Guest guest Posted June 6, 2010 Report Share Posted June 6, 2010 Here is a PDF of the presentation dts From: [mailto: ] On Behalf Of Eads Sent: Saturday, June 05, 2010 7:36 PM To: Subject: RE: payment reform Hmm… when I try to plug this url into my browser, it says no go – anyone else having that problem? Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of Sent: Saturday, June 05, 2010 3:17 PM To: Subject: Re: payment reform [1 Attachment] [Attachment(s) from included below] well that doesn'tt work Before Don steps in and sends it to you himself try this:) attached On Sat, Jun 5, 2010 at 5:11 PM, wrote: www.sammamishdiabetesandlipid.org/.../Improving%20Quality%20Improvement%20with%20an%20EHR%20by%.. This is one of Don 's PowerPoints- start with slide 12 or so The " exactly " question from HYH comes out of Wasson;s work on patietn centered collaborative care and the question which does look goofy on its surface reflects that when people agree with it they are saying they have certain aspects of care see also The journal of ambulatory Care management vol 29 no 3 2006 An Introduction to Patient centered collaborative Care p 195 Jean On Sat, Jun 5, 2010 at 3:28 PM, Locke wrote: But if the PATIENT is anwering the question and they thought they needed an antibiotic and you thought is was viral and they didn't need the antibiotic. Who is right in regards to anwering the HYH tool? The patient or the doc? That was my point -- patients often know what they want and need -- but not always. Just my humble opinion. Locke, MD On Sat, Jun 5, 2010 at 1:20 PM, wrote: " excatlyt " the care I want and need as on teh HYH tool is not exactly " what I wanted. " On Sat, Jun 5, 2010 at 3:06 PM, Locke wrote: Are there studies to show that patients who “get exactly the care….” etc -- are healthier? I can imagine the viral URI patient who didn't get the antibiotics they wanted or the narc seaker who didn't get the narcs they wated will check " No " they didn't get the care they wanted -- but got the care they needed. Or DID get the Abx and Narcs -- and are quite happy with my care - ca-ching, extra money for me -- but I am not giving best care to the patient. Just curious. Locke, MD -- 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 -- 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 1 of 1 File(s) Improving Quality Improvement with an EHR by Leveraging Technology.pdf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2010 Report Share Posted June 6, 2010 MIchele did you see the other email- yes the googl;e hit will not work so I SENT don's ppt. Hmm… when I try to plug this url into my browser, it says no go – anyone else having that problem? Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of Jean Antonucci Sent: Saturday, June 05, 2010 3:17 PM To: Subject: Re: payment reform [1 Attachment] [Attachment(s) from included below] well that doesn'tt work Before Don steps in and sends it to you himself try this:) attached www.sammamishdiabetesandlipid.org/.../Improving%20Quality%20Improvement%20with%20an%20EHR%20by%.. This is one of Don 's PowerPoints- start with slide 12 or so The " exactly " question from HYH comes out of Wasson;s work on patietn centered collaborative care and the question which does look goofy on its surface reflects that when people agree with it they are saying they have certain aspects of care see also The journal of ambulatory Care management vol 29 no 3 2006 An Introduction to Patient centered collaborative Care p 195 Jean On Sat, Jun 5, 2010 at 3:28 PM, Locke wrote: But if the PATIENT is anwering the question and they thought they needed an antibiotic and you thought is was viral and they didn't need the antibiotic. Who is right in regards to anwering the HYH tool? The patient or the doc? That was my point -- patients often know what they want and need -- but not always. Just my humble opinion. Locke, MD On Sat, Jun 5, 2010 at 1:20 PM, wrote: " excatlyt " the care I want and need as on teh HYH tool is not exactly " what I wanted. " On Sat, Jun 5, 2010 at 3:06 PM, Locke wrote: Are there studies to show that patients who “get exactly the care….” etc -- are healthier? I can imagine the viral URI patient who didn't get the antibiotics they wanted or the narc seaker who didn't get the narcs they wated will check " No " they didn't get the care they wanted -- but got the care they needed. Or DID get the Abx and Narcs -- and are quite happy with my care - ca-ching, extra money for me -- but I am not giving best care to the patient. Just curious. Locke, MD -- 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 -- 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 questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2010 Report Share Posted June 6, 2010 This sounds like a very good rate for a state that has low costs such as malpractice. You have to make sure that vaccines are not included. This will encourage PCPs to refer more and will encourage patient dumping by doctors of people who need to see the doctor more. Most people I have talked to think that some combination of a capitated rate plus some kind of office copayment for a visit might be a better option. This gives a slight reward to doctors for patients who are heavier utilizers.Larry LindemanSent from my iPad Deanna- you missed the idea I am talking about how to pay DOCS( providers) You and I think are making assumptions and getting into this RISK business that you as a doc will make less if your order more MRIs as the paymetn for them comes out of your salary?NOPE I am talking about how to pay for offciepracticeLabs and d rugs and Xrays are paid by th e payor separtely I can imagine that vaccines and "things" durable goods shall we say ? would be billed separately also The dollar a day idea pays for a doc (provider) to take care of people any way they want - to do the folow up calls that keep CHF'ers out of the hospital etc to follow up on sick kids to avoid the er etc To answer questions that avoid med erros to coorinate care with a call after being seen by Ms. Neurologist etc. This idea i s in lieu of e and M's and modifiers and office cpts. On Sat, Jun 5, 2010 at 3:02 PM, <tolpeopleaol> wrote: How about labs and radiology? Can't imagine fitting an MRI in that amount. I think all such "things" should be carved out. Deanna, FNP payment reform Serious question There has been a proposal to pay primary care at a bundled rate of a dollar a day for all the office care we can do so say you had a panel of 1000 patietns-->$ 365,000 gross then you can subtract out overhead, hiring a care coordaintior etc whatever grealty improves income and allows freedom to provide car e in many ways without the fee for service structure) It has been calcuated that this would allow docs freedom to take care of people in varying ways - email phone etc and reduce or eliminate the hassle of billing/coding( some records would need to be kept of course) and could improve primary care's bottom line, working conditions, abiltiy to function, and thereby increase access and hopefully quality in many way for patients So my question-- what are the possible downsides or what objections might be raised by payors or policy wonks etc , / or what have any of you encountered in pursing or thinking about such a model? thanks ( am asked to propose something here in MAIne and am preparing for possible objections) -- 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 -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 6, 2010 Report Share Posted June 6, 2010 What about sick time, vacation? Who will take care of your pts? for every day you are out , should covering MD get the $1 per day? What if pts what to switch docs? What if one doc does more procedure than another. How is equipment and materials paid for? I would break even w the current system if co pays were $30 but less insurance hassel. Deanna- you missed the idea I am talking about how to pay DOCS( providers) You and I think are making assumptions and getting into this RISK business that you as a doc will make less if your order more MRIs as the paymetn for them comes out of your salary?NOPE I am talking about how to pay for offciepracticeLabs and d rugs and Xrays are paid by th e payor separtely I can imagine that vaccines and " things " durable goods shall we say ? would be billed separately also The dollar a day idea pays for a doc (provider) to take care of people any way they want - to do the folow up calls that keep CHF'ers out of the hospital etc to follow up on sick kids to avoid the er etc To answer questions that avoid med erros to coorinate care with a call after being seen by Ms. Neurologist etc. This idea i s in lieu of e and M's and modifiers and office cpts. How about labs and radiology? Can't imagine fitting an MRI in that amount. I think all such " things " should be carved out. Deanna, FNP payment reform Serious question There has been a proposal to pay primary care at a bundled rate of a dollar a day for all the office care we can doso say you had a panel of 1000 patietns-->$ 365,000 gross then you can subtract out overhead, hiring a care coordaintior etc whatever grealty improves income and allows freedom to provide car e in many ways without the fee for service structure)It has been calcuated that this would allow docs freedom to take care of people in varying ways - email phone etc and reduce or eliminate the hassle of billing/coding( some records would need to be kept of course) and could improve primary care's bottom line, working conditions, abiltiy to function, and thereby increase access and hopefully quality in many way for patientsSo my question--what are the possible downsides or what objections might be raised by payors or policy wonks etc , / or what have any of you encountered in pursing or thinking about such a model? thanks( am asked to propose something here in MAIne and am preparing for possible objections) -- 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 -- 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 OK guys almost done torturing you Your comments are very helpful tome Elaine- the dollar a day is yours It is per patietn / per doc if a patietn switched docs well the doc getitng a dollar a day would probaly get paid monthly maybe quarterly so payment would be adjusted accordingly Who has any alternative?We all complain about the payment system now who has a viable alternative?You dont want E and M ,you don;t want coding and billing, Some of you do not want medicare rates do you have something that is well thouguht out that answers all the questions we have discussed, t hat is viable? thanks What about sick time, vacation? Who will take care of your pts? for every day you are out , should covering MD get the $1 per day? What if pts what to switch docs? What if one doc does more procedure than another. How is equipment and materials paid for? I would break even w the current system if co pays were $30 but less insurance hassel. Deanna- you missed the idea I am talking about how to pay DOCS( providers) You and I think are making assumptions and getting into this RISK business that you as a doc will make less if your order more MRIs as the paymetn for them comes out of your salary?NOPE I am talking about how to pay for offciepracticeLabs and d rugs and Xrays are paid by th e payor separtely I can imagine that vaccines and " things " durable goods shall we say ? would be billed separately also The dollar a day idea pays for a doc (provider) to take care of people any way they want - to do the folow up calls that keep CHF'ers out of the hospital etc to follow up on sick kids to avoid the er etc To answer questions that avoid med erros to coorinate care with a call after being seen by Ms. Neurologist etc. This idea i s in lieu of e and M's and modifiers and office cpts. How about labs and radiology? Can't imagine fitting an MRI in that amount. I think all such " things " should be carved out. Deanna, FNP payment reform Serious question There has been a proposal to pay primary care at a bundled rate of a dollar a day for all the office care we can doso say you had a panel of 1000 patietns-->$ 365,000 gross then you can subtract out overhead, hiring a care coordaintior etc whatever grealty improves income and allows freedom to provide car e in many ways without the fee for service structure)It has been calcuated that this would allow docs freedom to take care of people in varying ways - email phone etc and reduce or eliminate the hassle of billing/coding( some records would need to be kept of course) and could improve primary care's bottom line, working conditions, abiltiy to function, and thereby increase access and hopefully quality in many way for patientsSo my question--what are the possible downsides or what objections might be raised by payors or policy wonks etc , / or what have any of you encountered in pursing or thinking about such a model? thanks( am asked to propose something here in MAIne and am preparing for possible objections) -- 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 -- 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.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 questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 I prefer capitation for the basic care, with procedures, xrays, vaccines, and labs carved out and paid by CPT codes. This, for me, promotes health, since I do better if I keep people health and out of the office. I also do better with an IMP model, since if I do somewhat longer visits and do the preventive care when someone is in for any reason, then having them return to check their A1C. I also do not have to worry about covering all costs like an insurance co. If I can't get that, then E and M's work, but this is not " healthy care, it is being paid for sick visits, the more the better, not trying to keep people out of the office. ________________________________________ From: [ ] On Behalf Of [jnantonucci@...] Sent: Sunday, June 06, 2010 4:46 PM To: Subject: Re: payment reform OK guys almost done torturing you Your comments are very helpful tome Elaine- the dollar a day is yours It is per patietn / per doc if a patietn switched docs well the doc getitng a dollar a day would probaly get paid monthly maybe quarterly so payment would be adjusted accordingly Who has any alternative? We all complain about the payment system now who has a viable alternative? You dont want E and M ,you don;t want coding and billing, Some of you do not want medicare rates do you have something that is well thouguht out that answers all the questions we have discussed, t hat is viable? thanks On Sun, Jun 6, 2010 at 4:26 PM, > wrote: What about sick time, vacation? Who will take care of your pts? for every day you are out , should covering MD get the $1 per day? What if pts what to switch docs? What if one doc does more procedure than another. How is equipment and materials paid for? I would break even w the current system if co pays were $30 but less insurance hassel. On Sat, Jun 5, 2010 at 12:19 PM, > wrote: Deanna- you missed the idea I am talking about how to pay DOCS( providers) You and I think are making assumptions and getting into this RISK business that you as a doc will make less if your order more MRIs as the paymetn for them comes out of your salary?NOPE I am talking about how to pay for offciepractice Labs and d rugs and Xrays are paid by th e payor separtely I can imagine that vaccines and " things " durable goods shall we say ? would be billed separately also The dollar a day idea pays for a doc (provider) to take care of people any way they want - to do the folow up calls that keep CHF'ers out of the hospital etc to follow up on sick kids to avoid the er etc To answer questions that avoid med erros to coorinate care with a call after being seen by Ms. Neurologist etc. This idea i s in lieu of e and M's and modifiers and office cpts. On Sat, Jun 5, 2010 at 3:02 PM, > wrote: How about labs and radiology? Can't imagine fitting an MRI in that amount. I think all such " things " should be carved out. Deanna, FNP payment reform Serious question There has been a proposal to pay primary care at a bundled rate of a dollar a day for all the office care we can do so say you had a panel of 1000 patietns-->$ 365,000 gross then you can subtract out overhead, hiring a care coordaintior etc whatever grealty improves income and allows freedom to provide car e in many ways without the fee for service structure) It has been calcuated that this would allow docs freedom to take care of people in varying ways - email phone etc and reduce or eliminate the hassle of billing/coding( some records would need to be kept of course) and could improve primary care's bottom line, working conditions, abiltiy to function, and thereby increase access and hopefully quality in many way for patients So my question-- what are the possible downsides or what objections might be raised by payors or policy wonks etc , / or what have any of you encountered in pursing or thinking about such a model? thanks ( am asked to propose something here in MAIne and am preparing for possible objections) 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<http://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<http://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<http://impcenter.org/> -- M.D. www.elainemd.com<http://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<http://impcenter.org> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 but you are g oing to run into trouble with what you call a procedure( creating a tricky bureaucracy) I would posit that anythign expensive and ??over used- is taken out( echo cardiograms and cath's NOT usulaly even the stuff of PCPS) and most stuff PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? My thoughts are only about what to do with primary care, the cogntive stuffand basic procedures. I think ther e will be other ways that hospitals and specialists are paid I prefer capitation for the basic care, with procedures, xrays, vaccines, and labs carved out and paid by CPT codes. This, for me, promotes health, since I do better if I keep people health and out of the office. I also do better with an IMP model, since if I do somewhat longer visits and do the preventive care when someone is in for any reason, then having them return to check their A1C. I also do not have to worry about covering all costs like an insurance co. If I can't get that, then E and M's work, but this is not " healthy care, it is being paid for sick visits, the more the better, not trying to keep people out of the office. ________________________________________ From: [ ] On Behalf Of [jnantonucci@...] Sent: Sunday, June 06, 2010 4:46 PM To: Subject: Re: payment reform OK guys almost done torturing you Your comments are very helpful tome Elaine- the dollar a day is yours It is per patietn / per doc if a patietn switched docs well the doc getitng a dollar a day would probaly get paid monthly maybe quarterly so payment would be adjusted accordingly Who has any alternative? We all complain about the payment system now who has a viable alternative? You dont want E and M ,you don;t want coding and billing, Some of you do not want medicare rates do you have something that is well thouguht out that answers all the questions we have discussed, t hat is viable? thanks On Sun, Jun 6, 2010 at 4:26 PM, > wrote: What about sick time, vacation? Who will take care of your pts? for every day you are out , should covering MD get the $1 per day? What if pts what to switch docs? What if one doc does more procedure than another. How is equipment and materials paid for? I would break even w the current system if co pays were $30 but less insurance hassel. On Sat, Jun 5, 2010 at 12:19 PM, > wrote: Deanna- you missed the idea I am talking about how to pay DOCS( providers) You and I think are making assumptions and getting into this RISK business that you as a doc will make less if your order more MRIs as the paymetn for them comes out of your salary?NOPE I am talking about how to pay for offciepractice Labs and d rugs and Xrays are paid by th e payor separtely I can imagine that vaccines and " things " durable goods shall we say ? would be billed separately also The dollar a day idea pays for a doc (provider) to take care of people any way they want - to do the folow up calls that keep CHF'ers out of the hospital etc to follow up on sick kids to avoid the er etc To answer questions that avoid med erros to coorinate care with a call after being seen by Ms. Neurologist etc. This idea i s in lieu of e and M's and modifiers and office cpts. On Sat, Jun 5, 2010 at 3:02 PM, > wrote: How about labs and radiology? Can't imagine fitting an MRI in that amount. I think all such " things " should be carved out. Deanna, FNP payment reform Serious question There has been a proposal to pay primary care at a bundled rate of a dollar a day for all the office care we can do so say you had a panel of 1000 patietns-->$ 365,000 gross then you can subtract out overhead, hiring a care coordaintior etc whatever grealty improves income and allows freedom to provide car e in many ways without the fee for service structure) It has been calcuated that this would allow docs freedom to take care of people in varying ways - email phone etc and reduce or eliminate the hassle of billing/coding( some records would need to be kept of course) and could improve primary care's bottom line, working conditions, abiltiy to function, and thereby increase access and hopefully quality in many way for patients So my question-- what are the possible downsides or what objections might be raised by payors or policy wonks etc , / or what have any of you encountered in pursing or thinking about such a model? thanks ( am asked to propose something here in MAIne and am preparing for possible objections) 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<http://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<http://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<http://impcenter.org/> -- M.D. www.elainemd.com<http://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<http://impcenter.org> ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 Maybe I did not understand your overall question. I was ONLY talking about primary care. And yes you are correct the capitation only applies to basic e and m type codes, not the rest. ________________________________________ From: [ ] On Behalf Of [jnantonucci@...] Sent: Monday, June 07, 2010 4:31 AM To: Subject: Re: payment reform but you are g oing to run into trouble with what you call a procedure( creating a tricky bureaucracy) I would posit that anythign expensive and ??over used- is taken out( echo cardiograms and cath's NOT usulaly even the stuff of PCPS) and most stuff PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? My thoughts are only about what to do with primary care, the cogntive stuffand basic procedures. I think ther e will be other ways that hospitals and specialists are paid On Sun, Jun 6, 2010 at 10:26 PM, Kennedy, Jim > wrote: I prefer capitation for the basic care, with procedures, xrays, vaccines, and labs carved out and paid by CPT codes. This, for me, promotes health, since I do better if I keep people health and out of the office. I also do better with an IMP model, since if I do somewhat longer visits and do the preventive care when someone is in for any reason, then having them return to check their A1C. I also do not have to worry about covering all costs like an insurance co. If I can't get that, then E and M's work, but this is not " healthy care, it is being paid for sick visits, the more the better, not trying to keep people out of the office. ________________________________________ From: <mailto: \ > [ <mailto:@...\ m>] On Behalf Of [jnantonucci@...] Sent: Sunday, June 06, 2010 4:46 PM To: <mailto: \ > Subject: Re: payment reform OK guys almost done torturing you Your comments are very helpful tome Elaine- the dollar a day is yours It is per patietn / per doc if a patietn switched docs well the doc getitng a dollar a day would probaly get paid monthly maybe quarterly so payment would be adjusted accordingly Who has any alternative? We all complain about the payment system now who has a viable alternative? You dont want E and M ,you don;t want coding and billing, Some of you do not want medicare rates do you have something that is well thouguht out that answers all the questions we have discussed, t hat is viable? thanks On Sun, Jun 6, 2010 at 4:26 PM, <mailto:elaine2md@...<mail\ to:elaine2md@...>>> wrote: What about sick time, vacation? Who will take care of your pts? for every day you are out , should covering MD get the $1 per day? What if pts what to switch docs? What if one doc does more procedure than another. How is equipment and materials paid for? I would break even w the current system if co pays were $30 but less insurance hassel. On Sat, Jun 5, 2010 at 12:19 PM, <mailto:jnantonucci@...\ m>> wrote: Deanna- you missed the idea I am talking about how to pay DOCS( providers) You and I think are making assumptions and getting into this RISK business that you as a doc will make less if your order more MRIs as the paymetn for them comes out of your salary?NOPE I am talking about how to pay for offciepractice Labs and d rugs and Xrays are paid by th e payor separtely I can imagine that vaccines and " things " durable goods shall we say ? would be billed separately also The dollar a day idea pays for a doc (provider) to take care of people any way they want - to do the folow up calls that keep CHF'ers out of the hospital etc to follow up on sick kids to avoid the er etc To answer questions that avoid med erros to coorinate care with a call after being seen by Ms. Neurologist etc. This idea i s in lieu of e and M's and modifiers and office cpts. On Sat, Jun 5, 2010 at 3:02 PM, <mailto:tolpeople@...<mailto:tol\ people@...>>> wrote: How about labs and radiology? Can't imagine fitting an MRI in that amount. I think all such " things " should be carved out. Deanna, FNP payment reform Serious question There has been a proposal to pay primary care at a bundled rate of a dollar a day for all the office care we can do so say you had a panel of 1000 patietns-->$ 365,000 gross then you can subtract out overhead, hiring a care coordaintior etc whatever grealty improves income and allows freedom to provide car e in many ways without the fee for service structure) It has been calcuated that this would allow docs freedom to take care of people in varying ways - email phone etc and reduce or eliminate the hassle of billing/coding( some records would need to be kept of course) and could improve primary care's bottom line, working conditions, abiltiy to function, and thereby increase access and hopefully quality in many way for patients So my question-- what are the possible downsides or what objections might be raised by payors or policy wonks etc , / or what have any of you encountered in pursing or thinking about such a model? thanks ( am asked to propose something here in MAIne and am preparing for possible objections) 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<http://impcenter.org><http://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<http://impcenter.org><http://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<http://impcenter.org><http://impcenter.org/> -- M.D. www.elainemd.com<http://www.elainemd.com><http://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<http://impcenter.org><http://impcenter.org> ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 Congress has yet to address the issue of specialists, the ones with all the expensive procedures that are driving costs, and radiology's fancy stuff too. Office visits are our livelihood but nothing for the specialists who often now haver NPs doing some of that low paying work. The specialists, with their higher income, no doubt have the clout. Hospital care is another big cost and one we can help but I for one, don't have many pts who end up in the hospital, unlike many IM docs. Ellen Kennedy, Jim wrote: > Maybe I did not understand your overall question. I was ONLY talking about primary care. And yes you are correct the capitation only applies to basic e and m type codes, not the rest. > ________________________________________ > From: [ ] On Behalf Of [jnantonucci@...] > Sent: Monday, June 07, 2010 4:31 AM > To: > Subject: Re: payment reform > > but you are g oing to run into trouble with what you call a procedure( creating a tricky bureaucracy) I would posit that anythign expensive and ??over used- is taken out( echo cardiograms and cath's NOT usulaly even the stuff of PCPS) and most stuff PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? My thoughts are only about what to do with primary care, the cogntive stuffand basic procedures. I think ther e will be other ways that hospitals and specialists are paid > > On Sun, Jun 6, 2010 at 10:26 PM, Kennedy, Jim > wrote: > I prefer capitation for the basic care, with procedures, xrays, vaccines, and labs carved out and paid by CPT codes. This, for me, promotes health, since I do better if I keep people health and out of the office. I also do better with an IMP model, since if I do somewhat longer visits and do the preventive care when someone is in for any reason, then having them return to check their A1C. I also do not have to worry about covering all costs like an insurance co. If I can't get that, then E and M's work, but this is not " healthy care, it is being paid for sick visits, the more the better, not trying to keep people out of the office. > ________________________________________ > From: <mailto: \ > [ <mailto:@...\ m>] On Behalf Of [jnantonucci@...] > Sent: Sunday, June 06, 2010 4:46 PM > To: <mailto: \ > > Subject: Re: payment reform > > OK guys almost done torturing you Your comments are very helpful tome > > Elaine- the dollar a day is yours It is per patietn / per doc > if a patietn switched docs well the doc getitng a dollar a day would probaly get paid monthly maybe quarterly so payment would be adjusted accordingly > > Who has any alternative? > We all complain about the payment system now > who has a viable alternative? > You dont want E and M ,you don;t want coding and billing, Some of you do not want medicare rates > do you have something that is well thouguht out that answers all the questions we have discussed, t hat is viable? > thanks > > On Sun, Jun 6, 2010 at 4:26 PM, <mailto:elaine2md@...<mail\ to:elaine2md@...>>> wrote: > > > What about sick time, vacation? Who will take care of your pts? for every day you are out , should covering MD get the $1 per day? What if pts what to switch docs? What if one doc does more procedure than another. How is equipment and materials paid for? I would break even w the current system if co pays were $30 but less insurance hassel. > > On Sat, Jun 5, 2010 at 12:19 PM, <mailto:jnantonucci@...\ m>> wrote: > > > Deanna- you missed the idea > I am talking about how to pay DOCS( providers) You and I think are making assumptions and getting into this RISK business that you as a doc will make less if your order more MRIs as the paymetn for them comes out of your salary?NOPE > I am talking about how to pay for offciepractice > > Labs and d rugs and Xrays are paid by th e payor separtely > > I can imagine that vaccines and " things " durable goods shall we say ? would be billed separately also > The dollar a day idea pays for a doc (provider) to take care of people any way they want - to do the folow up calls that keep CHF'ers out of the hospital etc to follow up on sick kids to avoid the er etc To answer questions that avoid med erros to coorinate care with a call after being seen by Ms. Neurologist etc. > > This idea i s in lieu of e and M's and modifiers and office cpts. > > > > On Sat, Jun 5, 2010 at 3:02 PM, <mailto:tolpeople@...<mailto:tol\ people@...>>> wrote: > > > How about labs and radiology? Can't imagine fitting an MRI in that amount. I think all such " things " should be carved out. > > Deanna, FNP > > > > payment reform > > > Serious question > > There has been a proposal to pay primary care at a bundled rate of a dollar a day for all the office care we can do > so say you had a panel of 1000 patietns-->$ 365,000 gross then you can subtract out overhead, hiring a care coordaintior etc whatever > grealty improves income and allows freedom to provide car e in many ways without the fee for service structure) > It has been calcuated that this would allow docs freedom to take care of people in varying ways - email phone etc and reduce or eliminate the hassle of billing/coding( some records would need to be kept of course) > and could improve primary care's bottom line, working conditions, abiltiy to function, and thereby increase access and hopefully quality in many way for patients > So my question-- > what are the possible downsides or what objections might be raised by payors or policy wonks etc , / or what have any of you encountered in pursing or thinking about such a model? > thanks > ( am asked to propose something here in MAIne and am preparing for possible objections) > 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<http://impcenter.org><http://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<http://impcenter.org><http://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<http://impcenter.org><http://impcenter.org/> > > > > -- > M.D. > www.elainemd.com<http://www.elainemd.com><http://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<http://impcenter.org><http://impcenter.org> > > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinkingI mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine.I posit that it is all included. PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 I agree with you in theory and then, I don’t. When everyone was capitated, I started to refer out that stuff I felt should be paid for and wasn’t being paid for kind of with the feeling, well at least someone else could get paid for doing that. I started doing colposcopies, but they wouldn’t’ pay me more for doing that. Time consuming. My malpractice for doing minor surgery, biopsing possible cancers was a lot more and not getting paid extra for it didn’t work for me. If you do it all for the same capitation as someone who does none of it, one might start to get resentful and say, heck, I’m not going to do it if I can’t get paid for it. So I think human nature will work against this theory. Now one could argue that if the “capitation” was fair and decent, we wouldn’t care. But as you know, there aremany doctors who feel they should make more money, and it is never “enough”. And the free market system is set up with do more make more. Socialism or communism is do more, make the same as everyone else. I have a big capitalist hunk in me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Jean Antonucci Sent: Monday, June 07, 2010 12:57 PM To: Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinking I mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine. I posit that it is all included. PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 Dear Capitlaist hunk- but if you got$ 547,000 a year for 1500 pateitns wouldn't you do the colposcopy? Think concrete numbers here not theory . The idea is look you make A and for no billing hassle if you do primary care You may make more of less " B " as a say urologist but ya gotta bill and then you choose. me- let me never forget that I am on the under dog side of never seeing six figures I would love to make 90,000 !! 1 dollar a day would make me so guilty and rich I would die. I agree with you in theory and then, I don’t. When everyone was capitated, I started to refer out that stuff I felt should be paid for and wasn’t being paid for kind of with the feeling, well at least someone else could get paid for doing that. I started doing colposcopies, but they wouldn’t’ pay me more for doing that. Time consuming. My malpractice for doing minor surgery, biopsing possible cancers was a lot more and not getting paid extra for it didn’t work for me. If you do it all for the same capitation as someone who does none of it, one might start to get resentful and say, heck, I’m not going to do it if I can’t get paid for it. So I think human nature will work against this theory. Now one could argue that if the “capitation” was fair and decent, we wouldn’t care. But as you know, there aremany doctors who feel they should make more money, and it is never “enough”. And the free market system is set up with do more make more. Socialism or communism is do more, make the same as everyone else. I have a big capitalist hunk in me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Jean Antonucci Sent: Monday, June 07, 2010 12:57 PM To: Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinking I mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine. I posit that it is all included. PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 I agree, I could definately live on $547K, but I don't see that ever happening so this is all just wishful thinking. I think what is more likely, is more of the same, screw the nails to primary care, and Medicare, and Medicaid. The specialists, and the hospitals and the drug companies, make a little less but not a lot less. Then more and more primary care doctor's drop all the government plans, and go cash only. Another 2 tiered system. Those who can pay will get IMP like care, those who can't will have the government beuracracy (sp). Signature MD the concierge plan I looked at last fall, just sent out a letter, saying "we are the only conceirge plan, that will be legal with the new healthcare plan", since their whole thing isn't based on just one very pricey CPE. Not that they don't do the very pricey CPE, but their lawyers think they pass. More and more conceirge programs big, and small will flourish. Personally, I'm going to start looking at taking my jewelry making my full time job, I bet I'd make more money:). Cote' MD Cote, Medical, Laser, and Spa Re: payment reform Dear Capitlaist hunk- but if you got$ 547,000 a year for 1500 pateitns wouldn't you do the colposcopy? Think concrete numbers here not theory . The idea is look you make A and for no billing hassle if you do primary care You may make more of less "B" as a say urologist but ya gotta bill and then you choose. me- let me never forget that I am on the under dog side of never seeing six figures I would love to make 90,000 !! 1 dollar a day would make me so guilty and rich I would die. I agree with you in theory and then, I don’t. When everyone was capitated, I started to refer out that stuff I felt should be paid for and wasn’t being paid for kind of with the feeling, well at least someone else could get paid for doing that. I started doing colposcopies, but they wouldn’t’ pay me more for doing that. Time consuming. My malpractice for doing minor surgery, biopsing possible cancers was a lot more and not getting paid extra for it didn’t work for me. If you do it all for the same capitation as someone who does none of it, one might start to get resentful and say, heck, I’m not going to do it if I can’t get paid for it. So I think human nature will work against this theory. Now one could argue that if the “capitation†was fair and decent, we wouldn’t care. But as you know, there aremany doctors who feel they should make more money, and it is never “enoughâ€. And the free market system is set up with do more make more. Socialism or communism is do more, make the same as everyone else. I have a big capitalist hunk in me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Monday, June 07, 2010 12:57 PM To: Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinkingI mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine.I posit that it is all included. PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 ah now we are talkingI could use some new earrings.... I agree, I could definately live on $547K, but I don't see that ever happening so this is all just wishful thinking. I think what is more likely, is more of the same, screw the nails to primary care, and Medicare, and Medicaid. The specialists, and the hospitals and the drug companies, make a little less but not a lot less. Then more and more primary care doctor's drop all the government plans, and go cash only. Another 2 tiered system. Those who can pay will get IMP like care, those who can't will have the government beuracracy (sp). Signature MD the concierge plan I looked at last fall, just sent out a letter, saying " we are the only conceirge plan, that will be legal with the new healthcare plan " , since their whole thing isn't based on just one very pricey CPE. Not that they don't do the very pricey CPE, but their lawyers think they pass. More and more conceirge programs big, and small will flourish. Personally, I'm going to start looking at taking my jewelry making my full time job, I bet I'd make more money:). Cote' MD Cote, Medical, Laser, and Spa Re: payment reform Dear Capitlaist hunk- but if you got$ 547,000 a year for 1500 pateitns wouldn't you do the colposcopy? Think concrete numbers here not theory . The idea is look you make A and for no billing hassle if you do primary care You may make more of less " B " as a say urologist but ya gotta bill and then you choose. me- let me never forget that I am on the under dog side of never seeing six figures I would love to make 90,000 !! 1 dollar a day would make me so guilty and rich I would die. I agree with you in theory and then, I don’t. When everyone was capitated, I started to refer out that stuff I felt should be paid for and wasn’t being paid for kind of with the feeling, well at least someone else could get paid for doing that. I started doing colposcopies, but they wouldn’t’ pay me more for doing that. Time consuming. My malpractice for doing minor surgery, biopsing possible cancers was a lot more and not getting paid extra for it didn’t work for me. If you do it all for the same capitation as someone who does none of it, one might start to get resentful and say, heck, I’m not going to do it if I can’t get paid for it. So I think human nature will work against this theory. Now one could argue that if the “capitation” was fair and decent, we wouldn’t care. But as you know, there aremany doctors who feel they should make more money, and it is never “enough”. And the free market system is set up with do more make more. Socialism or communism is do more, make the same as everyone else. I have a big capitalist hunk in me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Monday, June 07, 2010 12:57 PM To: Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinkingI mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine.I posit that it is all included. PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 so - you're practicing this on us. For...? do you have a meeting with your state rep coming up?what're you doing with trying to work kinks out of this payment modeldrop it on us....LynnTo: From: jnantonucci@...Date: Mon, 7 Jun 2010 12:57:23 -0400Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinkingI mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine.I posit that it is all included. On Mon, Jun 7, 2010 at 12:46 PM, Sharon McCoy <docsharon> wrote: PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Hotmail is redefining busy with tools for the New Busy. Get more from your inbox. See how. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 Correct! step1 let the IMPS rip it to shreds step 2 run it by Gstep 3 go embarrass myslef in Augusta I have been asked to go to the legislative payment advisory group on June 16 so - you're practicing this on us. For...? do you have a meeting with your state rep coming up?what're you doing with trying to work kinks out of this payment modeldrop it on us....Lynn To: From: jnantonucci@... Date: Mon, 7 Jun 2010 12:57:23 -0400Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinkingI mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine.I posit that it is all included. PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Hotmail is redefining busy with tools for the New Busy. Get more from your inbox. See how. -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 Good luck, and congratulations about having the energy, to do this sort of thing. I already feel so burned out, I don't think I can do anything about it, but if it works, maybe I'll perk up. Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinkingI mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine.I posit that it is all included. PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Hotmail is redefining busy with tools for the New Busy. Get more from your inbox. See how. -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 Also, remember that if there is a payment for the patient stating they “get exactly the care…” then a practice will get much higher scores the more stuff they keep in house. From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Monday, June 07, 2010 1:25 PM To: Subject: RE: payment reform I agree with you in theory and then, I don’t. When everyone was capitated, I started to refer out that stuff I felt should be paid for and wasn’t being paid for kind of with the feeling, well at least someone else could get paid for doing that. I started doing colposcopies, but they wouldn’t’ pay me more for doing that. Time consuming. My malpractice for doing minor surgery, biopsing possible cancers was a lot more and not getting paid extra for it didn’t work for me. If you do it all for the same capitation as someone who does none of it, one might start to get resentful and say, heck, I’m not going to do it if I can’t get paid for it. So I think human nature will work against this theory. Now one could argue that if the “capitation” was fair and decent, we wouldn’t care. But as you know, there aremany doctors who feel they should make more money, and it is never “enough”. And the free market system is set up with do more make more. Socialism or communism is do more, make the same as everyone else. I have a big capitalist hunk in me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Monday, June 07, 2010 12:57 PM To: Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinking I mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine. I posit that it is all included. On Mon, Jun 7, 2010 at 12:46 PM, Sharon McCoy wrote: PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- PATIENTS-please remember that email may not be entirely secure, and that Email is part of the medical record and is placed into your chart ( be careful what you say!) Email is best used for appointment making and brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 Are you calling me a hunk? Is that a compliment for a female? J Kathy From: [mailto: ] On Behalf Of Jean Antonucci Sent: Monday, June 07, 2010 1:31 PM To: Subject: Re: payment reform Dear Capitalist hunk- but if you got$ 547,000 a year for 1500 pateitns wouldn't you do the colposcopy? Think concrete numbers here not theory . The idea is look you make A and for no billing hassle if you do primary care You may make more of less " B " as a say urologist but ya gotta bill and then you choose. me- let me never forget that I am on the under dog side of never seeing six figures I would love to make 90,000 !! 1 dollar a day would make me so guilty and rich I would die. I agree with you in theory and then, I don’t. When everyone was capitated, I started to refer out that stuff I felt should be paid for and wasn’t being paid for kind of with the feeling, well at least someone else could get paid for doing that. I started doing colposcopies, but they wouldn’t’ pay me more for doing that. Time consuming. My malpractice for doing minor surgery, biopsing possible cancers was a lot more and not getting paid extra for it didn’t work for me. If you do it all for the same capitation as someone who does none of it, one might start to get resentful and say, heck, I’m not going to do it if I can’t get paid for it. So I think human nature will work against this theory. Now one could argue that if the “capitation” was fair and decent, we wouldn’t care. But as you know, there aremany doctors who feel they should make more money, and it is never “enough”. And the free market system is set up with do more make more. Socialism or communism is do more, make the same as everyone else. I have a big capitalist hunk in me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Monday, June 07, 2010 12:57 PM To: Subject: Re: payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinking I mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine. I posit that it is all included. On Mon, Jun 7, 2010 at 12:46 PM, Sharon McCoy wrote: PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 I have a big capitalist hunk in me. I was just responding to the above I got patietns to see, you nuts! MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 7, 2010 Report Share Posted June 7, 2010 > Who has any alternative? > We all complain about the payment system now > who has a viable alternative? > You dont want E and M ,you don;t want coding and billing, Some of you do > not want medicare rates > do you have something that is well thouguht out that answers all the > questions we have discussed, t hat is viable? http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-kil\ led-my-father/7617/6/ > >>> > >>>> > >>>> The one area that would need carve out, IMHO is vaccine costs. Just > >>>> did a well check this week on a 15 yo gal and total bill was near $500. > >>>> Most of that was to cover vaccine costs (Gardisil, varicella, adacel). Just > >>>> a few of those a month would eat up that $365/year pretty quickly. > >>>> > >>>> Of course, I also think vaccines should be covered 100% by feds since > >>>> CDC makes the recommendations and expanding the VFC program to all kids > >>>> would simplify vaccine handling in the office. (We keep two separate sets > >>>> of inventory and it is time consuming…) > >>>> R > >>>> > >>>> Ramona G. Seidel, MD > >>>> www.baycrossingfamilymedicine.com > >>>> Your Bridge to Health > >>>> > >>>> 269 Peninsula Farm Road > >>>> Suite F > >>>> Arnold, MD 21012 > >>>> > >>>> 410 518-9808 > >>>> > >>>> > >>>> ------------------------------ > >>>> *From:* [mailto: > >>>> ] *On Behalf Of * > >>>> *Sent:* Friday, June 04, 2010 10:14 AM > >>>> *To:* > >>>> *Subject:* payment reform > >>>> > >>>> > >>>> Serious question > >>>> > >>>> There has been a proposal to pay primary care at a bundled rate of a > >>>> dollar a day for all the office care we can do > >>>> so say you had a panel of 1000 patietns-->$ 365,000 gross then you can > >>>> subtract out overhead, hiring a care coordaintior etc whatever > >>>> grealty improves income and allows freedom to provide car e in many ways > >>>> without the fee for service structure) > >>>> It has been calcuated that this would allow docs freedom to take care of > >>>> people in varying ways - email phone etc and reduce or eliminate the hassle > >>>> of billing/coding( some records would need to be kept of course) > >>>> and could improve primary care's bottom line, working conditions, > >>>> abiltiy to function, and thereby increase access and hopefully quality in > >>>> many way for patients > >>>> So my question-- > >>>> what are the possible downsides or what objections might be raised by > >>>> payors or policy wonks etc , / or what have any of you encountered in > >>>> pursing or thinking about such a model? > >>>> thanks > >>>> ( am asked to propose something here in MAIne and am preparing for > >>>> possible objections) > >>>> 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 > >>>> > >>> > >>> > >>> > >>> -- > >>> 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 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2010 Report Share Posted June 8, 2010 I have been keeping my big mouth out of this until just now but I think with payment reform has to come other totally forgotten about reforms... Not waiting for 2014 for pre-exsisting conditions or they don't count in primary care because the concept is to manage early to the long term benefit of all, the patient, the doc and the entire system and that includes my greater society concept of mass savings from other parts of a total gov't of safetynets that gets tag with more and more everyday to care for. Most importantly, there has to be some sort of REAL and meaningful, almost NO prior auths and fighting insurance companies for treatments, their second guessing your every move. And if and when they do, win lose or draw, they have to pay a reasonable hourly rate for us to have someone on staff to pay for having the back and forth exchange. If and until they have to deal with the full cost of their own BS, just as fossil energy companies really don't have to pay the full bang for their garbage (look at the gulf coast, need I say more) then they will continue to tie us all up in knots. That has got to go, assistant time at one rate per 15 minutes of time wasted, docs at a much higher rate the moment the assistant has to consult with the doc even for a moment. Your time is money and wasted lost care too, and they need to compensate you all for that waste of your time. Here is my answer to anyway who tries to challenge this.... 1) what did all of you go to med school and training programs but to learn how to properly tease apart and figure out peoples' issues and diseases. What was one of the most important parts of your clinical training??? How to properly manage your patients' health, care and needs. So like what is all this managed care crap? 2) If one could even get their lawyer on the phone at 8 pm or 2 am, the moment you got done with "so how's the wife and kids Chet?" you know he is punching the little chess clock and you are going to get banged for every 15 minutes or fraction there of, so like why can't a doctor who is on call 24/7, and pretty much 365 too??? Especially with your higher more time consuming, many years that is, more intense clinical training do likewise. We all know this, and the fair and balanced thing needs to be returned here.... And if your lawyer had his paralegal attend to some things while he oversaw and approved or reviewed what the paralegal did or researched and then applied his higher level of school and experience to your issue, he would certainly be billing you for both the paralegal's work at one rate while including his own time and expertise at a different one, and then they would be itemized on an invoice and charged to you and your account with his office... Plain and simple. So why are doctors treated like sanitation workers while lawyers are treated like fine dining fat cats???? You all deserve by the very nature of your jobs and responsibilities, no less your extensive training and clincal experiences to be treated at the very least on the same level as these vultures. Who can you live without longer and better, your doctor or your lawyer??? What is one's most valueable assest, their health. Also I feel that we need to get away from insurance that covers basic primary care at all and return the savings BOTH to the employees and the employers. If we dropped approx $4-5K from every insurance policy in the country and we all basically charge $125 bucks an hour plus our other basic services so we could all make at least $250 bucks an hour much like most decent lawyers in this country, we would all be pretty well off without the billing and the hassle involved and being allowed to keep almost all that we kill after overhead and expenses. We don't need insurance that covers ever last primary visit and urine and strep test, what weall need is "god forbid" insurance. I don't expect my auto insurance policy to buy me tires or brakes, tune-ups (well care) or water pumps, tranny repair, engine rebuilds even that is all upon me... But i do want my carrier to be there when I cross the double yellow by accident as I loose control of my car on an icy night, hurt another family in the oncoming car, and buy us both new cars and pay the medical bills from the accident for all of us and the like. And I also believe that we need trade and other economic reforms to go along with that so almost all Americans can afford $500 or so per family member for a few office visits a year. If a person had four visits here with us half of them 3's and half of them 4's they would barely pay a few dollars over $400 bucks for that... Now with $4-5 K returned to employees and employers for the savings, who could not afford that with a little bit more fair trade instead of any and all "free-trade" that the super rich insist upon... Lastly, I am going to post my Food Stamps concept now in another thread and I believe this is the direction we need to move towards. I like the dollar a day as a base rate to allow us some can bank on income to allow us to plan ahead and know that they lights will stay on. But we have to get away from having to be slaves to their metrics and measurements.... The best outcomes in social welfare and society payoffs can not be so easily measured or quantified as much as I know well intentioned and big hearted and Gordon will probably disagree upon. Again if we stay tied to only health care outcomes when clearly our services reach far beyond there with avoiding dibilatating diseases and injuries, career ending mental health care and the like, what we do really does matter and has a much greater impact on society as a whole then anybody, even some of the best give any of you credit for, and it is about time they started to. How many families do we have on disability because of preventable disease states if only people would do a better job of coming in and doing what they need to do and if they had better affordable access to all of you folks??? How much outside the healthcare system metrics did we just save the system if we can keep one mom and dad productive tax paying citizens instead of creating an entire family who is dependent upon the state for almost any and all of their economic and healtcare needs??? Half a million, a whole million??? Start mulitplying those sort of numbers around a state, no less around the entire country and don't tell me that we don't count and we are not worth 4 or 5 times what is being offered right now. And the hospitals too... What did that recent study show? The average primary care doc is worth about $1.6 million dollars to his or her hospital and yet where is the reward for being such an economic engine for these selfish institutions? And if more docs could easily and without any insurance be in private practice instead of in a hospital large clinic setting, how many of those over done and over blown tests might be naturally rationed by the change in venue no less mind set alone??? Who knows but I would gather that per patient the average Hospital clinic PCP verses the average IMP solo pcp there is a large difference in useage of tests and other extra services to reach diagnosis and treatment choices.... To: Sent: Mon, June 7, 2010 3:15:42 PMSubject: Re: payment reform Good luck, and congratulations about having the energy, to do this sort of thing. I already feel so burned out, I don't think I can do anything about it, but if it works, maybe I'll perk up. Re: [Practiceimprovemen t1] payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinkingI mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine.I posit that it is all included. On Mon, Jun 7, 2010 at 12:46 PM, Sharon McCoy <docsharoncox (DOT) net> wrote: PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Hotmail is redefining busy with tools for the New Busy. Get more from your inbox. See how. -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2010 Report Share Posted June 8, 2010 OK, OK, I'm sold. :-)I was just curious if it had been corroborated.Nice summary. I couldn't get your link to work - or you would have gotten a pat on the back for explaining it before . :-) , You are right to some degree. There was a study recently published (?JAMA) that if you allow the patient to get exactly what they want all the time, costs soar. After all, technology is being marketed as the way to be healthier--“As long as you get test A or B, or take drug C, you will be healthier.” Both patients and docs fall into this trap. However, having a patient strongly agree that they are “getting exactly the care they want and need exactly when and how they want and need it” (IHI definition of PCCC) comes with amazing results—ER visits are lower, hospitalizations are fewer, medication interactions are fewer, bps are better controlled, bs is better controlled, antidepressants work better, patients are more likely to have colon cancer screening, patients are less likely to smoke and more likely to exercise. In fact, nearly all the disease markers improve if a patient strongly agrees with the statement—which is why it is far better to use this simple statement to assess quality of care than tracking multiple disease data points (it is also a heck of a lot cheaper than buying an expensive database, data entry personnel, etc). Ah, you say, but isn’t a well informed, healthy person more likely to agree with this statement? Yep, but if you look at IMPs across the nation (at least in IMP Cohort1), we had >60% of our patients strongly agree with this statement compared to a national average of 35%. Even accounting for disease burden, our numbers remain statistically better. The reason is when you boil down what the patient wants and needs it ends up being---access, efficiency (wait times), continuity, great information, and collaboration with specialists—all the things IMPs excel at. Sure you can argue that patients will not be happy if you do not give them an antibiotic, but my guess is your response to that would be “the antibiotic is not necessary right now, but call me next week if you are not better and we may need to prescribe something then.” Being able to say this illustrates access (if you call, I will talk to you), efficiency (don’t even have to come back in), continuity (I will know what is happening to you), and good information (hey, I realize you are feeling poorly and may yet give you what you want, but antibiotics are not warranted yet). Compare that to the traditional office where the next available appointment is 2 weeks out (or go to the ER if you are really sick), then you wait for 2 hours, then you see whichever provider is available, and you get thrown an antibiotic rxn after a 2 minutes with the provider because no one has the time to actually talk to you about antibiotics and how they really don’t work on viruses, and you start to see why this kind of marker is pretty powerful and why IMPs do much better than average. From: [mailto: ] On Behalf Of Locke Sent: Saturday, June 05, 2010 3:29 PM To: Subject: Re: payment reform But if the PATIENT is anwering the question and they thought they needed an antibiotic and you thought is was viral and they didn't need the antibiotic. Who is right in regards to anwering the HYH tool? The patient or the doc? That was my point -- patients often know what they want and need -- but not always. Just my humble opinion. Locke, MD " excatlyt " the care I want and need as on teh HYH tool is not exactly " what I wanted. " On Sat, Jun 5, 2010 at 3:06 PM, Locke wrote: Are there studies to show that patients who “get exactly the care….” etc -- are healthier? I can imagine the viral URI patient who didn't get the antibiotics they wanted or the narc seaker who didn't get the narcs they wated will check " No " they didn't get the care they wanted -- but got the care they needed. Or DID get the Abx and Narcs -- and are quite happy with my care - ca-ching, extra money for me -- but I am not giving best care to the patient. Just curious. Locke, MD -- 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 8, 2010 Report Share Posted June 8, 2010 This is where I think a ... (oh, darn, I've lost the word!) some mathematical factor that is applied to the PCP payment should come in. The more complete your primary care services are, then likely, the lower the cost of care will be to the payor (and hopefully the patient). I would make the factor based on the HYH type data and cost. Thus, if you have high marks for patient satisfaction/coordination of care and lower cost of overall care, then your $1 per day may become $1.10 per day and soon you are making $602,250 per year.I do agree with the poster that suggested the patient has to bear some of the burden to pay for expensive diagnostics, and I would add also, the specialty referrals. Without that, it is the rare patient who won't always demand these.CarlaTo: Sent: Mon, June 7, 2010 11:25:07 AMSubject: RE: payment reform I agree with you in theory and then, I don’t. When everyone was capitated, I started to refer out that stuff I felt should be paid for and wasn’t being paid for kind of with the feeling, well at least someone else could get paid for doing that. I started doing colposcopies, but they wouldn’t’ pay me more for doing that. Time consuming. My malpractice for doing minor surgery, biopsing possible cancers was a lot more and not getting paid extra for it didn’t work for me. If you do it all for the same capitation as someone who does none of it, one might start to get resentful and say, heck, I’m not going to do it if I can’t get paid for it. So I think human nature will work against this theory. Now one could argue that if the “capitation†was fair and decent, we wouldn’t care. But as you know, there aremany doctors who feel they should make more money, and it is never “enoughâ€. And the free market system is set up with do more make more. Socialism or communism is do more, make the same as everyone else. I have a big capitalist hunk in me. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypr actice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: Practiceimprovement 1yahoogroups (DOT) com [mailto:Practiceimp rovement1@ yahoogroups. com] On Behalf Of Jean Antonucci Sent: Monday, June 07, 2010 12:57 PM To: Practiceimprovement 1yahoogroups (DOT) com Subject: Re: [Practiceimprovemen t1] payment reform well yes and no PCP's jobs vary Jim does alot of fx care( the XR itslef being a carve out. bill for it under the New Antonucci System) but Carla has to spend exhaustive cognitive time on anxitey Shaorn does young women reproducitve IUD endom bx work Brady does old people complex time consuming decision about end oflife care and do they see a specialist Lynn always has gloves on taking off lesions- distinguishing among them to some finer point is what got us into this mess isn;t it? Suppose radically bend your mind you said well primary care is priamry care and thisi s how we pay it and the scope may vary but only procedures not able to be done in an office that only specilist can do those are not paid this way those are paid to speciliast at X dollars an echo, X dollars /cath ly i tis mindlessly easier isn;t it to take off some mole than to counsel an anxious bipolar tobacco using person with a new dx of cancer? All scope of fp. That's what I am thinking I mean at 1500 patietns- that is $547,000. Who couldn;t get by?? You coudl hire the nurse pay for the forceps and the drape buy the damn ekg machine. I posit that it is all included. On Mon, Jun 7, 2010 at 12:46 PM, Sharon McCoy <docsharoncox (DOT) net> wrote: PCPs do is nOT : taking off a toenail? endometrail bx? shaving derm lesions? flush ears> I and D and complex cysts? If you are saying the above stuff stays in under the $1/day, I think many PCP's don't do some of that (IM, maybe some NP's), so there may need to be some allowance for PCP's who do more preocedures and those who don't. Sharon -- 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 Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.