Re: Re: Paper work or patient care; also a request for citation

[Guest guest]

Casalino LP, Nicholson S, Gans DN, et al. What Does It Cost Physician Practices To Interact With Health Insurance Plans? Health Affairs, July/August 2009; 28(4): w533-w543.  I think  this is it  KAth

 

But the endless administrative  'stuff'  seems to be eclipsing patient care, taking a huge chunk of money that could be used for patient care.  I say we ration this administrative stuff before we ration care.   For crying out loud, what is it that we want and need, patient care or paper work?

Sorry for yelling, but as said earlier today, we are screaming into a vacuum. There is a figure is tossed about, that purports to be an estimate of what the average  non-IMP doctor spends per year on the paperwork, phone, e filing, and push back to deal with  third party payers.  I understand it is about $67-69K per year per doctor.  None my (non-IMP) colleagues here in Boston, have any idea of what it is really costing them to accomplish this administrative stuff.  Yet the workforce doing all of this administrative work continues to proliferate unabated.  

Can someone help me out in verifying the $67-69K figure?  I used this number during an on-air conversation on the NPR radio show, On Point.  But I felt uncomfortable because I did not have citations. of interest, is that the experts on the show did not even blink at the figure.  I don't think they have any idea either. 

Now I've been asked to write a piece for a news outlet.  I need to back up my position. I'm looking for the citation. Gordon?  ?  ?  Please help.Kathleen

The endless admin stuff is necessary.  Without it, physicians and patients would be spending even more of other people's money and there'd be even less money available for necessary care.  Until we admit that we need to ration third party care, the admin stuff, high deductibles and copays are the only brakes on that part of the system.  

As for profit, I'd much rather deal with profit seeking Anthem than nonprofit Medicare or Medicaid.  My profit making mechanic, carpenter and supermarket aren't particularly overpriced either.Back to the article, I'm looking forward to see IMP ideas kicked around in JAMA but I don't have a copy yet at the office.  How does Farmington get mail so quickly?

 The money is in the system. How much more money would be left to pay the doctors if they got rid of the endless admin stuff and stream lined it and got rid the cut taken for profit. We could get paid by the hour, instead of by what.

On Mon, Apr 26, 2010 at 5:20 PM,   wrote:

 Yeah we a re tight . I dunno i go to the mailbox on Mondays and there it is

 the panel sizes were taken down TO 1800 from i think 2300.Obviously these guys are not iMPS they have staff to do followup and other stuff This was not an article per se it was a 2 ok 1.5 page  commentary but it hit the  nail on the  head( there wasn;t data on how much was  saved in er use..etc   They just said that justifed the cost  of changes they made in the offices..

What I thought wa s  interesting was that this was an  a article on Patient center medical homes that talked about Patient Homes without  NCQA, blue ribbons, metrics and certiifcates of achievement It was straight on basic- see th e patietn for longer, have followup , etc basic  primary care 101

 Continuity access efficiency comprehensive care over time  DUH( Someone named wrote about this in 2002 in FPM. " the practice has memory of the patient. " )I will try to scan it and send in the AM 

On Mon, Apr 26, 2010 at 7:29 PM, Locke  wrote:

 Do you live next door to the JAMA publishers?

April 28 edition isn't even online yet!http://jama.ama-assn.org/Current Issue: Vol. 303, No. 15, April 21, 2010

Dr DeAngelis, Editor in Chief of JAMA, summarizes and comments on this week's issue. You can also subscribe to the podcast or download the audio files.

This Week in JAMA Free Full TextOriginal Contributions

Caloric Sweetener Consumption and Dyslipidemia Among US Adults Free Full Text |  JAMA Report Video

Spoken Language Development in Children Following Cochlear Implantation Abstract | Full Text | eSupplement | Interactive Graphs

Association of Maternal Stature With Offspring Mortality, Underweight, and Stunting in Low- to Middle-Income Countries Abstract | Full Text | eTables and eFigures | Interactive Information Graphic

Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States Abstract | Full Text | eTable

Locke, MDOn Mon, Apr 26, 2010 at 4:04 PM,   wrote:

  beats me:)   JAma  April 28 2010 Vol 303 No16 p 1644- 1645    Larson  and  Reid 

On Mon, Apr 26, 2010 at 5:53 PM, Graham Chiu  wrote:

 What's the URI Jean?

On Tue, Apr 27, 2010 at 9:25 AM,   wrote:

Jama article today about The patient centered medical home movement - why nowGood stuffBasically I take this as 2 folks form Group Health in Washington touting their own stuff- rightfully so It is IMP stuff!

They report that by reducing panels size, increasing the length of visits, and building care around a care based relationship with increases in phone and email follow up  doing previsit chart reviews etc they were able  to  improve  the patient experience of care , clinical work experience as well, and they had fewer er visits and urgent  care visits(lower costs  which made up for the longer visits)

 DUH!  They are clear that for such a model to be broadly   successful  someone must " rethink reimbursmetn as well as adress resouce use "   DUh These guys are honorary IMPS. NOw how  do  we get anyone else to listen especially  those folks who might

" redesign  reimbursment "  PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .    MD         

ph   fax impcenter.org-- 

Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .    MD         

ph   fax impcenter.org

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .    MD         

ph   fax impcenter.org-- 

M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. 

If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. 

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .     MD    

    ph   fax impcenter.org

[Guest guest]

Thank you, thank you! You're the best. Casalino LP, Nicholson S, Gans DN, et al. What Does It Cost Physician Practices To Interact With Health Insurance Plans? Health Affairs, July/August 2009; 28(4): w533-w543. I think this is it KAthOn Tue, Apr 27, 2010 at 11:40 AM, Kathleen Patton <krpattoncomcast (DOT) net> wrote: But the endless administrative 'stuff' seems to be eclipsing patient care, taking a huge chunk of money that could be used for patient care. I say we ration this administrative stuff before we ration care. For crying out loud, what is it that we want and need, patient care or paper work?Sorry for yelling, but as said earlier today, we are screaming into a vacuum. There is a figure is tossed about, that purports to be an estimate of what the average non-IMP doctor spends per year on the paperwork, phone, e filing, and push back to deal with third party payers. I understand it is about $67-69K per year per doctor. None my (non-IMP) colleagues here in Boston, have any idea of what it is really costing them to accomplish this administrative stuff. Yet the workforce doing all of this administrative work continues to proliferate unabated. Can someone help me out in verifying the $67-69K figure? I used this number during an on-air conversation on the NPR radio show, On Point. But I felt uncomfortable because I did not have citations. of interest, is that the experts on the show did not even blink at the figure. I don't think they have any idea either. Now I've been asked to write a piece for a news outlet. I need to back up my position. I'm looking for the citation. Gordon? ? ? Please help.KathleenThe endless admin stuff is necessary. Without it, physicians and patients would be spending even more of other people's money and there'd be even less money available for necessary care. Until we admit that we need to ration third party care, the admin stuff, high deductibles and copays are the only brakes on that part of the system. As for profit, I'd much rather deal with profit seeking Anthem than nonprofit Medicare or Medicaid. My profit making mechanic, carpenter and supermarket aren't particularly overpriced either.Back to the article, I'm looking forward to see IMP ideas kicked around in JAMA but I don't have a copy yet at the office. How does Farmington get mail so quickly? The money is in the system. How much more money would be left to pay the doctors if they got rid of the endless admin stuff and stream lined it and got rid the cut taken for profit. We could get paid by the hour, instead of by what.On Mon, Apr 26, 2010 at 5:20 PM, <jnantonuccigmail> wrote: Yeah we a re tight . I dunno i go to the mailbox on Mondays and there it is the panel sizes were taken down TO 1800 from i think 2300.Obviously these guys are not iMPS they have staff to do followup and other stuff This was not an article per se it was a 2 ok 1.5 page commentary but it hit the nail on the head( there wasn;t data on how much was saved in er use..etc They just said that justifed the cost of changes they made in the offices..What I thought wa s interesting was that this was an a article on Patient center medical homes that talked about Patient Homes without NCQA, blue ribbons, metrics and certiifcates of achievement It was straight on basic- see th e patietn for longer, have followup , etc basic primary care 101 Continuity access efficiency comprehensive care over time DUH( Someone named wrote about this in 2002 in FPM. "the practice has memory of the patient.")I will try to scan it and send in the AM On Mon, Apr 26, 2010 at 7:29 PM, Locke <lockecoloradogmail> wrote: Do you live next door to the JAMA publishers?April 28 edition isn't even online yet!http://jama.ama-assn.org/Current Issue: Vol. 303, No. 15, April 21, 2010Dr DeAngelis, Editor in Chief of JAMA, summarizes and comments on this week's issue. You can also subscribe to the podcast or download the audio files.This Week in JAMA Free Full TextOriginal ContributionsCaloric Sweetener Consumption and Dyslipidemia Among US Adults Free Full Text | JAMA Report VideoSpoken Language Development in Children Following Cochlear Implantation Abstract | Full Text | eSupplement | Interactive GraphsAssociation of Maternal Stature With Offspring Mortality, Underweight, and Stunting in Low- to Middle-Income Countries Abstract | Full Text | eTables and eFigures | Interactive Information GraphicPandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States Abstract | Full Text | eTable Locke, MDOn Mon, Apr 26, 2010 at 4:04 PM, <jnantonuccigmail> wrote: beats me:) JAma April 28 2010 Vol 303 No16 p 1644- 1645 Larson and Reid On Mon, Apr 26, 2010 at 5:53 PM, Graham Chiu <compkarorigmail> wrote: What's the URI Jean?On Tue, Apr 27, 2010 at 9:25 AM, <jnantonuccigmail> wrote:Jama article today about The patient centered medical home movement - why nowGood stuffBasically I take this as 2 folks form Group Health in Washington touting their own stuff- rightfully so It is IMP stuff!They report that by reducing panels size, increasing the length of visits, and building care around a care based relationship with increases in phone and email follow up doing previsit chart reviews etc they were able to improve the patient experience of care , clinical work experience as well, and they had fewer er visits and urgent care visits(lower costs which made up for the longer visits) DUH! They are clear that for such a model to be broadly successful someone must "rethink reimbursmetn as well as adress resouce use" DUh These guys are honorary IMPS. NOw how do we get anyone else to listen especially those folks who might"redesign reimbursment" PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. -- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

[Guest guest]

I say we ration this administrative stuff before

we ration care.

You're missing the point.  We're rationing care already.  We're using

this administrative stuff as a rationing device.

You can't advocate removing the admin hassles unless you're prepared to

replace them with something else to prevent the third party payer

system from collapsing even faster.   Openly rationing ( the old Oregon

plan) or high deductibles (HSAs) are options as well as more insidious

means of getting physicians to quietly ration third party care ("social

justice" and the return of capitation).

..

[Guest guest]

I couldn't find a fulltext version of this online, but I found a related

article:

Costs of Health Care Administration in the United States and Canada

NEJM Volume 349:768-775, August 21, 2003, Number 8

http://content.nejm.org/cgi/content/full/349/8/768

Seto

South Pasadena, CA

> Casalino LP, Nicholson S, Gans DN, et al. What Does It Cost Physician

Practices To Interact With Health Insurance Plans? Health Affairs, July/August

2009; 28(4): w533-w543.

>

> I think this is it KAth

>

>

>

>

>

>

> On Tue, Apr 27, 2010 at 11:40 AM, Kathleen Patton

wrote:

>

> But the endless administrative 'stuff' seems to be eclipsing patient care,

taking a huge chunk of money that could be used for patient care.

>

> I say we ration this administrative stuff before we ration care. For crying

out loud, what is it that we want and need, patient care or paper work?

> Sorry for yelling, but as said earlier today, we are screaming into a

vacuum.

>

> There is a figure is tossed about, that purports to be an estimate of what the

average non-IMP doctor spends per year on the paperwork, phone, e filing, and

push back to deal with third party payers. I understand it is about $67-69K

per year per doctor. None my (non-IMP) colleagues here in Boston, have any idea

of what it is really costing them to accomplish this administrative stuff. Yet

the workforce doing all of this administrative work continues to proliferate

unabated.

>

> Can someone help me out in verifying the $67-69K figure? I used this number

during an on-air conversation on the NPR radio show, On Point. But I felt

uncomfortable because I did not have citations. of interest, is that the experts

on the show did not even blink at the figure. I don't think they have any idea

either.

>

> Now I've been asked to write a piece for a news outlet. I need to back up my

position. I'm looking for the citation. Gordon? ? ? Please help.

>

> Kathleen

>

>

>

>

>

>> The endless admin stuff is necessary. Without it, physicians and patients

would be spending even more of other people's money and there'd be even less

money available for necessary care. Until we admit that we need to ration third

party care, the admin stuff, high deductibles and copays are the only brakes on

that part of the system.

>>

>> As for profit, I'd much rather deal with profit seeking Anthem than nonprofit

Medicare or Medicaid. My profit making mechanic, carpenter and supermarket

aren't particularly overpriced either.

>>

>> Back to the article, I'm looking forward to see IMP ideas kicked around in

JAMA but I don't have a copy yet at the office. How does Farmington get mail so

quickly?

>>

>>

>>

>>

>>

>>>

>>> The money is in the system. How much more money would be left to pay the

doctors if they got rid of the endless admin stuff and stream lined it and got

rid the cut taken for profit. We could get paid by the hour, instead of by what.

>>>

>>>

>>> On Mon, Apr 26, 2010 at 5:20 PM,

wrote:

>>>

>>>

>>> Yeah we a re tight .

>>> I dunno i go to the mailbox on Mondays and there it is

>>>

>>>

>>> the panel sizes were taken down TO 1800 from i think 2300.

>>> Obviously these guys are not iMPS they have staff to do followup and other

stuff

>>> This was not an article per se it was a 2 ok 1.5 page commentary but it

hit the nail on the head( there wasn;t data on how much was saved in er

use..etc They just said that justifed the cost of changes they made in the

offices..

>>> What I thought wa s interesting was that this was an a article on Patient

center medical homes that talked about Patient Homes without NCQA, blue

ribbons, metrics and certiifcates of achievement

>>> It was straight on basic- see th e patietn for longer, have followup , etc

basic primary care 101

>>> Continuity access efficiency comprehensive care over time DUH

>>> ( Someone named wrote about this in 2002 in FPM. " the practice has

memory of the patient. " )

>>> I will try to scan it and send in the AM

>>>

>>>

>>> On Mon, Apr 26, 2010 at 7:29 PM, Locke

wrote:

>>>

>>>

>>> Do you live next door to the JAMA publishers?

>>> April 28 edition isn't even online yet!

>>>

>>> http://jama.ama-assn.org/

>>>

>>>

>>> Current Issue: Vol. 303, No. 15, April 21, 2010

>>>

>>>

>>> Dr DeAngelis, Editor in Chief of JAMA, summarizes and comments on this

week's issue. You can also subscribe to the podcast or download the audio files.

>>> This Week in JAMA Free Full Text

>>>

>>> Original Contributions

>>>

>>> • Caloric Sweetener Consumption and Dyslipidemia Among US Adults

>>> Free Full Text | JAMA Report Video

>>> • Spoken Language Development in Children Following Cochlear Implantation

>>> Abstract | Full Text | eSupplement | Interactive Graphs

>>> • Association of Maternal Stature With Offspring Mortality, Underweight,

and Stunting in Low- to Middle-Income Countries

>>> Abstract | Full Text | eTables and eFigures | Interactive Information

Graphic

>>> • Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the

United States

>>> Abstract | Full Text | eTable

>>> Locke, MD

>>>

>>>

>>>

>>> On Mon, Apr 26, 2010 at 4:04 PM,

wrote:

>>>

>>> beats me:) JAma April 28 2010 Vol 303 No16 p 1644- 1645 Larson

and Reid

>>>

>>>

>>>

>>> What's the URI Jean?

>>>

>>>

>>>

>>> On Tue, Apr 27, 2010 at 9:25 AM,

wrote:

>>>

>>>

>>> Jama article today about The patient centered medical home movement - why

now

>>> Good stuff

>>>

>>> Basically I take this as 2 folks form Group Health in Washington touting

their own stuff- rightfully so It is IMP stuff!

>>> They report that by reducing panels size, increasing the length of visits,

and building care around a care based relationship with increases in phone and

email follow up doing previsit chart reviews etc they were able to improve

the patient experience of care , clinical work experience as well, and they had

fewer er visits and urgent care visits(lower costs which made up for the

longer visits)

>>> DUH!

>>> They are clear that for such a model to be broadly successful someone

must " rethink reimbursmetn as well as adress resouce use " DUh

>>> These guys are honorary IMPS.

>>> NOw how do we get anyone else to listen especially those folks who might

>>> " redesign reimbursment "

>>>

>>> Jean

>>>

>>> --

>>> PATIENTS-please remember that email may not be entirely secure, and that

Email is part of the medical record and is placed into your chart ( be careful

what you say!)

>>> Email is best used for appointment making and brief questions

>>> Email replies can be expected within 24 hours-Please CALL if the matter is

more urgent .

>>>

>>>

>>> MD

>>>

>>>

>>> ph fax

>>> impcenter.org

>>>

>>>

>>>

>>>

>>>

>>> --

>>> Graham Chiu

>>> http://www.compkarori.co.nz:8090/

>>> Synapse - the use from anywhere EMR.

>>>

>>>

>>>

>>> --

>>> PATIENTS-please remember that email may not be entirely secure, and that

Email is part of the medical record and is placed into your chart ( be careful

what you say!)

>>> Email is best used for appointment making and brief questions

>>> Email replies can be expected within 24 hours-Please CALL if the matter is

more urgent .

>>>

>>>

>>> MD

>>>

>>>

>>> ph fax

>>> impcenter.org

>>>

>>>

>>>

>>>

>>> --

>>> PATIENTS-please remember that email may not be entirely secure, and that

Email is part of the medical record and is placed into your chart ( be careful

what you say!)

>>> Email is best used for appointment making and brief questions

>>> Email replies can be expected within 24 hours-Please CALL if the matter is

more urgent .

>>>

>>>

>>> MD

>>>

>>>

>>> ph fax

>>> impcenter.org

>>>

>>>

>>>

>>> --

>>> M.D.

>>> www.elainemd.com

>>> Office:

>>> Go in the directions of your dreams and live the life you've imagined.

>>> This email transmission may contain protected and privileged, highly

confidential medical, Personal and Health Information (PHI) and/or legal

information. The information is intended only for the use of the individual or

entity named above.

>>>

>>>

>>>

>>> If you are not the intended recipient of this material, you may not use,

publish, discuss, disseminate or otherwise distribute it. If you are not the

intended recipient, or if you have received this transmission in error, please

notify the sender immediately and confidentially destroy the information that

email in error.

>>

>

>

>

>

> --

> PATIENTS-please remember that email may not be entirely secure, and that

Email is part of the medical record and is placed into your chart ( be careful

what you say!)

> Email is best used for appointment making and brief questions

> Email replies can be expected within 24 hours-Please CALL if the matter is

more urgent .

>

>

> MD

>

>

> ph fax

> impcenter.org

>

>

[Guest guest]

I do not think I am missing the point here. Rationing assumes that there is a fixed amount of money available to procure a commodity or service. That assumption in healthcare, is debatable. It is much more complex than that. For example, a healthy population is capable of higher production.For simplicity sake let us make the assumption that there is a fixed amount of money available for healthcare. Of that fixed amount, who or what do you believe is in the best position to make the allocations?1. People or institutions that actually have some knowledge of medicine and healthcare. Or, 2. The massive, inefficient, self proliferating paper shuffle or your term, "admin hassles" required by third party payers. And a question for all us to consider: Why are we afraid of the collapse of the third party system? I say we ration this administrative stuff before we ration care.You're missing the point. We're rationing care already. We're using this administrative stuff as a rationing device.You can't advocate removing the admin hassles unless you're prepared to replace them with something else to prevent the third party payer system from collapsing even faster. Openly rationing ( the old Oregon plan) or high deductibles (HSAs) are options as well as more insidious means of getting physicians to quietly ration third party care ("social justice" and the return of capitation)..

[Guest guest]

Here try some of these on for size... Great rodent there.... "Hey Rockie, watch me pull a rabbit out of my hat!" "again??? But that trick never works!" "This time for sure!!!!.... Presto!!!... "Well, I'm getting close..."

http://www.pch.gc.ca/pgm/ceem-cced/symbl/anthem-eng.cfm

FYI, it is my understanding the Rockie and Bullwinkle were never allowed to be broadcast in the great white north because Duddlie DoRight made such a mockery of the RCMP....

To: Sent: Wed, April 28, 2010 7:19:48 PMSubject: Re: Re: Paper work or patient care; also a request for citationvery nice. Sounds like chipmunks playing accordions.

I always felt I was born a few hundred miles too far south...

"Oh Canada, My Home and Native Land, True Patriot Love, In All Thy Sons Command..... "

http://www.psd70. ab.ca/broxton/ Tutorial% 20folder/ Canada%20WebQues ts/Canada% 20-%20Gr% 203_4/song. html

Ya know how us left of center hockey players are... Hey wait a moment I used to play center and I shoot right, so what the heck does that mean then??? Aaaaahhh, I'm a real, original 1960's definition Liberal!!!! (not the bastardized Orwellian, Newt definition that cut off half the conversation, by redefining the middle of the road waffle, as the extreme far left. Sneaky little SOB he was.)

From: <elaine2mdgmail (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Wed, April 28, 2010 9:59:54 AMSubject: Re: [Practiceimprovemen t1] Re: Paper work or patient care; also a request for citation

also let me add, if we were non profits, then our retainer fees could be donations and pt could tax deduct....just a thought, I am not an accountant

On Wed, Apr 28, 2010 at 6:39 AM, <elaine2mdgmail (DOT) com> wrote:

I can speak directly about a what a non profit can do. I have a non profit disability insurance policy (from Canada). At the end of every year. Money not spent comes back to me. I get back about 75% of my preminums. Would that be nice for health care too? Money not spent by non profit goes back to the members. I think the Doctors Malpractice Co. offers something simular.

Looking back, I wonder if an IMP would be better off being a non profit? We pay ourselves a salary then donate a small portion of our profits to a charity. I think even our medical associations would count, as would a humane society, homeless shelter. Has anyone looked into this?

PS I worked in Canada, it is 1000 times easier to run an IMP there than here and better paid. Majority of Canadain doctors are IMP but don't know it. Almost everyone is in private practice in Canada, just doing their own thing

On Tue, Apr 27, 2010 at 8:40 AM, Kathleen Patton <krpattoncomcast (DOT) net> wrote:

But the endless administrative 'stuff' seems to be eclipsing patient care, taking a huge chunk of money that could be used for patient care.

I say we ration this administrative stuff before we ration care. For crying out loud, what is it that we want and need, patient care or paper work?

Sorry for yelling, but as said earlier today, we are screaming into a vacuum.

There is a figure is tossed about, that purports to be an estimate of what the average non-IMP doctor spends per year on the paperwork, phone, e filing, and push back to deal with third party payers. I understand it is about $67-69K per year per doctor. None my (non-IMP) colleagues here in Boston, have any idea of what it is really costing them to accomplish this administrative stuff. Yet the workforce doing all of this administrative work continues to proliferate unabated.

Can someone help me out in verifying the $67-69K figure? I used this number during an on-air conversation on the NPR radio show, On Point. But I felt uncomfortable because I did not have citations. of interest, is that the experts on the show did not even blink at the figure. I don't think they have any idea either.

Now I've been asked to write a piece for a news outlet. I need to back up my position. I'm looking for the citation. Gordon? ? ? Please help.

Kathleen

The endless admin stuff is necessary. Without it, physicians and patients would be spending even more of other people's money and there'd be even less money available for necessary care. Until we admit that we need to ration third party care, the admin stuff, high deductibles and copays are the only brakes on that part of the system. As for profit, I'd much rather deal with profit seeking Anthem than nonprofit Medicare or Medicaid. My profit making mechanic, carpenter and supermarket aren't particularly overpriced either.Back to the article, I'm looking forward to see IMP ideas kicked around in JAMA but I don't have a copy yet at the office. How does Farmington get mail so quickly?

The money is in the system. How much more money would be left to pay the doctors if they got rid of the endless admin stuff and stream lined it and got rid the cut taken for profit. We could get paid by the hour, instead of by what.

On Mon, Apr 26, 2010 at 5:20 PM, <jnantonucci@ gmail.com> wrote:

Yeah we a re tight . I dunno i go to the mailbox on Mondays and there it is the panel sizes were taken down TO 1800 from i think 2300.Obviously these guys are not iMPS they have staff to do followup and other stuff This was not an article per se it was a 2 ok 1.5 page commentary but it hit the nail on the head( there wasn;t data on how much was saved in er use..etc They just said that justifed the cost of changes they made in the offices..What I thought wa s interesting was that this was an a article on Patient center medical homes that talked about Patient Homes without NCQA, blue ribbons, metrics and certiifcates of

achievement It was straight on basic- see th e patietn for longer, have followup , etc basic primary care 101 Continuity access efficiency comprehensive care over time DUH( Someone named wrote about this in 2002 in FPM. "the practice has memory of the patient.")I will try to scan it and send in the AM

On Mon, Apr 26, 2010 at 7:29 PM, Locke <lockecolorado@ gmail.com> wrote:

Do you live next door to the JAMA publishers?April 28 edition isn't even online yet!http://jama. ama-assn. org/

Current Issue: Vol. 303, No. 15, April 21, 2010 Dr DeAngelis, Editor in Chief of JAMA, summarizes and comments on this week's issue. You can also subscribe to the podcast or download the audio files.

This Week in JAMA Free Full Text

Original Contributions

Caloric Sweetener Consumption and Dyslipidemia Among US Adults Free Full Text | JAMA Report Video

Spoken Language Development in Children Following Cochlear Implantation Abstract | Full Text | eSupplement | Interactive Graphs

Association of Maternal Stature With Offspring Mortality, Underweight, and Stunting in Low- to Middle-Income Countries Abstract | Full Text | eTables and eFigures | Interactive Information

Graphic

Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States Abstract | Full Text | eTable Locke, MD

On Mon, Apr 26, 2010 at 4:04 PM, <jnantonucci@ gmail.com> wrote:

beats me:) JAma April 28 2010 Vol 303 No16 p 1644- 1645 Larson and Reid

On Mon, Apr 26, 2010 at 5:53 PM, Graham Chiu <compkarorigmail (DOT) com> wrote:

What's the URI Jean?

On Tue, Apr 27, 2010 at 9:25 AM, <jnantonucci@ gmail.com> wrote:

Jama article today about The patient centered medical home movement - why nowGood stuffBasically I take this as 2 folks form Group Health in Washington touting their own stuff- rightfully so It is IMP stuff!They report that by reducing panels size, increasing the length of visits, and building care around a care based relationship with increases in phone and email follow up doing previsit chart reviews etc they were able to improve the patient experience of care , clinical work experience as well, and they had fewer er visits and urgent care visits(lower costs which made up for the longer visits) DUH! They are clear that for

such a model to be broadly successful someone must "rethink reimbursmetn as well as adress resouce use" DUh These guys are honorary IMPS. NOw how do we get anyone else to listen especially those folks who might"redesign reimbursment"-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph

fax impcenter.org-- Graham Chiuhttp://www.compkaro ri.co.nz: 8090/Synapse - the use from anywhere EMR.

-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org

-- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org-- M.D.www.elainemd. comOffice: Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected and privileged, highly confidential medical, Personal and Health

Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

--

M.D.www.elainemd. comOffice: Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are

not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. -- M.D.www.elainemd. comOffice: Go in the directions of your dreams and live the life you've imagined.This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information

(PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

[Guest guest]

For whatever wiki is worth.http://en.wikipedia.org/wiki/The_Rocky_and_Bullwinkle_ShowReception

and cultural impact

Rocky and Friends has aired in over 100 countries. A popular urban legend claimed that it was banned in Canada, because of the portrayal of Dudley Do-Right, even though neither Canadian

Radio-television and Telecommunications Commission (CRTC) (nor its predecessor, the Board of Broadcast Governors) has the ability to ban TV shows—it can only fine broadcasters that violate broadcast standards which deal mostly with obscenity, violence, and racism, and not with depictions of Mounties. The show aired in Canada in the early 1960s, and was on YTV throughout the 1990s. It is currently a part of Canada's Teletoon Retro lineup.

Broadcast

Original channel

ABC (1959–61)

NBC (1961–64)

Original run

November 19, 1959 – 1964Turn your head and cough.

Locke, MD

Here try some of these on for size... Great rodent there.... " Hey Rockie, watch me pull a rabbit out of my hat! "   " again??? But that trick never works! "   " This time for sure!!!!.... Presto!!!... " Well, I'm getting close... "

 

http://www.pch.gc.ca/pgm/ceem-cced/symbl/anthem-eng.cfm

 

FYI, it is my understanding the Rockie and Bullwinkle were never allowed to be broadcast in the great white north because Duddlie DoRight made such a mockery of the RCMP....

[Guest guest]

Elaine,

 

The retainer fee/non-profit model is exactly what St. Luke's Family Practice in Modesto does.  Bob Forester used to post occasionally on the listserve...search for his posts and look at their website:  http://www.stlukesfp.org/.  He and his volunteer board worked very hard to get the IRS to approve the model. 

 

From their website: 

 

 

One SolutionSt. Luke's Family Practice is a non-profit organization that bridges the gap. We provide primary health care to two very important groups -- Benefactors and Recipients.

 

 

Benefactors are individuals and families blessed with the ability to support the work of St. Luke's Family Practice. They also receive their primary care from one of the physicians at St. Luke's Family Practice.

Recipients are those less fortunate who cannot currently obtain health insurance and do not qualify for government programs. They can also obtain primary medical care without charge from St. Luke's Family Practice.

 

The benefactors pay based on this schedule:

Benefactor Medical Service Contracts for 2008 are:

Benefactor

$1,300

Benefactor Couple

$2,500

Each Benefactor < 35 years

Subtract $300

Each Benefactor > 60 years

Add $300

Child age < 19 years or full-time student < 23 years

$550

 

 

They get a lot of equipment and services donated by the community.  It seems like a pretty cool idea, although does take some administrative effort to set up.

 

Has anyone else followed their lead?

 

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com