Re: payment reform

[Guest guest]

Hmm what would be that term for the factor? a 'multiplicand' ? sorry, I am still on 3rd grade level. Brady will tell us.So there should be a comprehensiveness factor, some sort of question like -'Do you receive the bulk of your health care at your primary care provider's office?' most of the time/some of the time/not at all.I'm not clear that HYH has a question to measure comprehensiveness of care, though it would be easy to add. (though of course it wouldn't have been statistically vetted yet (sigh)) Hard to pull the cost data re specialty care directly from HYH survey, though the cost data for ER/hospitalization is there - suppose that could sort of be a proxy for comprehensiveness for emergency stuff, though not for routine specialty stuff. Also just wanted to point out that "patient satisfaction" i.e. 'do you like this doctor, would you recommend this doctor to your friends and family'?' is NOT what HYH measures directly. It measures care attributes that affect outcomes: access, efficiency , continuity, information, and the road to confidence. Still one clearly COULD EASILY pull a overall medical home score from the HYH data and use that as a factor for increased (or decreased HA!) payment. I would love to see that happen in a pilot somewhere like Maine or RI. LynnTo: From: carlygold@...Date: Mon, 7 Jun 2010 22:15:04 -0700Subject: Re: payment reform

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.CarlaFrom: Kathy Saradarian <qualityfphughes (DOT) net>To: 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 “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.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

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