Re: Ideal Home certification

[Guest guest]

I attended the meeting of the physicians' steering committee of the

Maine Regional Extension Center (REC), Healthinfonet , yesterday.  

They have federal money earmarked for teaching small practices how

to achieve AHRQ medical home certification and are eager to market

this service to small practices which have been slow to sign up so

far.

Please let me know when Ideal Medical Home certification is approved

and I'll see if we can add that to Maine's REC services.

 

We're waiting to see if we've been recognized. 4 other

small practices

in OR were just recognized. Portland IPA helped us all out

with the process.

We are the only clinic without an EHR and they are not

being as friendly

to us though their Survey Tool specifically says you don't

have to have

an EHR.

Hopefully we'll know if a few wks. Small practices are

different and

they are bugging us about the way we combined some of our

cue systems to

make it

easier. They do not specify how anyone must do it, so it's

really up to

the reviewer to pass/fail our work. The IPA person who

helped us said

that each clinic

really had to figure out how to do it on their own--the

two EHRs they

were using did not have cue/tickler systems set up. I hope

we make it,

for the record.

But i'm all for a true Primary Care Oriented MH for

smaller practices.

The NCQA model wants to depend on a "team" approach so it

is already biased

against many IMPs. And we are not robots.

[Guest guest]

I attended the meeting of the physicians' steering committee of the

Maine Regional Extension Center (REC), Healthinfonet , yesterday.  

They have federal money earmarked for teaching small practices how

to achieve AHRQ medical home certification and are eager to market

this service to small practices which have been slow to sign up so

far.

Please let me know when Ideal Medical Home certification is approved

and I'll see if we can add that to Maine's REC services.

 

We're waiting to see if we've been recognized. 4 other

small practices

in OR were just recognized. Portland IPA helped us all out

with the process.

We are the only clinic without an EHR and they are not

being as friendly

to us though their Survey Tool specifically says you don't

have to have

an EHR.

Hopefully we'll know if a few wks. Small practices are

different and

they are bugging us about the way we combined some of our

cue systems to

make it

easier. They do not specify how anyone must do it, so it's

really up to

the reviewer to pass/fail our work. The IPA person who

helped us said

that each clinic

really had to figure out how to do it on their own--the

two EHRs they

were using did not have cue/tickler systems set up. I hope

we make it,

for the record.

But i'm all for a true Primary Care Oriented MH for

smaller practices.

The NCQA model wants to depend on a "team" approach so it

is already biased

against many IMPs. And we are not robots.

[Guest guest]

I attended the meeting of the physicians' steering committee of the

Maine Regional Extension Center (REC), Healthinfonet , yesterday.  

They have federal money earmarked for teaching small practices how

to achieve AHRQ medical home certification and are eager to market

this service to small practices which have been slow to sign up so

far.

Please let me know when Ideal Medical Home certification is approved

and I'll see if we can add that to Maine's REC services.

 

We're waiting to see if we've been recognized. 4 other

small practices

in OR were just recognized. Portland IPA helped us all out

with the process.

We are the only clinic without an EHR and they are not

being as friendly

to us though their Survey Tool specifically says you don't

have to have

an EHR.

Hopefully we'll know if a few wks. Small practices are

different and

they are bugging us about the way we combined some of our

cue systems to

make it

easier. They do not specify how anyone must do it, so it's

really up to

the reviewer to pass/fail our work. The IPA person who

helped us said

that each clinic

really had to figure out how to do it on their own--the

two EHRs they

were using did not have cue/tickler systems set up. I hope

we make it,

for the record.

But i'm all for a true Primary Care Oriented MH for

smaller practices.

The NCQA model wants to depend on a "team" approach so it

is already biased

against many IMPs. And we are not robots.

[Guest guest]

Perhaps someone will correct my misunderstandings about how the RECs are incentivized. My general understanding is that the RECs get 1/3 of their money when we sign up as an “interested practice”, 1/3 when our practice goes live with a certified product and 1/3 when we do the attestations. I’m guessing each REC is different, but if this is generally correct there appears to be little the RECs do directly for us to collect the first two-thirds of their money? If RECs indeed get two thirds of their payments from the Government by filling out a few forms and perhaps some of the last one-third by “attesting” to the easy ones – how much help will practices that need it the most get? Do the math. The last third with modest overhead probably pays for a day or two of on-site support. It would seem that success of the RECs depends on finding people that know my EMR, have an in depth understanding of practice management, a modest understanding of clinical issues and have been trained on meaningful use – four skills in one person. Will people this talented make a career change for a job that’s mostly over (funds gone) in 24 months? No doubt I’m missing something. Neighbors, MD From: [mailto: ] On Behalf Of PierceSent: Thursday, February 17, 2011 7:32 AMTo: Subject: Re: Re: Ideal Home certification I attended the meeting of the physicians' steering committee of the Maine Regional Extension Center (REC), Healthinfonet , yesterday. They have federal money earmarked for teaching small practices how to achieve AHRQ medical home certification and are eager to market this service to small practices which have been slow to sign up so far.Please let me know when Ideal Medical Home certification is approved and I'll see if we can add that to Maine's REC services. We're waiting to see if we've been recognized. 4 other small practices in OR were just recognized. Portland IPA helped us all out with the process.We are the only clinic without an EHR and they are not being as friendly to us though their Survey Tool specifically says you don't have to have an EHR.Hopefully we'll know if a few wks. Small practices are different and they are bugging us about the way we combined some of our cue systems to make iteasier. They do not specify how anyone must do it, so it's really up to the reviewer to pass/fail our work. The IPA person who helped us said that each clinicreally had to figure out how to do it on their own--the two EHRs they were using did not have cue/tickler systems set up. I hope we make it, for the record.But i'm all for a true Primary Care Oriented MH for smaller practices. The NCQA model wants to depend on a " team " approach so it is already biasedagainst many IMPs. And we are not robots.Error! Filename not specified.

[Guest guest]

Apparently four groups (so far)

will be offering Medical Home certification:

http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20110216pcmhaccredguidelines.html

[Guest guest]

Apparently four groups (so far)

will be offering Medical Home certification:

http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20110216pcmhaccredguidelines.html

[Guest guest]

Apparently four groups (so far)

will be offering Medical Home certification:

http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20110216pcmhaccredguidelines.html

[Guest guest]

At the rate solo practices are fading away - will it matter in the near future if insurances exclude solo docs from the trough?

There may not be any left.

Just wondering out loud.

 

Locke, MD

 

http://www.medscape.com/viewarticle/727420

 

Physicians Say White House Should Not Write Off Small Practices

 The percentage of physicians in solo practice declined from roughly 41% in 1983 to 25% in 2007 - 2008, according to data from the American Medical Association. According to an oft-quoted study from the Center for Studying Health System Change, the percentage of physicians who are solo practitioners or are practicing in groups of fewer than 6 physicians fell from 53% in 1996 - 1997 to 42% in 2004 - 2005.

 

 

http://www.aafp.org/fpm/980500fm/cover.html

 

Check out that incredible rate in 1980!

'

 

http://www.hschange.com/CONTENT/941/

 

 

 

 

 

Joy M. Grossman

 

 

Liebhaber

 

 

 

 

Print This Page Email This Page Download pdf

Share:

Digg ItExpand

Buzz Up

Mixx It

CiteULike

Connotea

Facebook

Google Bookmarks

Delicious

Physicians Moving to Mid-Sized, Single-Specialty Practices

Tracking Report No. 18

August 2007 Liebhaber, Joy M. Grossman

The proportion of physicians in solo and two-physician practices decreased significantly from 40.7 percent to 32.5 percent between 1996-97 and 2004-05, according to a national study from the Center for Studying Health System Change (HSC). At the same time, the proportion of physicians with an ownership stake in their practice declined from 61.6 percent to 54.4 percent as more physicians opted for employment. Both the trends away from solo and two-physician practices and toward employment were more pronounced for specialists and for older physicians. Physicians increasingly are practicing in mid-sized, single-specialty groups of six to 50 physicians. Despite the shift away from the smallest practices, physicians are not moving to large, multispecialty practices, the organizational model that may be best able to support care coordination, quality improvement and reporting activities, and investments in health information technology.

Solo and Two-Physician Practices Decline Practice Trends Reflect Changing Incentives Trends Vary by Specialty Changes Greater Among Older Physicians Policy Implications Notes Data Source Supplementary Table

Solo and Two-Physician Practices Decline

hanges in physician practice settings and organization have important implications for the practice of medicine and the care patients receive. Some experts believe that large, multispecialty practices, which combine primary care physicians and a range of specialists in the same practice, are the organizational structure with the greatest potential to provide consistently high-quality care.1 Indeed, the federal government has targeted some of these practices for quality improvement activities.2 Despite various clinical advantages of multispeciality practice, this organizational structure has declined as more physicians gravitate toward single-specialty practice. The proportion of physicians in multispecialty practices decreased from 30.9 percent to 27.5 percent between 1998-99 and 2004-053 (data not shown), according to HSC’s nationally representative Community Tracking Study (CTS) Physician Survey (see Data Source). While growth of multispecialty practices stalled, other significant changes in physician practice settings and organization took place over the last decade as more physicians have moved to larger practices and forgone an ownership stake in their practices. Although solo and two-physician practices were still the most common practice setting in the United States in 2004-05, the percentage of physicians in solo or two-physician practices decreased from 40.7 percent in 1996-97 to 32.5 percent in 2004-05 (see Figure 1). Likewise, the proportion of physicians in three- to five-physician practices decreased from 12.2 percent to 9.8 percent (see Table 1).

As physicians moved into larger practices, the proportion in groups of six to 50 physicians increased from 13.1 percent to 17.6 percent between 1996-97 and 2004-05.4 Smaller increases were seen in the proportion of physicians in practices with more than 50 physicians and in practices affiliated with medical schools.

Trends in physician ownership over the period mirrored those in practice type. As physicians moved out of the smallest practices, the percentage of physicians who were full or part owners of their practice declined from 61.6 percent to 54.4 percent (see Table 2).

Click here to view this figure as a PowerPoint slide.

Table 1Physicians by Practice Setting, 1996-97 to 2004-05

 

1996-97

1998-99

2000-01

2004-05

Solo/2-Physician Practices

40.7%

37.4%

35.2%

32.5%*

3-5 Physician Practices

12.2

9.6

11.7

9.8*

6-50 Physician Practices

13.1

14.2

15.8

17.6*

>50 Physician Practices

2.9

3.5

2.7

4.2*

Medical School

7.3

7.7

8.4

9.3*

HMO

5.0

4.6

3.8

4.5

Hospital1

10.7

12.6

12.0

12.0

Other2

8.3

10.5

10.4

10.1*

* Change from 1996-97 is statistically significant at p<.05.1 Includes physicians employed in hospitals and office-based practices owned by hospitals. Forty percent of physicians in this category were in office-based practices in 2004-05.

2 Includes physicians practicing in community health centers, freestanding clinics and other settings, as well as independent contractors.Source: HSC Community Tracking Study Physician Survey

 

I am shocked that an insurance carrier would explicitly exclude solo practices from this work.  Solo practices still make up a huge percentage of practices in the US and there is nothing inherent in solo that contradicts high performing primary care.  In fact (as you've alluded below), there are indications that larger institutional health care may have more difficulty achieving meaningful medical home-ness because of internal bureaucratic complexity. Gordon

 

I ran into this question recently.  One insurance plan is marketing its services as linked to medical homes.  For a subset of patients in the plan it is mandatory that they go to a medical home. I contacted provider relations stating my practice already has the features of a medical home.  Provider rep states they do not offer medical home designation to solo practices at this time.  As an IMP modeled practice with the cardinal features that Gordon described, I believe I can offer a medical home to my patients.

 

It would be a big difference for patients to be part of an IMP medical home versus an industrial medical feedlot where patients are herded like cows and you get care from a harried physican who does not really know you.

 

 

 

More on the same theme:

I have been part of some very encouraging conversations with health plans that 1: recognize the inherent flaws in the NCQA process, 2: Want some meaningful way to assess " medical home-ness " , and 3: are interested in the HowsYourHealth data.

This bodes well for our future. 

Gordon

__,_._,That's encouraging.   Our new need to meet the NCQA criteria to avoid penalties is taking time and energy that would've gone toward incorporating HYH or other ideal methods.

__