Re: Re: FM/Primary Care Match #'s 2011 and before

[Guest guest]

aren't acos really aimed at practices that have more than 5000 medicare patients. how will it help small groups like ours?

 

 

 

On the other hand, Gordon, I do SO appreciate your efforts, and those of our other activists, like and Pam and and many others. Without folks like you doing the work you are doing, I know things would be even less hopeful. I wish I had some time and energy...

Sharlene

> > >> > > I feel sorry for these new graduates who either didn't hear or didn't believe what they heard about what primary care is like these days. I was once ardently enthusiastic about Family Medicine, so it now saddens me terribly to say that the one thing I made sure to teach my son was NOT to go into primary care! He just matched in anesthesiology.---Sharlene---

> > >> >>

[Guest guest]

RE will primary care ONLY be recognized as part of an "ACO"?

But Gordon, I do NOT WANT to be in a multispeciality group and beaten up by the specialist/leaders of the group!

Why can't I do IMP medicine AND be paid well if I meet benchmarks.

Matt Levin, MD

Western PA solo FP

Re: FM/Primary Care Match #'s 2011 and before

I totally understand steering clear of primary care given the toxicity of the general environment. I am finally seeing some movement on the payment side that gives me some hope for our collective future. I have recently been talking with insurers who are ready to change their payment systems to reward the work of effective primary care. This is due to the CMS proposed rule-making regarding Accountable Care Organizations.Successful ACOs must rely on effective primary care. Payment that gets primary care off the hamster wheel and provides necessary support for effective population health management is seen as essential. These issues are front and center in payment negotiations.Street level effect will take time, but this is the first I've seen of very serious payer alignment with the goals of effective primary care.I suspect that some medical students see this coming and are betting on primary care's central and essential position in the future. The future does not look as rosy for proceduralists.Gordon>> I feel sorry for these new graduates who either didn't hear or didn't believe what they heard about what primary care is like these days. I was once ardently enthusiastic about Family Medicine, so it now saddens me terribly to say that the one thing I made sure to teach my son was NOT to go into primary care! He just matched in anesthesiology.---Sharlene--->

[Guest guest]

Matt and Gordon,

The heck with that.... Why do we have to keep proving and re-proving ourselves, and appologize for the flaws that the system itself has created in the first place??? I don't want to nor should we have to Prove a Gosh Darn thing to anyone but to our very own, Customer of the end services, THE PATIENT!!! Sorry you can't do Brake Jobs anymore because your metrics are outlying??? Like WTF??? I choose whether or not to use this Vet or that Vet, this auto repair shop or the other one... This lawyer or that lawyer for that matter...

Why, tell me why only here in medicine and only when these gov't and the greedy insurance carriers get involved do we suddenly have to prove ourselves beyond our ability to be licensed and trained in approved schools and programs, do we have to meet someone else's unproven standards and metrics???

Screw that, let the patient hire or fire just was we sometimes do to them as well. They are the one's who find us 99% of the time, calling or walking into our office, and it them who are in the room with us and it is the combination of the two, the patient and the doc who do or do not form a good theraputic relationship. To be judged and forced to meet P4P like standards set us all up for a new world order that is too frightening to allow to come to life.... Docs firing patients to keep their numbers up just for starters....

ACO are just this time frames new BS of HMO's thrown at us all over again.... I choose to learn from history instead of allowing myself and those that will listen to repeat the same failures... What do the rest of you choose to do?????

To: Sent: Fri, April 22, 2011 9:38:16 PMSubject: Re: Re: FM/Primary Care Match #'s 2011 and before

RE will primary care ONLY be recognized as part of an "ACO"?

But Gordon, I do NOT WANT to be in a multispeciality group and beaten up by the specialist/leaders of the group!

Why can't I do IMP medicine AND be paid well if I meet benchmarks.

Matt Levin, MD

Western PA solo FP

Re: FM/Primary Care Match #'s 2011 and before

I totally understand steering clear of primary care given the toxicity of the general environment. I am finally seeing some movement on the payment side that gives me some hope for our collective future. I have recently been talking with insurers who are ready to change their payment systems to reward the work of effective primary care. This is due to the CMS proposed rule-making regarding Accountable Care Organizations.Successful ACOs must rely on effective primary care. Payment that gets primary care off the hamster wheel and provides necessary support for effective population health management is seen as essential. These issues are front and center in payment negotiations.Street level effect will take time, but this is the first I've seen of very serious payer alignment with the goals of effective primary care.I suspect that some medical students see this coming and are betting on primary care's central and essential

position in the future. The future does not look as rosy for proceduralists.Gordon>> I feel sorry for these new graduates who either didn't hear or didn't believe what they heard about what primary care is like these days. I was once ardently enthusiastic about Family Medicine, so it now saddens me terribly to say that the one thing I made sure to teach my son was NOT to go into primary care! He just matched in anesthesiology.---Sharlene--->

[Guest guest]

ACOs are a way of NOT paying us...do more with less.

For, what, 3 years now, Gordon, you have shown that IMPs can do the job "better" but who pays more?

Primaries now will work for big organizations to capture the monies, like the fast food industry captures the "customers" who want to just get a 'script or get taken care of "faster," while the quality issue continues to get dumped on our laps.

Forgive me, but I bought a vanilla capuccino today at McD's and it was NOT STARBUCKS, nope...

But I pay 50% more for the Starbucks.

So I have to "prove" my quality and MAYBE I'll be paid later? Sounds like a good deal for someone else...not for me.

But I'm lucky...in my area, the insurers know how few good primaries are left and we get paid reasonably well.

Matt in Western PA.

Solo since 2004 as FP trained in residency, completed 1988

Re: FM/Primary Care Match #'s 2011 and before

We've certainly heard nice talk before, so skepticism is totally understandable.ACOs are certainly a new layer of bureaucracy and come with a host of regulations and reporting requirements.ACOs are an attempt to get health care to begin breaking down the silos. It is not a practice but an aggregation of practices working together on behalf of their patient population. There are some very promising models: Community care of North Carolina supports independent practices (solo and larger) as they share resources (e.g. case manager, registry, etc) and receive extra payment. How this all shakes out remains to be seen. The positive part I take from the discussions is the emphasis on primary care as the central actor and the willingness to change the payment system to support effective population health management.Gordon> > >> > > I'm sorry, Gordon, but I still don't feel optimistic, and I feel sorry> > for medical students who are hearing the talk and thinking things will be a> > lot better by the time they get out of residency. Like the PCMH, ACOs sound> > to me like just another layer of bureaucracy and paperwork in between me and> > the fair payment that I need right now! And the new proposals being made all> > seem to involve penalties if we decide we cannot participate! If the> > proceduralists' incomes get cut in half, they will still be making more than> > I make now, so I think they will still have the better deal for a long> > time.---Sharlene---> > >> > > -

[Guest guest]

Right on Matt,From the Health Policy and Market Blog by bob laszewskihttp://healthpolicyandmarket.blogspot.com/THURSDAY, APRIL 7, 2011Why ACOs Won’t WorkFirst, I think Accountable Care Organizations

(ACOs) are a great idea. Just like I thought

HMOs were a good idea in 1988 and I thought IPAs were a good idea in 1994.The whole notion of making providers accountable for balancing cost, medical necessity, appropriateness of care, and quality just has to be the answer.But here’s the problem with ACOs: They are a tool in a big tool box of care and cost management tools but, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.I see the $2.5 trillion American health care system as a giant health care industrial complex. It just grows on itself and sucks in more and more money. Why not? The bigger it gets the more money we give it.How do you make it efficient? You change the game. You can’t let it any longer make money just getting bigger. The new game has to be one that only pays out a profit

for results—better care for a budget the country can live with. There are lots of tools available to do that. ACOs, capitated HMOs, IPAs, disease management, enormous data mines, Electronic Patient Data Systems, and so on.But, here’s the rub. There isn’t a lot of incentive for payers and providers to do more than talk about these things and actually make these tools work. Right now they can just make lots more money off the fee-for-service system. They demand more money and employers and government and consumers are willing to just dump more money into the system. Sure they complain about it but they just keep doing it.On the heels of the “Patients Rights Rebellion†(or maybe better titled the Provider Rights Rebellion) in the late 1990s, a CEO of one of the biggest health plans told me, “We’ve had it. We tried to manage care. Actually got results. Then consumers and employers and the politicians all sawed the limb off on

us. Screw it. Back to fee-for-service. We can make more money doing that and not take all of this heat. They won’t admit it but that is what they [patients, employers, and politicians] really want.â€ACOs won’t succeed in the near term any more than capitated HMOs and IPAs accomplished anything in their day because there is no reason—no imperative—for the health care industrial complex to want them to succeed.Here’s a flash for the policy wonks pushing ACOs: They only work if the provider gets paid less for the same patient population. Why would they be dumb enough to voluntarily accept that outcome?Oh, there will be some providers—particularly hospital administrators—who can’t wait to build an ACO but probably more because they want another excuse to corner the primary care docs as a marketing channel for their growing system. But spend millions to develop an ACO so they can get less money? Only in the policy

wonk netherland does that compute.The only people on the ball when it comes to this ACO idea are the anti-trust lawyers and with good reason.In my next post, I will talk more about how we might change the game so that these tools can work.Subject: Re: Re: FM/Primary Care Match #'s 2011 and beforeTo: Date: Saturday, April 23, 2011, 10:02 PM

ACOs are a way of NOT paying us...do more with less.

For, what, 3 years now, Gordon, you have shown that IMPs can do the job "better" but who pays more?

Primaries now will work for big organizations to capture the monies, like the fast food industry captures the "customers" who want to just get a 'script or get taken care of "faster," while the quality issue continues to get dumped on our laps.

Forgive me, but I bought a vanilla capuccino today at McD's and it was NOT STARBUCKS, nope...

But I pay 50% more for the Starbucks.

So I have to "prove" my quality and MAYBE I'll be paid later? Sounds like a good deal for someone else...not for me.

But I'm lucky...in my area, the insurers know how few good primaries are left and we get paid reasonably well.

Matt in Western PA.

Solo since 2004 as FP trained in residency, completed 1988

Re: FM/Primary Care Match #'s 2011 and before

We've certainly heard nice talk before, so skepticism is totally understandable.ACOs are certainly a new layer of bureaucracy and come with a host of regulations and reporting requirements.ACOs are an attempt to get health care to begin breaking down the silos. It is not a practice but an aggregation of practices working together on behalf of their patient population. There are some very promising models: Community care of North Carolina supports independent practices (solo and larger) as they share resources (e.g. case manager, registry, etc) and receive extra payment. How this all shakes out remains to be seen. The positive part I take from the discussions is the emphasis on primary care as the central actor and the willingness to change the payment system to support effective population health management.Gordon> > >> > > I'm sorry, Gordon, but I still don't feel optimistic, and I feel sorry> > for medical students who are hearing the talk and thinking things will be a> > lot better by the time they get out of residency. Like the PCMH, ACOs sound> > to me like just another layer of bureaucracy and paperwork in between me and> > the fair payment that I need right now! And the new proposals being made all> > seem to involve penalties if we decide we cannot participate! If the> > proceduralists' incomes get cut in half, they will still be making more than> > I make now, so I think they will still have the better deal for a long> > time.---Sharlene---> > >> > > -

[Guest guest]

I have been part of an accountable health care organization for about 4 years and like it a lot. There is significant red tape but also a significant increase in income. The medical director is a family physician which I think helps. Most but not all of the red tape involves updating their disease registry for lots of things which they then report to payors and which they use for bonus determination. We use the same registry to improve our care. It is nice to report our quality indicators to just one organization instead of to multiple insurance companies. We also get to rate our specialists which affects their bonuses. That keeps the specialists attentive. They also will provide case managers. If you have enough patients they will have the case manager in your office at no charge to help you coordinate care. Our office is too small to qualify for that. Right now we only have commercial contracts with them but they are getting ready for medicare.

Larry Lindeman MDRoscoe Village Family Medicine2255 W. RoscoeChicago, Illinois 60618www.roscoevillagefamilymedicine.com

We've certainly heard nice talk before, so skepticism is totally understandable.

ACOs are certainly a new layer of bureaucracy and come with a host of regulations and reporting requirements.

ACOs are an attempt to get health care to begin breaking down the silos. It is not a practice but an aggregation of practices working together on behalf of their patient population.

There are some very promising models: Community care of North Carolina supports independent practices (solo and larger) as they share resources (e.g. case manager, registry, etc) and receive extra payment.

How this all shakes out remains to be seen.

The positive part I take from the discussions is the emphasis on primary care as the central actor and the willingness to change the payment system to support effective population health management.

Gordon

> > >

> > > I'm sorry, Gordon, but I still don't feel optimistic, and I feel sorry

> > for medical students who are hearing the talk and thinking things will be a

> > lot better by the time they get out of residency. Like the PCMH, ACOs sound

> > to me like just another layer of bureaucracy and paperwork in between me and

> > the fair payment that I need right now! And the new proposals being made all

> > seem to involve penalties if we decide we cannot participate! If the

> > proceduralists' incomes get cut in half, they will still be making more than

> > I make now, so I think they will still have the better deal for a long

> > time.---Sharlene---

> > >

> > > -