interested-- I applied to participate and didn't even get an email back), I'm a member! MAKE ME BELIEVE IT, I haven't seen it YET!

Matt Levin, MD

dr-levincomcast (DOT) net

Admin is matlevcomcast (DOT) net

[Practiceimprovemen t1] transformed' s medical home network

Anyone know how much this costs? I couldn’t find it on their website. It seems to have some good components that would be neat if we could offer them, but that would require a cost, as they have implemented (webinars, tools, etc). http://www.transfor med.com/MedicalH omeNetwork/ A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park , CO 80863 www.PinnacleFamilyM edicine.com