RE: ACO's --> end of solo? --> Re: Anyone Following This?

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Patients are responsible for the cost of healthcare as much as docs. They eattoo much, smoke and don't exercise, they demand a certain level of care whether they need it or not. If you take on the

actuarial risk, how do you define " your patients. " If they don't show up for visits, are you going to bare the burdon of the outcome. If you share care with an endocrinologist for a group of diabetics, are they yours or theirs. Who gets the credit who bares

the cost. If your patient has an appy, are you responsible.?

These are the reverse to pay per performance, something else that is a bogus flash in the pan of useless activity.

From: [ ] On Behalf Of Kathleen Patton [krpatton@...]

Sent: Monday, January 04, 2010 4:01 PM

To:

Subject: Re: ACO's --> end of solo? --> Re: Anyone Following This?

I think IMPs could circle in this way. Like honeycombs.

The thing that troubles me so much about Accountable Care Organizations is that the underlying assumptions are:

1. Doctors are responsible for rise in health care costs.

2. Doctors can control the cost of healthcare

3. Doctors should take on the actuarial risks of individuals' health.

I don't know about you all but I just do not have that kind of power by myself. The questions then become:

1. Can a collection of docs have that kind of power to take that kind of risk?

2. So what is it that insurance companies do if they are not the ones taking on actuarial risk?

3. Didn't we try this before?

4. The last time we tried this, seems to be the time when patients' mistrust in their doctors, escalated?

4. Do we really think it will improve the therapeutic alliance if patients have it the backs of their minds that medical decisions will be made according to the needs of the doctors' wallet?

Call me blind or not 'forward' thinking. I think we need to learn from history.

Kathleen (who is grumbling about a spot heard on NPR about some ACO in California.)

Here's a well publicized example of an interdependent practice organization with several specialties working together (courtesy of the AAFP list server). This is one potential model for future ACOs:

http://www.tafp.org/news/TFP/09No1/cover.asp

Maybe a variation of this could be the foundation of what you'd like to create here.

R. Pierce MD

Rockport, Maine

www.midcoastmedicine.com

so cindy why not talk to the other 10 and also some of the hospital's docs about working with specialist and case managing and working on quality and access issues? EVERYONE is unhappy in medicien and you could get them talking ;who cares who they work

for?

( we are beginning having all the private PCPs in MAine talk to each other Thanks to PIerce on this list serv a nd a way cool head of the MAine medical Association One needs someone on t heir side to facilitate) If you are competeing for patients

well what if you joined up since you do need to use specialista and ERs and hospitals The best one wins and if pcps decide to work for patietns and for their own dr satisfaction and setup some rules then maybe( dunno if this happens) patients will not

leave the two area hospitals an d go elsewhere

I think you are VALubale to the hospitals in terms of your use of XR LAb specialist yes? DOEs the hospital not care about that ? 10 docs is alot of XR and labs coming into them... No?

On Tue, Dec 29, 2009 at 3:42 PM, <magnetdoctorcomcast (DOT) net> wrote:

, that's great that it is working in your area. But in my area, there are very few of us solo's I would say less than 10 in the 2 competing hospitals overlapping areas. They each run their own primaray care outpatient clinics, with their own bevy of

specialist. They make no bones about the fact the I am in direct competition to their primary care clinics, one next door, 2 less than 10 minutes away, and I am the only solo primary care in about a 15 min radius. What about solo's like me?

Cote'

Re: [practicemgt] Anyone Following This?

>

> Once again Glenn, you've expressed my thoughts better than I could.

>

> As an independent small group owner, I don't think that AAFP supports

> us in this fight.

>

> R. Pierce MD

> Rockport, Maine

> www.midcoastmedicine.com

>

>

>

>

> On 12/28/2009 12:13 PM, gswheetfastmail (DOT) us wrote:

>> But my AAFP leadership assured me that this legislation was good

>> overall, though admittedly imperfect! How could it be so flawed?

>>

>> The truth is, for various reasons, I suspect our leadership would have

>> swallowed ANY bill, as long as it had healthcare reform in the title.

>> Honestly, it seemed that no matter what got crammed into this bill, no

>> matter how much good stuff got taken out, we kept modifying our degree

>> of support, but never withdrew it. Our Board of Directors sees some

>> significant difference between saying " support " and " endorse " , but in

>> the end, laws either pass or fail, regardless of whether the legislators

>> can claim 100%, 90%, or 65% support from the doctors.

>>

>> Guaranteed, all they heard in Congress was that the AAFP was on board.

>> Qualifying our support is of what meaninful consequence after this bill

>> is signed into law?

>>

>> Will we be allowed to obey only 80% of its provisions because the AAFP

>> was only 80% satisfied with it?

>>

>> As to the provisions that effectively aim for the extinction of

>> solo/small groups, it is clear that our leadership sold us out.

>> When confronted with this, I can already tell you what we will hear:

>> 1) Silence. Hope the questioner goes away.

>> 2) " Oh, no. " " You're reading this all wrong. It won't be that bad. "

>> 3) " This was a necessary compromise to ensure the overall position of

>> primary care in HCR. Better to have large groups of primary care than

>> multiple solo specialists as the future of healthcare in the U.S. "

>>

>> I've refused to give a dime to our PAC as I feel it is advancing the

>> cause of Corporate, Top-heavy Family Medicine (at best), and Corporate,

>> Top-heavy Primary Care (with the FP gradually being phased out to the

>> NP/PA model) at worst. I've listened to Board members within our own

>> specialty say that they think this is the future of primary care and

>> that we should be preparing to be managers rather than face-to-face

>> clinicians. They may be right (I pray not), but I'm not going to fund a

>> lobbyist to facilitate that process. My money will go to oppose such

>> trends.

>>

>> The AAFP claims to be strong medicine for America. Our support for this

>> so-called HCR looks more like a placebo with nauseating side-effects.

>>

>> Glenn Wheet, MD

>> South Bend, MD

>>

>>

>>

>>

>> On Thu, 24 Dec 2009 16:04:19 -0500, " Pennie Marchetti "

>> <pmarchettiameritech (DOT) net> said:

>>

>>> Just to scare you some more, here are some details about the bill that

>>> just

>>> passed that make me want to weep.

>>>

>>>

>>> From the Wall Street Journal

>>> http://online.wsj.com/article/SB10001424052748704254604574613992408387548.html

>>> :

>>>

>>>

>>> Primary-care doctors who refer patients to specialists will face

>>> financial

>>> penalties under the plan. Doctors will see 5% of their Medicare pay cut

>>> when their " aggregated " use of resources is " at or above the 90th

>>> percentile of national utilization, " according to the chairman's mark of

>>> Section 3003 of the bill. Doctors will feel financial pressure to limit

>>> referrals to costly specialists like surgeons, since these penalties will

>>> put the referring physician on the hook for the cost of the referral and

>>> perhaps any resulting procedures.

>>>

>>> Next, the plan creates financial incentives for doctors to consolidate

>>> their practices. The idea here is that Medicare can more easily apply its

>>> regulations to institutions that manage large groups of doctors than it

>>> can

>>> to individual physicians. So the Obama plan imposes new costs on doctors

>>> who remain solo, mostly by increasing their overhead requirementssuch as

>>> requiring three years of medical records every time a doctor orders

>>> routine

>>> medical equipment like wheelchairs.

>>>

>>> The plan also offers doctors financial carrots if they give up their

>>> small

>>> practices and consolidate into larger medical groups, or become salaried

>>> employees of large institutions such as hospitals or " staff model "

>>> medical

>>> plans like Kaiser Permanente. One provision, laid out in Section 3022,

>>> allows doctors to share with the government any savings to the government

>>> they achieve by delivering less carebut only if physicians are part of

>>> groups caring for more than 5,000 Medicare patients and " have in place a

>>> leadership and management structure, including with regard to clinical

>>> and

>>> administrative systems. "

>>>

>>> While these payment reforms are structured as pilot programs in the

>>> legislation, this distinction has little practical meaning. Medicare is

>>> being given broad authority, for the first time, to roll these

>>> demonstration programs out nationally without the need for a second

>>> authorization by Congress.

>>>

>>>

>>> And then there's this proof of what we've all felt intuitively - that

>>> government intrusion in our business is already unbearable:

>>>

>>> http://healthcare.nationalreview.com/post/?q=NjZhZGE1ODZhOGJlMDY0OTU3ZDBjYjdjZmRlYWJlZmM=

>>>

>>> The Public Welfare Code contains 109 pages of rules governing providers.

>>> This includes rules governing the National Practitioners Database, HIPAA,

>>> as well as other administrative regulations. A mere ten years earlier,

>>> the

>>> number of pages was only seven!

>>>

>>> That's an increase of 1,457% over ten years. Ouch! Don't expect that to

>>> go down.

>>>

>>> Merry Christmas, here's hoping we all survive the New Year.

>>>

>>> Pennie Marchetti, MD

>>> Stow, Ohio

>>> solo practice

>>>

>>> At 10:27 PM 12/22/2009, you wrote:

>>>

>>>> " Why else would they pursue healthcare bills that their own party's left

>>>> wing detests, unless they are doing so with a wink and a nod indicating

>>>> that the liberals will eventually get everything they want & #8211; a

>>>> single-payer system? "

>>>>

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