AAFP SAMs or other Modules

[Guest guest]

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular 8 years. We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ectCould any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?Thank you very much for any input.Helen

[Guest guest]

It seems to me that the Part II and IV modules that I've done have taken 5-6

hours apiece. For Part IV, I've only done the diabetes modules in order to get

them to count for PQRI also. Most of the time has been spent in chart review,

since most of the data points are not searchable in my current EMR.

Haresch

>

>

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't

done any of the AAFP modules since the recert. I would have to start doing the

Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year

track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

[Guest guest]

Helen,

The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am

now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

Hope that helps,

________________________________________

From:

[ ] On Behalf Of Helen Yang

[helenwyang@...]

Sent: Wednesday, July 27, 2011 8:38 PM

To: IMP Group

Subject: AAFP SAMs or other Modules

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done

any of the AAFP modules since the recert. I would have to start doing the Part

II SAMs Modules and /or Part IV modules in order to stay on the 10 year track

instead of regular 8 years.

We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

Thank you very much for any input.

Helen

[Guest guest]

Isn't it ABFM now?To: " " < >Sent: Saturday, August 6, 2011 9:19 AMSubject: RE: AAFP SAMs or other ModulesHelen,The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell

you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen. The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get everyone ready for them being on the recertification exam by 2014.The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I even learned a little. There is a Part IV module now that sort of

replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements. BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have seen the way the board works, I believe it

is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years. Hope that helps,________________________________________From: [ ] On Behalf Of Helen Yang [helenwyang@...]Sent: Wednesday, July 27, 2011 8:38 PMTo: IMP GroupSubject: AAFP SAMs or other ModulesBusy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in

order to stay on the 10 year track instead of regular 8 years.We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ectCould any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?Thank you very much for any input.Helen------------------------------------

[Guest guest]

Jim I appreciate your work on thisPLus I  get to  see your face on the newsletter  It is good to see someone , an IMP,  a small independent practice have a voice in the  professional organizationsThe PQRi measure for ABFM is a challenge for little practices - I  wasted a bunch of time  on it  -turns out that many of us  do ot have 30 diabetics in t he right age range then another 30  I think  to go back after review. That's a real issue to think about out  While sample size matters for measuring and for learning ; it  cut many of us out of this  beneficial  program

 thanksJean

Helen,

The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get everyone ready for them being on the recertification exam by 2014.

The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I even learned a little.

There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

Hope that helps,

________________________________________

From: [ ] On Behalf Of Helen Yang [helenwyang@...]

Sent: Wednesday, July 27, 2011 8:38 PM

To: IMP Group

Subject: AAFP SAMs or other Modules

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert.  I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular 8 years.

We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

Thank you very much for any input.

Helen

------------------------------------

[Guest guest]

This may be a bit off topic, but is the ABFM a non-profit

organization? I was looking at their web site, and did not

see anywhere where they publish an audited statement of their

finances. If I was going to apply for certification,

and was paying as much as $2500 (if I was applying late, as I'm sure I

would be) just for taking the test, I'd

want to know where the money actually goes. I'm sure a lot of it goes into

security at the test sites. Do they have any of those

TSA type body scanners yet when you go in for the test? How about

pat-downs? Anybody have to wear adult diapers yet? I'm 63, it may not

be too far off.

I notice if you did a 3 year residency, re-certified twice, but are

now past your recertification deadline, you immediately drop off the face of the

earth as far as they are concerned. It's as if you never existed at all. I

realize they do not

recognize the term " board eligible " . But you think that previous

certification might show up on some sort of second tier list, so at least it

would count for something. Just wondering.

>

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I

am now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

>

> The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From:

[ ] On Behalf Of Helen Yang [helenwyang@...]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't

done any of the AAFP modules since the recert. I would have to start doing the

Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year

track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

[Guest guest]

Yes the ABFM is a nonprofit and a member of the Am. Board of Medical Specialties. The ABMS is responsible for certifying all specialites. There is enhanced security these days, since their " product " is the testing, both online and on sight. A ring of theives

were caught trying to steal questions from the INteral Med exam last year, I believe these docs are going to jail.

The money goes to developing the tests, and the security as well as being sure that the residencies, and everyone else is in compliance. A large part is also spent on being sure that everyone stays licensed. If you loss you

license you are not elgible to be certified, and it takes a lot of work to chase those who screw up.

You are correct, there is no such thing as Board Elgible, since FM takes the exam immediately after graduation. (This changes to the April of Graduation next year.) Only those specialites that require practice have a category

like this.

Can't speak the " fallen off the radar " , but I bet that they still have your information somewhere. CAll them, they are actually really nice.

I am 60 and know how you feel.

From: [ ] On Behalf Of [alcald3000@...]

Sent: Monday, August 08, 2011 1:59 PM

To:

Subject: Re: AAFP SAMs or other Modules

This may be a bit off topic, but is the ABFM a non-profit

organization? I was looking at their web site, and did not

see anywhere where they publish an audited statement of their

finances. If I was going to apply for certification,

and was paying as much as $2500 (if I was applying late, as I'm sure I

would be) just for taking the test, I'd

want to know where the money actually goes. I'm sure a lot of it goes into security at the test sites. Do they have any of those

TSA type body scanners yet when you go in for the test? How about

pat-downs? Anybody have to wear adult diapers yet? I'm 63, it may not

be too far off.

I notice if you did a 3 year residency, re-certified twice, but are

now past your recertification deadline, you immediately drop off the face of the earth as far as they are concerned. It's as if you never existed at all. I realize they do not

recognize the term " board eligible " . But you think that previous

certification might show up on some sort of second tier list, so at least it would count for something. Just wondering.

>

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing

Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

>

> The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get

everyone ready for them being on the recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think

I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the

DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met

the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I

have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From: [ ] On Behalf Of Helen Yang [helenwyang@...]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular

8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

[Guest guest]

I agree with you and that is one of the things I brought up at my first board meeting. I believe that we will be able to change some of this and hopefully getting Meaningful Use as a criteria.

I see my consituents as us, the small practices who have trouble doing these due to volume or cost. I believe we can make headway on both.

Jim

From: [ ] On Behalf Of [jnantonucci@...]

Sent: Sunday, August 07, 2011 7:40 AM

To:

Subject: Re: AAFP SAMs or other Modules

Jim I appreciate your work on this

PLus I get to see your face on the newsletter

It is good to see someone , an IMP, a small independent practice have a voice in the professional organizations

The PQRi measure for ABFM is a challenge for little practices - I wasted a bunch of time on it -turns out that many of us do ot have 30 diabetics in t he right age range then another 30 I think to go back after review. That's a real issue to think about

out While sample size matters for measuring and for learning ; it cut many of us out of this beneficial program

thanks

Jean

On Sat, Aug 6, 2011 at 9:19 AM, Kennedy, Jim

wrote:

Helen,

The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing

Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get

everyone ready for them being on the recertification exam by 2014.

The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I

even learned a little.

There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM

one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the

folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have

seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

Hope that helps,

________________________________________

From: [ ] On Behalf Of Helen Yang [helenwyang@...]

Sent: Wednesday, July 27, 2011 8:38 PM

To: IMP Group

Subject: AAFP SAMs or other Modules

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular

8 years.

We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

Thank you very much for any input.

Helen

------------------------------------

[Guest guest]

Yes, my misprint

From: [ ] On Behalf Of Madonna [docmadonna@...]

Sent: Saturday, August 06, 2011 9:13 PM

To:

Subject: Re: AAFP SAMs or other Modules

Isn't it ABFM now?

To: " " < >

Sent: Saturday, August 6, 2011 9:19 AM

Subject: RE: AAFP SAMs or other Modules

Helen,

The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing

Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get

everyone ready for them being on the recertification exam by 2014.

The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I

even learned a little.

There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM

one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the

folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have

seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

Hope that helps,

________________________________________

From: [ ] On Behalf Of Helen Yang [helenwyang@...]

Sent: Wednesday, July 27, 2011 8:38 PM

To: IMP Group

Subject: AAFP SAMs or other Modules

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular

8 years.

We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

Thank you very much for any input.

Helen

------------------------------------

[Guest guest]

It's a shame we can't use How's your Health data to satisfy the Part IV

module requirement. I'd be willing to be a guinea pig for this.

Pierce

>

> I agree with you and that is one of the things I brought up at my first board

meeting. I believe that we will be able to change some of this and hopefully

getting Meaningful Use as a criteria.

> I see my consituents as us, the small practices who have trouble doing these

due to volume or cost. I believe we can make headway on both.

> Jim

>

> ________________________________

> From:

[ ] On Behalf Of

[jnantonucci@...]

> Sent: Sunday, August 07, 2011 7:40 AM

> To:

> Subject: Re: AAFP SAMs or other Modules

>

>

>

> Jim I appreciate your work on this

> PLus I get to see your face on the newsletter

> It is good to see someone , an IMP, a small independent practice have a

voice in the professional organizations

> The PQRi measure for ABFM is a challenge for little practices - I wasted a

bunch of time on it -turns out that many of us do ot have 30 diabetics in t

he right age range then another 30 I think to go back after review. That's a

real issue to think about out While sample size matters for measuring and for

learning ; it cut many of us out of this beneficial program

> thanks

> Jean

>

>

> On Sat, Aug 6, 2011 at 9:19 AM, Kennedy,

Jim> wrote:

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I

am now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

>

> The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From:

<mailto: \

>

[ <mailto:@...\

m>] On Behalf Of Helen Yang

[helenwyang@...]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't

done any of the AAFP modules since the recert. I would have to start doing the

Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year

track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

A more important underlying issues is the degree of match between current data sets and overall outcomes.Most quality measurement focuses on disease and organ systems. This approach can lead to rewarding improvements in organ system management but often fail to address more important outcomes. The hypothesis that disease management translates to overall improvement in care delivery has not been demonstrated. Moreover, there is a wealth of evidence that overall population health improvement is based on good primary care delivery. This is not the same thing as disease management, and in fact our continued quality emphasis on disease states and organ systems keeps our focus narrow while we miss the big picture.Primary care is defined as the presence of four cardinal components:First point of contact (access)Person-focused relationship over time Comprehensive servicesCare coordinationWhen done well, population health outcomes improve, disease states improve, patient experience improves, total cost of care improves.The ABFM can help the country re-orient measurement to focus on what really matters. Barbara Starfield laid this out very well in her FPM editorial of 2009.We don't give up measuring things like A1c, pneumovax, etc, but we cannot let these small measures squeeze out measures of how well we deliver on primary care key performance indicators (access, person-focused relationship, comprehensiveness, care coordination).The IMP self-assessment recognition program focuses on the broad themes, is accessible to small independent as well as large practices, and is much more aligned with the real value of primary care. We should not continue to follow a broken paradigm just because it is familiar and touted by experts.Gordon

I agree with you and that is one of the things I brought up at my first board meeting. I believe that we will be able to change some of this and hopefully getting Meaningful Use as a criteria.

I see my consituents as us, the small practices who have trouble doing these due to volume or cost. I believe we can make headway on both.

Jim

From: [ ] On Behalf Of [jnantonucci@...]

Sent: Sunday, August 07, 2011 7:40 AM

To:

Subject: Re: AAFP SAMs or other Modules

Jim I appreciate your work on this

PLus I get to see your face on the newsletter

It is good to see someone , an IMP, a small independent practice have a voice in the professional organizations

The PQRi measure for ABFM is a challenge for little practices - I wasted a bunch of time on it -turns out that many of us do ot have 30 diabetics in t he right age range then another 30 I think to go back after review. That's a real issue to think about

out While sample size matters for measuring and for learning ; it cut many of us out of this beneficial program

thanks

Jean

On Sat, Aug 6, 2011 at 9:19 AM, Kennedy, Jim

wrote:

Helen,

The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing

Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get

everyone ready for them being on the recertification exam by 2014.

The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I

even learned a little.

There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM

one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the

folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have

seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

Hope that helps,

________________________________________

From: [ ] On Behalf Of Helen Yang [helenwyang@...]

Sent: Wednesday, July 27, 2011 8:38 PM

To: IMP Group

Subject: AAFP SAMs or other Modules

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular

8 years.

We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

Thank you very much for any input.

Helen

------------------------------------

[Guest guest]

PS: Please feel free to share these comments with the others at the board. I bet they have not heard feedback quite as Raw as this before. Doctors are so controlled and well spoken sometimes too much so, but it is part of being a decent professional is that self control. But that does not mean that undernether the calm exterior that others are not likewise irritated and upset in a similar fashion and at a similar level. Someone has to finally speak the Full Truth and tell these folks that the only reason they don't have a mass exidose on their hands like the AMA and AAFP is because of the Economic and Professional Fallout that can ruin the average career and income potential in almost an instant.

Do they really want to be seen and know as we don't care, hear, see, and speak no evil kind of rulers from high above whose only authority comes from the power to ruin their members carreers if those members don't tow the line and do whatever is required of them. Not because the membership feels like they are doing a decent and difficult job the best they humanly can and that no human project is ever going to be perfect or please everybody 100%? Do they derive their power from the support of their members or simply like a Mafia Don, it is only by the ever present and implied, terribly threatening power of ruining one's professional life, career and most hopes of paying down one's debts and making a semi-reasonable and professionally acceptable living that keeps them even modestly viable and still have the majority of their membership

towing the line against their own better judgement or beliefs????

Please I beg of you to implore them to get away from this broken and misguided model that after all the hoops docs are going to go thru in their attemps (who says how many are going to actuall succeed???) to comply and meet the "New Standard" who says it's going to be worth a gosh darn thing? They need to return to the old ways of basic testing and matching credits of CME if and until some new, well thought out, polled, researched and proven valid and Truly Meaningful, and understandable and not overly impossing upon most FP's who don't have the time to blow their own noses, no less their poor kids most of the time is created and worked out over a much longer and better used period of time... Jumping onto the Next HMO bandwagon really reduces their level of respect From the Membership to practically Zero.... My 10 & 12 year old kids

are smart enough to not jump on the e Beaver or the Next flash in the pan, one season wonder team's bandwagon.... So why is not our supposedly so astute and intelligent board not able to have that same basic mature critical thinking, reasoning and questioning skills to form good hypothosis and then perform decent research into what actual might be a sensable way to slowly evolve and improve the standards and measures of what it means to be a true Board Certified practioneer of Family Medicine?????

And again just because someone can collect and vomit back on cue does not mean a damn thing about the quality of their work especially as it relates to something as multifacetted and interpersonal and hard to define as the doctor patient relationship of working together torwards a lifetime of better health on a case by case, individual basis. And taking the larger longer view as Gordon said so well as opposed to the serverly dysfunctional and short sighted and myopic view of measures of individual disease states might and frequently does run in opposition to what really could and is better long term outcomes... Great data collectors and reporters are frequently NOT the best one on one clinicians... And great clinicians are not always the best data collectors and reporters.... So on that alone where is the great corrolations and

connections of such skills being related and tied to one another that one actually is a good predictive measure for the other???? Because I not sure that such a set of connections exists at a significant level but then again it is not my hypothosis or theory to present or defend.... It is theirs to show the greater world and membership that such things are truly worthy of becoming the new normative standard and measure that all Certified docs must be able to attain and prove capable of. And as of right now it seems to many of us, that they have failed pretty miserably at all of that...

Lastly and then I promise to shut up for awhile one and all.... Because of the large economic differences between clinics, practices hospitals no less the larger the clinic both the more likely they are to have a larger IT budget with a team of folks attacking these CCHIT and MU issues for them... While of the opposite side of those same larger places is a doctor's inability to control what is and is NOT priority or programmed into the system, which tools are turned on or off by the IT team and the partner of Exec in charge of all of that.... One the flip side us small guys can barely get the refills called in, the patients seen for nice longer more high quality visits, get the billing done, copy or print out the records and other request, go home and get some dinner in ourselves no less our kids, family by 6-7 pm most nights... Like what they

heck is the real intent of this?

Do they really want to start weeding out what might even be a majority of their members who can not for so many free market and other reasons be bothered or have the resources or time to do so? Is this an IT data collection test or is this a Board Certification process to make sure we have good, knowledgeable, intelligent able to think on their feet doctors practicing medicine all across the country? Because the more I think about it being combined in ANY Fashion with Meaningless Use, the more it is starting to seem like a "Verification Process" or even backdoor Certification Process for the Clinics, practices and hospitals themselves.... This is as much about day to day process of charting and data collection, EMR selection, back end tweaking and turning on and off various options and the like and who

has the best kiss up data collection clip boards and support staff to collect such garbage in the first place, no less then have it become "Meaningful" when crunched and presented in some fashion... So is this checking up on and verifying, certifying my wife's ability to manage and treat any given patient that walks thru the door or is this more of a test of her's and her practice manager's ability to shop, choose, code and bill, be financially viable enough to even be able to play in the first place, no less tech savvy enough to set it up and manage it all... to then hopefully put us in the proper place to even begin to go along with such a thing in the first place?????

In closing IMHO it seems that perhaps the worst thing that is happening here by blindly if ever adopting Meaningless Use and making it part of the Board Certification process is as follows. It seems to me that the defining line between being some sort of a regulatory body and oversight, quality control agency that in many ways is not truly measuring the doc here but instead much of it depends on other not easily defined and controlled for variable about the clinic, practice, tech support, managment, EMR vendor and the like; verses a professional and privately run BY the profession and it's professionals themselves (Super Critical Here, like an internal Review Board too, right?) organization that makes sure that their members meet up to and can perform at a certain

proven viable level of expertise and compentency has been has been utterly destroyed here and it sets a a New and very frightening standard of what it means to be tested and certified... This boundary is now severely blurred, oblithorated practically, when in fact such a boundary needs to remain forever extra sharp, focused and well defined. Hopefully we can now restore order back to where it needs to be, and that these two very different goals and outcomes desired of such vastly different kinds of organizations and agencies needs to remain forever well defined and separated pretty darn far apart so as to never come half as close as this to blurring the line EVER again.... We might even need to be reminded and to set up some sort of firewall, neutral zone or DMZ here to remind other new replacement board members that such should never, ever be allowed to get this close, no less crossed ever again...

Honestly, how many great docs did you know who couldn't barely program a VCR sometimes, but darn it if their clinical skills, knowledge, experience and relationship with their patients where not some of the best and most respected you have every seen??? And if forced to choose between horrible interpersonal skills and doctor patient relationship, less able to problem solve and combind concepts and ideas to reach great and insightful helpful clinical conclussions, or a doctor like most of our IMP brothers and sisters here with stickers and lolly pops, and cool ties and toys to play with, brings their toy dog to work with them to entertain the patients (we do this) which doctor would you want your own 4 year old daughter to be getting treated and cared for long term in a Primary Care relationship???

Doctor Numbers or Doctor Lolly Pop???? I'll take Doctor Lolly Pop each and every time, wouldn't you??? And how the heck are we ever really going to measure Doctor Lolly Pop??? Ask Gordon and friends because I think they are the one's who have better ideas and concepts that are getting a whole lot closer to that better more valid concept, then did our board who blindly adopted this, did your EMR collect the right data, can you work those numbers correctly to prove something about a segment of your patient panel and report them back to our Board (wasn't this what the Government was going to use and do, make us do, to start paying us based upon supposed Quality reporting and numbers, NOT our Board???) to gain access to the club to even be able to walk into the locker room and get dressed, no less have the coach actually put us in the game to play???? That's BS, it's bad enough our government wants to try and impose this upon us as means of

pay or punishment, but when our our professional board is so blind and short sighted and feels it should start to share and perhaps switch roles with our government agencies, then I know someone has lost his or her mind and has jump the tracks and entered into a relm that was never theirs to enter in the first place....

Test and probe for real professional competance, skills and knowledge base no less critical thinking and deducting why don't you. Perhaps we could and should start to do personality and pysch evals too, as perhaps there is or is not a correlation between such and real world outcomes? At what point has one gone way too far astray from their Original Mandate and their real purpose and real implied and understood Authority? Well, here is a great clear example of doing just that... way over stepping and over reaching and without even any real substanciated supportable reasons no less.... And not even a bit aware or concerned that in almost an instant they changed all of this, and are now outside their field of play, expertise and mandate themselves.... That is very frightening and concerning indeed and I

call for an immediate stay of all of this and to perhaps allow all previous members in good standing prior to SAM's, and Modules and MU over the past few years to simply take a decent test and pay their now present fees until we properly investigate and understand just what happened here and why??? This is a board and not a police department or licensing agency.... Knowledge and Skills, not enforcement and equipment quality...

Check this out.... The folks that license an Electrican are not the same folks who come to his worksite to inspect and approve of his actual work before the sheetrockers seal up the walls. And neither of these organizations would ever claim to be allowed to start playing in the other's park and for perfectly good, well defined and divided up reasons. If the Government wants to start Observing or requiring doctors to have to report such things, over sight their work, that is completely different than their board whose job it is to set a knowledge and skills based set with tests and procedures to prove or disprove such knowledge and skills, to then Certify them as qualified to walk onto the contstruction site and start reading blue prints and wiring and laying out conduit... Then the inspector

reviews their work before the job is finished and says whether it's good enough or not... Two different organizations one run by the profession to measure professional standards of knowledge and skills the other to oversee actual work quality.... The board has completely over stepped its autority and mandate here and should be held accountable for this horrible mistake. If any tradesman could see and understand these very real differences, then why not a Board of supposedly intelligent and well thought doctors setting standards and policy... Oversight of actual Work was never in nor should it ever be in their mandate...

I've gotta go and have ranted way too long already here..... Be well and let's really start to think about what has really happened here folks....

To: " " < >Sent: Tuesday, August 9, 2011 4:00 PMSubject: Re: AAFP SAMs or other Modules

Here Here Gordon,

Well said as always.... Jim personally I have written three emails that I never sent (See I am Learning Some Restraint... :-) because this issue has me fumming. Why is it our Board's responsibility almost to "Certify Any of Us" as basically being able to meet a Gov't set of requirements that as Gordon points out are not even surely relevant??? For goodness sake, teach us, keep us abreast of upcoming and new issues, therapies and theories, and then somehow test our Knowledge on it. But to actually try to somehow "Test and Quantify" the quality of our work is Insane and Unacceptable on any and all fronts. Tell me what other Board is doing this to their Diplomats???? It is disrespectful to doubt basic competance in clinic practice especially in something that is so people, relationship based and oriented....

We all KNOW that Gordon et al (the Great Gang of Mentors here (and thanks to one and all, you folks are awesome!!!) have a much better handle of these kinds of things than any part time meeting board does as they are not influenced by Big Medicine, Big Pharma, Hospitals and Gov't Make Myself a Self Perpetuating Job and new dept while feeding the Super Vendors who pay and bribe their way in to becoming "Required". This Meaningless Use crap is not even truly proven "valid" or "significant" and worse yet it seems to lack a certain important transferability as well as repeatability across thousands of clinics and providers' office across the country....

I won't even get started on some of the links I almost sent you about Amazing Charts Newest "Meaningless Use" 6.0.9 being rushed out exactly because of stupid deadlines and people clamoring to meet them for Incentives NO LESS PUNISHMENT.... If you are running Windows XP, Pro even there is a 99% chance of the E-Rx bring your entire visit and any and all refills to a crawl, where as users have reported, one can literally watch the scan lines being rendered that is how incredibly slow it goes to render the windows needed to write print etc.... The free market is still struggling to get this together, many offices have NO EMR at all! Yet Now to be Board Certified our own Board has Ignored it members so badly or they are so deaf and out of touch that they can not hear the clamors of struggling to catch-up, make choices, get systems up and running? What is some small IMP or soon to retire

doc wants to say, hey with only 5-10 years to go, what the heck, I'm not going to deal with all this tech headaches.... Now it is required by the board just to remain Certified.....

But because of the first part that it is still not proven that such CCHIT, CCHIT is even valid or worthy of the efforts no less that other members should Always be allowed to Opt-Out of being part of this Grand and not yet proven experiment because of all the other garbage in our Business of Medicine, that a Realist and Connected Board would actually understand at some gut viseral level as opposed to needing to be hit over the head with a hard Mallet or something, this is really worst of all, "Economic Extortion" forcing all FP's to suck up and be cut out completely. We are facing this exact problem as we speak. Ask Gordon who practice one city away in Rochester for years, just how over bloated and Full of themselves, our regional Engulf and Devour BC/BS Affiliate Excellus is.... They may have as much as 70% of our market coving both regular commercial as well as managed gov't

like CHIP's, FHIP's and NY Medicaid and some Medicare as well... They are a Monster the 800 lb gorilla in the room out here and they are threatening to drop my wife if she doesn't "Promise" to start getting her board certification stuff in order and get "Back on Board"!!!

These are the realities that we really do face and live in and to hold our own Certification Hostage from us, literally threatening our Hospital affiliations and r Credentials, both of whom what to know that the other is properly in place as well, no less, RIGHT???? This is Extortion with our Board now acting as the Defacto Government Screeners to make sure that all FP's are now Meaningless Use and CCHIT certified before we can even walk on to the field and play....

And what about not wanting or believing in sharing Clinical Data for research purposes, doesn't a doc no less the patients have a RIGHT, an American Right, to opt-out of having their data used without their explicit knowledge? We are going to start marketing our practice as being as properly protective and NOT Sharing of our Patients' data refusing to even get hooked up to the regional exchanges.... I believe this is perhaps our best marketing and patient service approach to one day start a membership and cash only practice. We don't share if you don't share anymore than you do yourself... Other than perhaps Rx's we can promise to keep our end of your medical history out of this not well protected or designed nationally connected systems.... I'm trying to find ways like lab downloads in one direct only that I can get "E Reports" and things that make sense to be Data Points

that are trackable to see changes in patients values (we do believe in tracking the individual patient, Population of ONE, thank-you...) and the like but without opening up our side to the hack and wack wild west of the www... I don't want my kids on the net nor myself or my wife's data and info out there either..... no less our patients. Huge government controlled data bases that contain all Americans' PHI is just so morally offensive to us both as Civil not conservative based Libertarians... Now we have no choice to take a stand against such things as Big Brother tries to capture all of this on us forever, never to be removed, at best ammended... All Diagnosis good or bad, proper or off the wall and incorrect... Patient advocating for good care and what they want, or combative and non-compliant???? Not in My America and I wish more of the IMP members would listen and heed this call and I have tried to raise a few time before.... But

anyway....

This meaningless use and proving of things based on clinical data that has yet to be repeatably significant and useful, no less runs amuck of so many other important and critical issues in today's real frontlines of practice medicine in America and in our Specialty is so offensive to both of us, we are about ready to try and have that fight again with the 800 lb gorilla of Central NY.... This is Insane and so reaching beyond original scope and purpose, no less further using the Power Vested in Them to use such unproven and hard to produce on an equal footing between all docs and practices... Replicate and test... Did they actually go to different Meaningless Use offices of various sizes and EMR programs all across the country to see what it takes to collect any of the CCHIT??? Did they even bother to try and run real tests and measures themselves verses observed doctor patient

interactions, chart notes, OUTCOMES for real, the entire greater health of the patient, to see if such measures were even worthy of their consideration, no less Full Adoption???? Pardon my French here, but Like WTF were these people smoking and perhaps they need to get themselves to a rehab and fast... Or did they simply assume and buy into the gov't and carriers lines about all of the garbage??? I bet they did the latter and not the former. So they don't have to really test and measure themselves in this regard to prove the standard is valid and worthy, but nonetheless, the membership if they care to remain Certified not economically cut off and ruined in most cases must do and uphold to performance and levels of "Proof" that their own board does not feel they should have to be held to likewise...

Sorry Jim, I have known you for a some time now and I really like you, admire you and respect you, but I can not remain silent about this any longer and I have the clarity of good perspective to see the inherent flaws and misguided path this was created on and will continue following. It is unethical and weakens the board's own credibility with us, and it seems a growing number of those that they claim to represent, which they are losing it seems. If not for the Severe Economic and Professional impact of letting one's Certification laps, IMHO much like the AMA and the AAFP many more perhaps even a growing majority of FP's would not be re-upping anymore when their time came to do so... The mutual respect that comes from being connected and acting in a supportable and provable, valid fashion, Logical and Scientific, has been lost, perhaps even destroyed. Now staying

Certified is but a PITA formality that most docs no longer have any use or respect for.... It is another requirement and demand from some way disconnected people who have no real idea what it is like to be practicing their specialty on a day to day basis... That's a shame and they should be ashamed of that. It is but another roadblock, barrier to providing good care, another "Jump Fido" and I'll tell you when and how high as well, that has no real meaning or connection back to what docs do in their real world trade...

Gotta go pick up the kids from their different camps.... Sorry but I had to get this off my chest...

To: Sent: Tuesday, August 9, 2011 2:36 PMSubject: Re: AAFP SAMs or other Modules [1 Attachment]

A more important underlying issues is the degree of match between current data sets and overall outcomes.

Most quality measurement focuses on disease and organ systems. This approach can lead to rewarding improvements in organ system management but often fail to address more important outcomes. The hypothesis that disease management translates to overall improvement in care delivery has not been demonstrated. Moreover, there is a wealth of evidence that overall population health improvement is based on good primary care delivery. This is not the same thing as disease management, and in fact our continued quality emphasis on disease states and organ systems keeps our focus narrow while we miss the big picture.

Primary care is defined as the presence of four cardinal components:

First point of contact (access)

Person-focused relationship over time

Comprehensive services

Care coordination

When done well, population health outcomes improve, disease states improve, patient experience improves, total cost of care improves.

The ABFM can help the country re-orient measurement to focus on what really matters. Barbara Starfield laid this out very well in her FPM editorial of 2009.

We don't give up measuring things like A1c, pneumovax, etc, but we cannot let these small measures squeeze out measures of how well we deliver on primary care key performance indicators (access, person-focused relationship, comprehensiveness, care coordination).

The IMP self-assessment recognition program focuses on the broad themes, is accessible to small independent as well as large practices, and is much more aligned with the real value of primary care.

We should not continue to follow a broken paradigm just because it is familiar and touted by experts.

Gordon

I agree with you and that is one of the things I brought up at my first board meeting. I believe that we will be able to change some of this and hopefully getting Meaningful Use as a criteria.

I see my consituents as us, the small practices who have trouble doing these due to volume or cost. I believe we can make headway on both.

Jim

From: [ ] On Behalf Of [jnantonucci@...]Sent: Sunday, August 07, 2011 7:40 AMTo: Subject: Re: AAFP SAMs or other Modules

Jim I appreciate your work on thisPLus I get to see your face on the newsletter It is good to see someone , an IMP, a small independent practice have a voice in the professional organizationsThe PQRi measure for ABFM is a challenge for little practices - I wasted a bunch of time on it -turns out that many of us do ot have 30 diabetics in t he right age range then another 30 I think to go back after review. That's a real issue to think about out While sample size matters for measuring and for learning ; it cut many of us out of this beneficial program thanksJean

Helen,The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get everyone ready for them being on the recertification exam by 2014.The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is

found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I even learned a little.There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the folks that run this and they are top notch and committed to helping you work through the recert process.

The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.Hope that helps,________________________________________From: [ ] On Behalf Of Helen Yang [helenwyang@...]Sent: Wednesday, July 27, 2011 8:38 PMTo: IMP

GroupSubject: AAFP SAMs or other ModulesBusy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular 8 years.We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ectCould any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?Thank you very much for any input.Helen------------------------------------

[Guest guest]

I will float the idea.

________________________________________

From:

[ ] On Behalf Of Pierce

[bpierce@...]

Sent: Tuesday, August 09, 2011 12:29 PM

To:

Subject: Re: AAFP SAMs or other Modules

It's a shame we can't use How's your Health data to satisfy the Part IV

module requirement. I'd be willing to be a guinea pig for this.

Pierce

>

> I agree with you and that is one of the things I brought up at my first board

meeting. I believe that we will be able to change some of this and hopefully

getting Meaningful Use as a criteria.

> I see my consituents as us, the small practices who have trouble doing these

due to volume or cost. I believe we can make headway on both.

> Jim

>

> ________________________________

> From:

[ ] On Behalf Of

[jnantonucci@...]

> Sent: Sunday, August 07, 2011 7:40 AM

> To:

> Subject: Re: AAFP SAMs or other Modules

>

>

>

> Jim I appreciate your work on this

> PLus I get to see your face on the newsletter

> It is good to see someone , an IMP, a small independent practice have a

voice in the professional organizations

> The PQRi measure for ABFM is a challenge for little practices - I wasted a

bunch of time on it -turns out that many of us do ot have 30 diabetics in t

he right age range then another 30 I think to go back after review. That's a

real issue to think about out While sample size matters for measuring and for

learning ; it cut many of us out of this beneficial program

> thanks

> Jean

>

>

> On Sat, Aug 6, 2011 at 9:19 AM, Kennedy,

Jim> wrote:

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I

am now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

>

> The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From:

<mailto: \

>

[ <mailto:@...\

m>] On Behalf Of Helen Yang

[helenwyang@...]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't

done any of the AAFP modules since the recert. I would have to start doing the

Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year

track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Sorry , they have heard this and much more. There are lots of folks who

don't like the system. Maybe if you could condense this into a few bullet points

with concrete ideas for change, I could send it on.

________________________________________

From:

[ ] On Behalf Of Bleiweiss

[hockeyref1@...]

Sent: Tuesday, August 09, 2011 5:50 PM

To:

Subject: Re: AAFP SAMs or other Modules

PS: Please feel free to share these comments with the others at the board. I bet

they have not heard feedback quite as Raw as this before. Doctors are so

controlled and well spoken sometimes too much so, but it is part of being a

decent professional is that self control. But that does not mean that

undernether the calm exterior that others are not likewise irritated and upset

in a similar fashion and at a similar level. Someone has to finally speak the

Full Truth and tell these folks that the only reason they don't have a mass

exidose on their hands like the AMA and AAFP is because of the Economic and

Professional Fallout that can ruin the average career and income potential in

almost an instant.

Do they really want to be seen and know as we don't care, hear, see, and

speak no evil kind of rulers from high above whose only authority comes from the

power to ruin their members carreers if those members don't tow the line and do

whatever is required of them. Not because the membership feels like they are

doing a decent and difficult job the best they humanly can and that no human

project is ever going to be perfect or please everybody 100%? Do they derive

their power from the support of their members or simply like a Mafia Don, it is

only by the ever present and implied, terribly threatening power of ruining

one's professional life, career and most hopes of paying down one's debts and

making a semi-reasonable and professionally acceptable living that keeps them

even modestly viable and still have the majority of their membership towing the

line against their own better judgement or beliefs????

Please I beg of you to implore them to get away from this broken and

misguided model that after all the hoops docs are going to go thru in their

attemps (who says how many are going to actuall succeed???) to comply and meet

the " New Standard " who says it's going to be worth a gosh darn thing? They need

to return to the old ways of basic testing and matching credits of CME if and

until some new, well thought out, polled, researched and proven valid and Truly

Meaningful, and understandable and not overly impossing upon most FP's who don't

have the time to blow their own noses, no less their poor kids most of the time

is created and worked out over a much longer and better used period of time...

Jumping onto the Next HMO bandwagon really reduces their level of respect From

the Membership to practically Zero.... My 10 & 12 year old kids are smart enough

to not jump on the e Beaver or the Next flash in the pan, one season

wonder team's bandwagon.... So why is not our supposedly so astute and

intelligent board not able to have that same basic mature critical thinking,

reasoning and questioning skills to form good hypothosis and then perform decent

research into what actual might be a sensable way to slowly evolve and improve

the standards and measures of what it means to be a true Board Certified

practioneer of Family Medicine?????

And again just because someone can collect and vomit back on cue does not

mean a damn thing about the quality of their work especially as it relates to

something as multifacetted and interpersonal and hard to define as the doctor

patient relationship of working together torwards a lifetime of better health on

a case by case, individual basis. And taking the larger longer view as Gordon

said so well as opposed to the serverly dysfunctional and short sighted and

myopic view of measures of individual disease states might and frequently does

run in opposition to what really could and is better long term outcomes... Great

data collectors and reporters are frequently NOT the best one on one

clinicians... And great clinicians are not always the best data collectors and

reporters.... So on that alone where is the great corrolations and connections

of such skills being related and tied to one another that one actually is a good

predictive measure for the other???? Because I not sure that such a set of

connections exists at a significant level but then again it is not my hypothosis

or theory to present or defend.... It is theirs to show the greater world and

membership that such things are truly worthy of becoming the new normative

standard and measure that all Certified docs must be able to attain and prove

capable of. And as of right now it seems to many of us, that they have failed

pretty miserably at all of that...

Lastly and then I promise to shut up for awhile one and all.... Because of

the large economic differences between clinics, practices hospitals no less the

larger the clinic both the more likely they are to have a larger IT budget with

a team of folks attacking these CCHIT and MU issues for them... While of the

opposite side of those same larger places is a doctor's inability to control

what is and is NOT priority or programmed into the system, which tools are

turned on or off by the IT team and the partner of Exec in charge of all of

that.... One the flip side us small guys can barely get the refills called in,

the patients seen for nice longer more high quality visits, get the billing

done, copy or print out the records and other request, go home and get some

dinner in ourselves no less our kids, family by 6-7 pm most nights... Like what

they heck is the real intent of this?

Do they really want to start weeding out what might even be a majority of

their members who can not for so many free market and other reasons be bothered

or have the resources or time to do so? Is this an IT data collection test or is

this a Board Certification process to make sure we have good, knowledgeable,

intelligent able to think on their feet doctors practicing medicine all across

the country? Because the more I think about it being combined in ANY Fashion

with Meaningless Use, the more it is starting to seem like a " Verification

Process " or even backdoor Certification Process for the Clinics, practices and

hospitals themselves.... This is as much about day to day process of charting

and data collection, EMR selection, back end tweaking and turning on and off

various options and the like and who has the best kiss up data collection clip

boards and support staff to collect such garbage in the first place, no less

then have it become " Meaningful " when crunched and presented in some fashion...

So is this checking up on and verifying, certifying my wife's ability to manage

and treat any given patient that walks thru the door or is this more of a test

of her's and her practice manager's ability to shop, choose, code and bill, be

financially viable enough to even be able to play in the first place, no less

tech savvy enough to set it up and manage it all... to then hopefully put us in

the proper place to even begin to go along with such a thing in the first

place?????

In closing IMHO it seems that perhaps the worst thing that is happening here

by blindly if ever adopting Meaningless Use and making it part of the Board

Certification process is as follows. It seems to me that the defining line

between being some sort of a regulatory body and oversight, quality control

agency that in many ways is not truly measuring the doc here but instead much of

it depends on other not easily defined and controlled for variable about the

clinic, practice, tech support, managment, EMR vendor and the like; verses a

professional and privately run BY the profession and it's professionals

themselves (Super Critical Here, like an internal Review Board too, right?)

organization that makes sure that their members meet up to and can perform at a

certain proven viable level of expertise and compentency has been has been

utterly destroyed here and it sets a a New and very frightening standard of what

it means to be tested and certified... This boundary is now severely blurred,

oblithorated practically, when in fact such a boundary needs to remain forever

extra sharp, focused and well defined. Hopefully we can now restore order back

to where it needs to be, and that these two very different goals and outcomes

desired of such vastly different kinds of organizations and agencies needs to

remain forever well defined and separated pretty darn far apart so as to never

come half as close as this to blurring the line EVER again.... We might even

need to be reminded and to set up some sort of firewall, neutral zone or DMZ

here to remind other new replacement board members that such should never, ever

be allowed to get this close, no less crossed ever again...

Honestly, how many great docs did you know who couldn't barely program a VCR

sometimes, but darn it if their clinical skills, knowledge, experience and

relationship with their patients where not some of the best and most respected

you have every seen??? And if forced to choose between horrible interpersonal

skills and doctor patient relationship, less able to problem solve and combind

concepts and ideas to reach great and insightful helpful clinical conclussions,

or a doctor like most of our IMP brothers and sisters here with stickers and

lolly pops, and cool ties and toys to play with, brings their toy dog to work

with them to entertain the patients (we do this) which doctor would you want

your own 4 year old daughter to be getting treated and cared for long term in a

Primary Care relationship??? Doctor Numbers or Doctor Lolly Pop???? I'll take

Doctor Lolly Pop each and every time, wouldn't you??? And how the heck are we

ever really going to measure Doctor Lolly Pop??? Ask Gordon and friends because

I think they are the one's who have better ideas and concepts that are getting a

whole lot closer to that better more valid concept, then did our board who

blindly adopted this, did your EMR collect the right data, can you work those

numbers correctly to prove something about a segment of your patient panel and

report them back to our Board (wasn't this what the Government was going to use

and do, make us do, to start paying us based upon supposed Quality reporting and

numbers, NOT our Board???) to gain access to the club to even be able to walk

into the locker room and get dressed, no less have the coach actually put us in

the game to play???? That's BS, it's bad enough our government wants to try and

impose this upon us as means of pay or punishment, but when our our professional

board is so blind and short sighted and feels it should start to share and

perhaps switch roles with our government agencies, then I know someone has lost

his or her mind and has jump the tracks and entered into a relm that was never

theirs to enter in the first place....

Test and probe for real professional competance, skills and knowledge base

no less critical thinking and deducting why don't you. Perhaps we could and

should start to do personality and pysch evals too, as perhaps there is or is

not a correlation between such and real world outcomes? At what point has one

gone way too far astray from their Original Mandate and their real purpose and

real implied and understood Authority? Well, here is a great clear example of

doing just that... way over stepping and over reaching and without even any real

substanciated supportable reasons no less.... And not even a bit aware or

concerned that in almost an instant they changed all of this, and are now

outside their field of play, expertise and mandate themselves.... That is very

frightening and concerning indeed and I call for an immediate stay of all of

this and to perhaps allow all previous members in good standing prior to SAM's,

and Modules and MU over the past few years to simply take a decent test and pay

their now present fees until we properly investigate and understand just what

happened here and why??? This is a board and not a police department or

licensing agency.... Knowledge and Skills, not enforcement and equipment

quality...

Check this out.... The folks that license an Electrican are not the same

folks who come to his worksite to inspect and approve of his actual work before

the sheetrockers seal up the walls. And neither of these organizations would

ever claim to be allowed to start playing in the other's park and for perfectly

good, well defined and divided up reasons. If the Government wants to start

Observing or requiring doctors to have to report such things, over sight their

work, that is completely different than their board whose job it is to set a

knowledge and skills based set with tests and procedures to prove or disprove

such knowledge and skills, to then Certify them as qualified to walk onto the

contstruction site and start reading blue prints and wiring and laying out

conduit... Then the inspector reviews their work before the job is finished and

says whether it's good enough or not... Two different organizations one run by

the profession to measure professional standards of knowledge and skills the

other to oversee actual work quality.... The board has completely over stepped

its autority and mandate here and should be held accountable for this horrible

mistake. If any tradesman could see and understand these very real differences,

then why not a Board of supposedly intelligent and well thought doctors setting

standards and policy... Oversight of actual Work was never in nor should it ever

be in their mandate...

I've gotta go and have ranted way too long already here..... Be well and

let's really start to think about what has really happened here folks....

To: " "

< >

Sent: Tuesday, August 9, 2011 4:00 PM

Subject: Re: AAFP SAMs or other Modules

Here Here Gordon,

Well said as always.... Jim personally I have written three emails that I

never sent (See I am Learning Some Restraint... :-) because this issue has me

fumming. Why is it our Board's responsibility almost to " Certify Any of Us " as

basically being able to meet a Gov't set of requirements that as Gordon points

out are not even surely relevant??? For goodness sake, teach us, keep us abreast

of upcoming and new issues, therapies and theories, and then somehow test our

Knowledge on it. But to actually try to somehow " Test and Quantify " the quality

of our work is Insane and Unacceptable on any and all fronts. Tell me what other

Board is doing this to their Diplomats???? It is disrespectful to doubt basic

competance in clinic practice especially in something that is so people,

relationship based and oriented....

We all KNOW that Gordon et al (the Great Gang of Mentors here (and thanks to

one and all, you folks are awesome!!!) have a much better handle of these kinds

of things than any part time meeting board does as they are not influenced by

Big Medicine, Big Pharma, Hospitals and Gov't Make Myself a Self Perpetuating

Job and new dept while feeding the Super Vendors who pay and bribe their way in

to becoming " Required " . This Meaningless Use crap is not even truly proven

" valid " or " significant " and worse yet it seems to lack a certain important

transferability as well as repeatability across thousands of clinics and

providers' office across the country....

I won't even get started on some of the links I almost sent you about

Amazing Charts Newest " Meaningless Use " 6.0.9 being rushed out exactly because

of stupid deadlines and people clamoring to meet them for Incentives NO LESS

PUNISHMENT.... If you are running Windows XP, Pro even there is a 99% chance of

the E-Rx bring your entire visit and any and all refills to a crawl, where as

users have reported, one can literally watch the scan lines being rendered that

is how incredibly slow it goes to render the windows needed to write print

etc.... The free market is still struggling to get this together, many offices

have NO EMR at all! Yet Now to be Board Certified our own Board has Ignored it

members so badly or they are so deaf and out of touch that they can not hear the

clamors of struggling to catch-up, make choices, get systems up and running?

What is some small IMP or soon to retire doc wants to say, hey with only 5-10

years to go, what the heck, I'm not going to deal with all this tech

headaches.... Now it is required by the board just to remain Certified.....

But because of the first part that it is still not proven that such CCHIT,

CCHIT is even valid or worthy of the efforts no less that other members should

Always be allowed to Opt-Out of being part of this Grand and not yet proven

experiment because of all the other garbage in our Business of Medicine, that a

Realist and Connected Board would actually understand at some gut viseral level

as opposed to needing to be hit over the head with a hard Mallet or something,

this is really worst of all, " Economic Extortion " forcing all FP's to suck up

and be cut out completely. We are facing this exact problem as we speak. Ask

Gordon who practice one city away in Rochester for years, just how over bloated

and Full of themselves, our regional Engulf and Devour BC/BS Affiliate Excellus

is.... They may have as much as 70% of our market coving both regular commercial

as well as managed gov't like CHIP's, FHIP's and NY Medicaid and some Medicare

as well... They are a Monster the 800 lb gorilla in the room out here and they

are threatening to drop my wife if she doesn't " Promise " to start getting her

board certification stuff in order and get " Back on Board " !!!

These are the realities that we really do face and live in and to hold our

own Certification Hostage from us, literally threatening our Hospital

affiliations and r Credentials, both of whom what to know that the other

is properly in place as well, no less, RIGHT???? This is Extortion with our

Board now acting as the Defacto Government Screeners to make sure that all FP's

are now Meaningless Use and CCHIT certified before we can even walk on to the

field and play....

And what about not wanting or believing in sharing Clinical Data for

research purposes, doesn't a doc no less the patients have a RIGHT, an American

Right, to opt-out of having their data used without their explicit knowledge?

We are going to start marketing our practice as being as properly protective and

NOT Sharing of our Patients' data refusing to even get hooked up to the regional

exchanges.... I believe this is perhaps our best marketing and patient service

approach to one day start a membership and cash only practice. We don't share if

you don't share anymore than you do yourself... Other than perhaps Rx's we can

promise to keep our end of your medical history out of this not well protected

or designed nationally connected systems.... I'm trying to find ways like lab

downloads in one direct only that I can get " E Reports " and things that make

sense to be Data Points that are trackable to see changes in patients values (we

do believe in tracking the individual patient, Population of ONE, thank-you...)

and the like but without opening up our side to the hack and wack wild west of

the www... I don't want my kids on the net nor myself or my wife's data and info

out there either..... no less our patients. Huge government controlled data

bases that contain all Americans' PHI is just so morally offensive to us both as

Civil not conservative based Libertarians... Now we have no choice to take a

stand against such things as Big Brother tries to capture all of this on us

forever, never to be removed, at best ammended... All Diagnosis good or bad,

proper or off the wall and incorrect... Patient advocating for good care and

what they want, or combative and non-compliant???? Not in My America and I wish

more of the IMP members would listen and heed this call and I have tried

to raise a few time before.... But anyway....

This meaningless use and proving of things based on clinical data that has

yet to be repeatably significant and useful, no less runs amuck of so many other

important and critical issues in today's real frontlines of practice medicine in

America and in our Specialty is so offensive to both of us, we are about ready

to try and have that fight again with the 800 lb gorilla of Central NY.... This

is Insane and so reaching beyond original scope and purpose, no less further

using the Power Vested in Them to use such unproven and hard to produce on an

equal footing between all docs and practices... Replicate and test... Did they

actually go to different Meaningless Use offices of various sizes and EMR

programs all across the country to see what it takes to collect any of the

CCHIT??? Did they even bother to try and run real tests and measures themselves

verses observed doctor patient interactions, chart notes, OUTCOMES for real, the

entire greater health of the patient, to see if such measures were even worthy

of their consideration, no less Full Adoption???? Pardon my French here, but

Like WTF were these people smoking and perhaps they need to get themselves to a

rehab and fast... Or did they simply assume and buy into the gov't and carriers

lines about all of the garbage??? I bet they did the latter and not the former.

So they don't have to really test and measure themselves in this regard to prove

the standard is valid and worthy, but nonetheless, the membership if they care

to remain Certified not economically cut off and ruined in most cases must do

and uphold to performance and levels of " Proof " that their own board does not

feel they should have to be held to likewise...

Sorry Jim, I have known you for a some time now and I really like you,

admire you and respect you, but I can not remain silent about this any longer

and I have the clarity of good perspective to see the inherent flaws and

misguided path this was created on and will continue following. It is unethical

and weakens the board's own credibility with us, and it seems a growing number

of those that they claim to represent, which they are losing it seems. If not

for the Severe Economic and Professional impact of letting one's Certification

laps, IMHO much like the AMA and the AAFP many more perhaps even a growing

majority of FP's would not be re-upping anymore when their time came to do so...

The mutual respect that comes from being connected and acting in a supportable

and provable, valid fashion, Logical and Scientific, has been lost, perhaps even

destroyed. Now staying Certified is but a PITA formality that most docs no

longer have any use or respect for.... It is another requirement and demand from

some way disconnected people who have no real idea what it is like to be

practicing their specialty on a day to day basis... That's a shame and they

should be ashamed of that. It is but another roadblock, barrier to providing

good care, another " Jump Fido " and I'll tell you when and how high as well, that

has no real meaning or connection back to what docs do in their real world

trade...

Gotta go pick up the kids from their different camps.... Sorry but I had to

get this off my chest...

To:

Sent: Tuesday, August 9, 2011 2:36 PM

Subject: Re: AAFP SAMs or other Modules [1 Attachment]

A more important underlying issues is the degree of match between current data

sets and overall outcomes.

Most quality measurement focuses on disease and organ systems. This approach

can lead to rewarding improvements in organ system management but often fail to

address more important outcomes. The hypothesis that disease management

translates to overall improvement in care delivery has not been demonstrated.

Moreover, there is a wealth of evidence that overall population health

improvement is based on good primary care delivery. This is not the same thing

as disease management, and in fact our continued quality emphasis on disease

states and organ systems keeps our focus narrow while we miss the big picture.

Primary care is defined as the presence of four cardinal components:

First point of contact (access)

Person-focused relationship over time

Comprehensive services

Care coordination

When done well, population health outcomes improve, disease states improve,

patient experience improves, total cost of care improves.

The ABFM can help the country re-orient measurement to focus on what really

matters. Barbara Starfield laid this out very well in her FPM editorial of

2009<http://www.aafp.org/online/en/home/publications/journals/fpm/opinion.html>.

We don't give up measuring things like A1c, pneumovax, etc, but we cannot let

these small measures squeeze out measures of how well we deliver on primary care

key performance indicators (access, person-focused relationship,

comprehensiveness, care coordination).

The IMP self-assessment recognition program focuses on the broad themes, is

accessible to small independent as well as large practices, and is much more

aligned with the real value of primary care.

We should not continue to follow a broken paradigm just because it is familiar

and touted by experts.

Gordon

I agree with you and that is one of the things I brought up at my first board

meeting. I believe that we will be able to change some of this and hopefully

getting Meaningful Use as a criteria.

I see my consituents as us, the small practices who have trouble doing these due

to volume or cost. I believe we can make headway on both.

Jim

From:

<mailto: \

> [ ] On Behalf Of

[jnantonucci@...]

Sent: Sunday, August 07, 2011 7:40 AM

To:

<mailto: \

>

Subject: Re: AAFP SAMs or other Modules

Jim I appreciate your work on this

PLus I get to see your face on the newsletter

It is good to see someone , an IMP, a small independent practice have a voice

in the professional organizations

The PQRi measure for ABFM is a challenge for little practices - I wasted a

bunch of time on it -turns out that many of us do ot have 30 diabetics in t

he right age range then another 30 I think to go back after review. That's a

real issue to think about out While sample size matters for measuring and for

learning ; it cut many of us out of this beneficial program

thanks

Jean

On Sat, Aug 6, 2011 at 9:19 AM, Kennedy, Jim

> wrote:

Helen,

The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am

now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

Hope that helps,

________________________________________

From:

<mailto: \

>

[ <mailto:@...\

m>] On Behalf Of Helen Yang

[helenwyang@...]

Sent: Wednesday, July 27, 2011 8:38 PM

To: IMP Group

Subject: AAFP SAMs or other Modules

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done

any of the AAFP modules since the recert. I would have to start doing the Part

II SAMs Modules and /or Part IV modules in order to stay on the 10 year track

instead of regular 8 years.

We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

Thank you very much for any input.

Helen

------------------------------------

[Guest guest]

Jim,

How does one become a "Member of this Club Board"??? I know nobody every asked my wife to Vote for anyone.... This board stuff has a similar negative disconnected and all too full of themselves like, much like the Law Suit moving forward by Dr. Fischer and his partners... Much like the AMA and CMS stupidity. You are either a great wonderful glutton for punishment man or you are almost nuts for trying this....

To: " " < >Sent: Thursday, August 11, 2011 12:02 AMSubject: RE: AAFP SAMs or other Modules

Sorry , they have heard this and much more. There are lots of folks who don't like the system. Maybe if you could condense this into a few bullet points with concrete ideas for change, I could send it on.________________________________________From: [ ] On Behalf Of Bleiweiss [hockeyref1@...]Sent: Tuesday, August 09, 2011 5:50 PMTo: Subject: Re: AAFP SAMs or other ModulesPS: Please feel free to share these comments with the others at the board. I bet they have not heard feedback quite as Raw as this before. Doctors are so controlled and well spoken sometimes too much so, but it is part of being a decent professional is that self control. But that does not mean that undernether the calm exterior that others are not likewise irritated and upset in a similar fashion and at a similar level. Someone has to finally speak the Full Truth and tell these folks that the only reason they don't have a mass exidose on their hands like the AMA and AAFP is because of the Economic and Professional Fallout that can ruin the average career and income potential in almost an instant.Do they really want to be seen and know as we don't care, hear, see, and speak no

evil kind of rulers from high above whose only authority comes from the power to ruin their members carreers if those members don't tow the line and do whatever is required of them. Not because the membership feels like they are doing a decent and difficult job the best they humanly can and that no human project is ever going to be perfect or please everybody 100%? Do they derive their power from the support of their members or simply like a Mafia Don, it is only by the ever present and implied, terribly threatening power of ruining one's professional life, career and most hopes of paying down one's debts and making a semi-reasonable and professionally acceptable living that keeps them even modestly viable and still have the majority of their membership towing the line against their own better judgement or beliefs????Please I beg of you to implore them to get away from this broken and misguided model that after all the hoops docs are going to go

thru in their attemps (who says how many are going to actuall succeed???) to comply and meet the "New Standard" who says it's going to be worth a gosh darn thing? They need to return to the old ways of basic testing and matching credits of CME if and until some new, well thought out, polled, researched and proven valid and Truly Meaningful, and understandable and not overly impossing upon most FP's who don't have the time to blow their own noses, no less their poor kids most of the time is created and worked out over a much longer and better used period of time... Jumping onto the Next HMO bandwagon really reduces their level of respect From the Membership to practically Zero.... My 10 & 12 year old kids are smart enough to not jump on the e Beaver or the Next flash in the pan, one season wonder team's bandwagon.... So why is not our supposedly so astute and intelligent board not able to have that same basic mature critical thinking, reasoning

and questioning skills to form good hypothosis and then perform decent research into what actual might be a sensable way to slowly evolve and improve the standards and measures of what it means to be a true Board Certified practioneer of Family Medicine?????And again just because someone can collect and vomit back on cue does not mean a damn thing about the quality of their work especially as it relates to something as multifacetted and interpersonal and hard to define as the doctor patient relationship of working together torwards a lifetime of better health on a case by case, individual basis. And taking the larger longer view as Gordon said so well as opposed to the serverly dysfunctional and short sighted and myopic view of measures of individual disease states might and frequently does run in opposition to what really could and is better long term outcomes... Great data collectors and reporters are frequently NOT the best one on one

clinicians... And great clinicians are not always the best data collectors and reporters.... So on that alone where is the great corrolations and connections of such skills being related and tied to one another that one actually is a good predictive measure for the other???? Because I not sure that such a set of connections exists at a significant level but then again it is not my hypothosis or theory to present or defend.... It is theirs to show the greater world and membership that such things are truly worthy of becoming the new normative standard and measure that all Certified docs must be able to attain and prove capable of. And as of right now it seems to many of us, that they have failed pretty miserably at all of that...Lastly and then I promise to shut up for awhile one and all.... Because of the large economic differences between clinics, practices hospitals no less the larger the clinic both the more likely they are to have a larger

IT budget with a team of folks attacking these CCHIT and MU issues for them... While of the opposite side of those same larger places is a doctor's inability to control what is and is NOT priority or programmed into the system, which tools are turned on or off by the IT team and the partner of Exec in charge of all of that.... One the flip side us small guys can barely get the refills called in, the patients seen for nice longer more high quality visits, get the billing done, copy or print out the records and other request, go home and get some dinner in ourselves no less our kids, family by 6-7 pm most nights... Like what they heck is the real intent of this?Do they really want to start weeding out what might even be a majority of their members who can not for so many free market and other reasons be bothered or have the resources or time to do so? Is this an IT data collection test or is this a Board Certification process to make sure we have

good, knowledgeable, intelligent able to think on their feet doctors practicing medicine all across the country? Because the more I think about it being combined in ANY Fashion with Meaningless Use, the more it is starting to seem like a "Verification Process" or even backdoor Certification Process for the Clinics, practices and hospitals themselves.... This is as much about day to day process of charting and data collection, EMR selection, back end tweaking and turning on and off various options and the like and who has the best kiss up data collection clip boards and support staff to collect such garbage in the first place, no less then have it become "Meaningful" when crunched and presented in some fashion... So is this checking up on and verifying, certifying my wife's ability to manage and treat any given patient that walks thru the door or is this more of a test of her's and her practice manager's ability to shop, choose, code and bill, be

financially viable enough to even be able to play in the first place, no less tech savvy enough to set it up and manage it all... to then hopefully put us in the proper place to even begin to go along with such a thing in the first place?????In closing IMHO it seems that perhaps the worst thing that is happening here by blindly if ever adopting Meaningless Use and making it part of the Board Certification process is as follows. It seems to me that the defining line between being some sort of a regulatory body and oversight, quality control agency that in many ways is not truly measuring the doc here but instead much of it depends on other not easily defined and controlled for variable about the clinic, practice, tech support, managment, EMR vendor and the like; verses a professional and privately run BY the profession and it's professionals themselves (Super Critical Here, like an internal Review Board too, right?) organization that makes sure

that their members meet up to and can perform at a certain proven viable level of expertise and compentency has been has been utterly destroyed here and it sets a a New and very frightening standard of what it means to be tested and certified... This boundary is now severely blurred, oblithorated practically, when in fact such a boundary needs to remain forever extra sharp, focused and well defined. Hopefully we can now restore order back to where it needs to be, and that these two very different goals and outcomes desired of such vastly different kinds of organizations and agencies needs to remain forever well defined and separated pretty darn far apart so as to never come half as close as this to blurring the line EVER again.... We might even need to be reminded and to set up some sort of firewall, neutral zone or DMZ here to remind other new replacement board members that such should never, ever be allowed to get this close, no less crossed ever

again...Honestly, how many great docs did you know who couldn't barely program a VCR sometimes, but darn it if their clinical skills, knowledge, experience and relationship with their patients where not some of the best and most respected you have every seen??? And if forced to choose between horrible interpersonal skills and doctor patient relationship, less able to problem solve and combind concepts and ideas to reach great and insightful helpful clinical conclussions, or a doctor like most of our IMP brothers and sisters here with stickers and lolly pops, and cool ties and toys to play with, brings their toy dog to work with them to entertain the patients (we do this) which doctor would you want your own 4 year old daughter to be getting treated and cared for long term in a Primary Care relationship??? Doctor Numbers or Doctor Lolly Pop???? I'll take Doctor Lolly Pop each and every time, wouldn't you??? And how the heck are we ever really

going to measure Doctor Lolly Pop??? Ask Gordon and friends because I think they are the one's who have better ideas and concepts that are getting a whole lot closer to that better more valid concept, then did our board who blindly adopted this, did your EMR collect the right data, can you work those numbers correctly to prove something about a segment of your patient panel and report them back to our Board (wasn't this what the Government was going to use and do, make us do, to start paying us based upon supposed Quality reporting and numbers, NOT our Board???) to gain access to the club to even be able to walk into the locker room and get dressed, no less have the coach actually put us in the game to play???? That's BS, it's bad enough our government wants to try and impose this upon us as means of pay or punishment, but when our our professional board is so blind and short sighted and feels it should start to share and perhaps switch roles with our

government agencies, then I know someone has lost his or her mind and has jump the tracks and entered into a relm that was never theirs to enter in the first place....Test and probe for real professional competance, skills and knowledge base no less critical thinking and deducting why don't you. Perhaps we could and should start to do personality and pysch evals too, as perhaps there is or is not a correlation between such and real world outcomes? At what point has one gone way too far astray from their Original Mandate and their real purpose and real implied and understood Authority? Well, here is a great clear example of doing just that... way over stepping and over reaching and without even any real substanciated supportable reasons no less.... And not even a bit aware or concerned that in almost an instant they changed all of this, and are now outside their field of play, expertise and mandate themselves.... That is very frightening and

concerning indeed and I call for an immediate stay of all of this and to perhaps allow all previous members in good standing prior to SAM's, and Modules and MU over the past few years to simply take a decent test and pay their now present fees until we properly investigate and understand just what happened here and why??? This is a board and not a police department or licensing agency.... Knowledge and Skills, not enforcement and equipment quality...Check this out.... The folks that license an Electrican are not the same folks who come to his worksite to inspect and approve of his actual work before the sheetrockers seal up the walls. And neither of these organizations would ever claim to be allowed to start playing in the other's park and for perfectly good, well defined and divided up reasons. If the Government wants to start Observing or requiring doctors to have to report such things, over sight their work, that is completely different than

their board whose job it is to set a knowledge and skills based set with tests and procedures to prove or disprove such knowledge and skills, to then Certify them as qualified to walk onto the contstruction site and start reading blue prints and wiring and laying out conduit... Then the inspector reviews their work before the job is finished and says whether it's good enough or not... Two different organizations one run by the profession to measure professional standards of knowledge and skills the other to oversee actual work quality.... The board has completely over stepped its autority and mandate here and should be held accountable for this horrible mistake. If any tradesman could see and understand these very real differences, then why not a Board of supposedly intelligent and well thought doctors setting standards and policy... Oversight of actual Work was never in nor should it ever be in their mandate...I've gotta go and have ranted way

too long already here..... Be well and let's really start to think about what has really happened here folks....To: " " < >Sent: Tuesday, August 9, 2011 4:00 PMSubject: Re: AAFP SAMs or other ModulesHere Here Gordon,Well said as always.... Jim personally I have written three emails that I never sent (See I am Learning Some Restraint... :-) because this issue has me fumming.

Why is it our Board's responsibility almost to "Certify Any of Us" as basically being able to meet a Gov't set of requirements that as Gordon points out are not even surely relevant??? For goodness sake, teach us, keep us abreast of upcoming and new issues, therapies and theories, and then somehow test our Knowledge on it. But to actually try to somehow "Test and Quantify" the quality of our work is Insane and Unacceptable on any and all fronts. Tell me what other Board is doing this to their Diplomats???? It is disrespectful to doubt basic competance in clinic practice especially in something that is so people, relationship based and oriented....We all KNOW that Gordon et al (the Great Gang of Mentors here (and thanks to one and all, you folks are awesome!!!) have a much better handle of these kinds of things than any part time meeting board does as they are not influenced by Big Medicine, Big Pharma, Hospitals and Gov't Make Myself a Self

Perpetuating Job and new dept while feeding the Super Vendors who pay and bribe their way in to becoming "Required". This Meaningless Use crap is not even truly proven "valid" or "significant" and worse yet it seems to lack a certain important transferability as well as repeatability across thousands of clinics and providers' office across the country....I won't even get started on some of the links I almost sent you about Amazing Charts Newest "Meaningless Use" 6.0.9 being rushed out exactly because of stupid deadlines and people clamoring to meet them for Incentives NO LESS PUNISHMENT.... If you are running Windows XP, Pro even there is a 99% chance of the E-Rx bring your entire visit and any and all refills to a crawl, where as users have reported, one can literally watch the scan lines being rendered that is how incredibly slow it goes to render the windows needed to write print etc.... The free market is still struggling to get this

together, many offices have NO EMR at all! Yet Now to be Board Certified our own Board has Ignored it members so badly or they are so deaf and out of touch that they can not hear the clamors of struggling to catch-up, make choices, get systems up and running? What is some small IMP or soon to retire doc wants to say, hey with only 5-10 years to go, what the heck, I'm not going to deal with all this tech headaches.... Now it is required by the board just to remain Certified.....But because of the first part that it is still not proven that such CCHIT, CCHIT is even valid or worthy of the efforts no less that other members should Always be allowed to Opt-Out of being part of this Grand and not yet proven experiment because of all the other garbage in our Business of Medicine, that a Realist and Connected Board would actually understand at some gut viseral level as opposed to needing to be hit over the head with a hard Mallet or something, this is

really worst of all, "Economic Extortion" forcing all FP's to suck up and be cut out completely. We are facing this exact problem as we speak. Ask Gordon who practice one city away in Rochester for years, just how over bloated and Full of themselves, our regional Engulf and Devour BC/BS Affiliate Excellus is.... They may have as much as 70% of our market coving both regular commercial as well as managed gov't like CHIP's, FHIP's and NY Medicaid and some Medicare as well... They are a Monster the 800 lb gorilla in the room out here and they are threatening to drop my wife if she doesn't "Promise" to start getting her board certification stuff in order and get "Back on Board"!!!These are the realities that we really do face and live in and to hold our own Certification Hostage from us, literally threatening our Hospital affiliations and r Credentials, both of whom what to know that the other is properly in place as well, no less, RIGHT????

This is Extortion with our Board now acting as the Defacto Government Screeners to make sure that all FP's are now Meaningless Use and CCHIT certified before we can even walk on to the field and play....And what about not wanting or believing in sharing Clinical Data for research purposes, doesn't a doc no less the patients have a RIGHT, an American Right, to opt-out of having their data used without their explicit knowledge? We are going to start marketing our practice as being as properly protective and NOT Sharing of our Patients' data refusing to even get hooked up to the regional exchanges.... I believe this is perhaps our best marketing and patient service approach to one day start a membership and cash only practice. We don't share if you don't share anymore than you do yourself... Other than perhaps Rx's we can promise to keep our end of your medical history out of this not well protected or designed nationally connected systems.... I'm

trying to find ways like lab downloads in one direct only that I can get "E Reports" and things that make sense to be Data Points that are trackable to see changes in patients values (we do believe in tracking the individual patient, Population of ONE, thank-you...) and the like but without opening up our side to the hack and wack wild west of the www... I don't want my kids on the net nor myself or my wife's data and info out there either..... no less our patients. Huge government controlled data bases that contain all Americans' PHI is just so morally offensive to us both as Civil not conservative based Libertarians... Now we have no choice to take a stand against such things as Big Brother tries to capture all of this on us forever, never to be removed, at best ammended... All Diagnosis good or bad, proper or off the wall and incorrect... Patient advocating for good care and what they want, or combative and non-compliant???? Not in My America and I

wish more of the IMP members would listen and heed this call and I have tried to raise a few time before.... But anyway....This meaningless use and proving of things based on clinical data that has yet to be repeatably significant and useful, no less runs amuck of so many other important and critical issues in today's real frontlines of practice medicine in America and in our Specialty is so offensive to both of us, we are about ready to try and have that fight again with the 800 lb gorilla of Central NY.... This is Insane and so reaching beyond original scope and purpose, no less further using the Power Vested in Them to use such unproven and hard to produce on an equal footing between all docs and practices... Replicate and test... Did they actually go to different Meaningless Use offices of various sizes and EMR programs all across the country to see what it takes to collect any of the CCHIT??? Did they even bother to try and run real

tests and measures themselves verses observed doctor patient interactions, chart notes, OUTCOMES for real, the entire greater health of the patient, to see if such measures were even worthy of their consideration, no less Full Adoption???? Pardon my French here, but Like WTF were these people smoking and perhaps they need to get themselves to a rehab and fast... Or did they simply assume and buy into the gov't and carriers lines about all of the garbage??? I bet they did the latter and not the former. So they don't have to really test and measure themselves in this regard to prove the standard is valid and worthy, but nonetheless, the membership if they care to remain Certified not economically cut off and ruined in most cases must do and uphold to performance and levels of "Proof" that their own board does not feel they should have to be held to likewise...Sorry Jim, I have known you for a some time now and I really like you, admire you and

respect you, but I can not remain silent about this any longer and I have the clarity of good perspective to see the inherent flaws and misguided path this was created on and will continue following. It is unethical and weakens the board's own credibility with us, and it seems a growing number of those that they claim to represent, which they are losing it seems. If not for the Severe Economic and Professional impact of letting one's Certification laps, IMHO much like the AMA and the AAFP many more perhaps even a growing majority of FP's would not be re-upping anymore when their time came to do so... The mutual respect that comes from being connected and acting in a supportable and provable, valid fashion, Logical and Scientific, has been lost, perhaps even destroyed. Now staying Certified is but a PITA formality that most docs no longer have any use or respect for.... It is another requirement and demand from some way disconnected people who have no

real idea what it is like to be practicing their specialty on a day to day basis... That's a shame and they should be ashamed of that. It is but another roadblock, barrier to providing good care, another "Jump Fido" and I'll tell you when and how high as well, that has no real meaning or connection back to what docs do in their real world trade...Gotta go pick up the kids from their different camps.... Sorry but I had to get this off my chest...To: Sent: Tuesday, August 9, 2011 2:36 PMSubject: Re: AAFP SAMs or other Modules [1

Attachment]A more important underlying issues is the degree of match between current data sets and overall outcomes.Most quality measurement focuses on disease and organ systems. This approach can lead to rewarding improvements in organ system management but often fail to address more important outcomes. The hypothesis that disease management translates to overall improvement in care delivery has not been demonstrated. Moreover, there is a wealth of evidence that overall population health improvement is based on good primary care delivery. This is not the same thing as disease management, and in fact our continued quality emphasis on disease states and organ systems keeps our focus narrow while we miss the big picture.Primary care is defined as the presence of four cardinal components:First point of contact (access)Person-focused relationship over timeComprehensive servicesCare coordinationWhen done well,

population health outcomes improve, disease states improve, patient experience improves, total cost of care improves.The ABFM can help the country re-orient measurement to focus on what really matters. Barbara Starfield laid this out very well in her FPM editorial of 2009<http://www.aafp.org/online/en/home/publications/journals/fpm/opinion.html>.We don't give up measuring things like A1c, pneumovax, etc, but we cannot let these small measures squeeze out measures of how well we deliver on primary care key performance indicators (access, person-focused relationship, comprehensiveness, care coordination).The IMP self-assessment recognition program focuses on the broad themes, is accessible to small independent as well as large practices, and is much more aligned with the real value of primary care.We

should not continue to follow a broken paradigm just because it is familiar and touted by experts.GordonI agree with you and that is one of the things I brought up at my first board meeting. I believe that we will be able to change some of this and hopefully getting Meaningful Use as a criteria.I see my consituents as us, the small practices who have trouble doing these due to volume or cost. I believe we can make headway on both.JimFrom: <mailto: > [ ] On Behalf Of [jnantonucci@...]Sent: Sunday, August 07, 2011 7:40 AMTo: <mailto: >Subject: Re: AAFP SAMs or other ModulesJim I appreciate your work on thisPLus I get to see your face on the newsletter :)It is good to see someone , an IMP, a

small independent practice have a voice in the professional organizationsThe PQRi measure for ABFM is a challenge for little practices - I wasted a bunch of time on it -turns out that many of us do ot have 30 diabetics in t he right age range then another 30 I think to go back after review. That's a real issue to think about out While sample size matters for measuring and for learning ; it cut many of us out of this beneficial programthanksJeanOn Sat, Aug 6, 2011 at 9:19 AM, Kennedy, Jim > wrote:Helen,The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the

board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get everyone ready for them being on the recertification exam by 2014.The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I even learned a little.There is a Part IV module now that sort of replicates the

Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have seen the way the board works, I believe it is a dedicated effort,

and not just a punitive process. There are more and better things coming in the next few years.Hope that helps,________________________________________From: <mailto: > [ <mailto: >] On Behalf Of Helen Yang [helenwyang@...]Sent: Wednesday, July 27, 2011 8:38 PMTo: IMP GroupSubject: AAFP SAMs or other ModulesBusy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular 8 years.We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ectCould any of you who have done these modules please share your thoughts about these modules and how much time it may

take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?Thank you very much for any input.Helen------------------------------------

[Guest guest]

,

Actually, I was nominated by the Colorado AFP and the AAFP, which is interesting

since I am not now a member of either. I was also nominated by an old retired

ABFM president, Larry Green. There are 15 members, 3 new each year, nominated

by various organizations. Out of that group, beside the family docs, there is a

pediatrician from the ABP, a surgeon, an OB-Gyn, and a shrink. I will try to let

up to date on what we need to do to do this. I am sure I could help from those

of you who use HYH. I do not know if it is validated, and trackable.

In many ways I agree with your sentiment, I disagree with top down telling folks

how things should go; sort of like the federal government thinking they have all

the answers, and therefore all the money. I am also tired of the intellectual BS

that comes with that attitude. On the the other hand, as my old business school

professor use to say, " complaining with out offering solutions is simply

whining. "

I can choose to put up with the TSA and fly, or I can drive.

I can choose to put up with the ABFM, or not be boarded. I have also chosen to

try to change it from within. I sent an email to the current Chair, Jim Puffer,

and the Chair of the MOC committee to find out what would need to happen to get

HYH as a type 4 module, and will work this direction. Starfield was well known

and respected by all on the ABFM, they are very familiar with what she has

written. They also have to balance the issues of the credibility with the

public, other boards, and agencies. I do not think we will every get away from

" testing for knowledge " but I see no reason that HYH could not be used for a

quality improvement project. I may be wrong, but will find out

________________________________________

From:

[ ] On Behalf Of Bleiweiss

[hockeyref1@...]

Sent: Thursday, August 11, 2011 12:09 AM

To:

Subject: Re: AAFP SAMs or other Modules

Jim,

How does one become a " Member of this Club Board " ??? I know nobody every

asked my wife to Vote for anyone.... This board stuff has a similar negative

disconnected and all too full of themselves like, much like the Law Suit moving

forward by Dr. Fischer and his partners... Much like the AMA and CMS stupidity.

You are either a great wonderful glutton for punishment man or you are almost

nuts for trying this....

To: " "

< >

Sent: Thursday, August 11, 2011 12:02 AM

Subject: RE: AAFP SAMs or other Modules

Sorry , they have heard this and much more. There are lots of folks who

don't like the system. Maybe if you could condense this into a few bullet points

with concrete ideas for change, I could send it on.

________________________________________

From:

<mailto:%40yahoogroups.c\

om>

[ <mailto:%40yahoogroups.\

com>] On Behalf Of Bleiweiss

[hockeyref1@...<mailto:hockeyref1%40yahoo.com>]

Sent: Tuesday, August 09, 2011 5:50 PM

To:

<mailto:%40yahoogroups.c\

om>

Subject: Re: AAFP SAMs or other Modules

PS: Please feel free to share these comments with the others at the board. I bet

they have not heard feedback quite as Raw as this before. Doctors are so

controlled and well spoken sometimes too much so, but it is part of being a

decent professional is that self control. But that does not mean that

undernether the calm exterior that others are not likewise irritated and upset

in a similar fashion and at a similar level. Someone has to finally speak the

Full Truth and tell these folks that the only reason they don't have a mass

exidose on their hands like the AMA and AAFP is because of the Economic and

Professional Fallout that can ruin the average career and income potential in

almost an instant.

Do they really want to be seen and know as we don't care, hear, see, and speak

no evil kind of rulers from high above whose only authority comes from the power

to ruin their members carreers if those members don't tow the line and do

whatever is required of them. Not because the membership feels like they are

doing a decent and difficult job the best they humanly can and that no human

project is ever going to be perfect or please everybody 100%? Do they derive

their power from the support of their members or simply like a Mafia Don, it is

only by the ever present and implied, terribly threatening power of ruining

one's professional life, career and most hopes of paying down one's debts and

making a semi-reasonable and professionally acceptable living that keeps them

even modestly viable and still have the majority of their membership towing the

line against their own better judgement or beliefs????

Please I beg of you to implore them to get away from this broken and misguided

model that after all the hoops docs are going to go thru in their attemps (who

says how many are going to actuall succeed???) to comply and meet the " New

Standard " who says it's going to be worth a gosh darn thing? They need to return

to the old ways of basic testing and matching credits of CME if and until some

new, well thought out, polled, researched and proven valid and Truly Meaningful,

and understandable and not overly impossing upon most FP's who don't have the

time to blow their own noses, no less their poor kids most of the time is

created and worked out over a much longer and better used period of time...

Jumping onto the Next HMO bandwagon really reduces their level of respect From

the Membership to practically Zero.... My 10 & 12 year old kids are smart enough

to not jump on the e Beaver or the Next flash in the pan, one season

wonder team's bandwagon.... So why is not our supposedly so astute and

intelligent board not able to have that same basic mature critical thinking,

reasoning and questioning skills to form good hypothosis and then perform decent

research into what actual might be a sensable way to slowly evolve and improve

the standards and measures of what it means to be a true Board Certified

practioneer of Family Medicine?????

And again just because someone can collect and vomit back on cue does not mean a

damn thing about the quality of their work especially as it relates to something

as multifacetted and interpersonal and hard to define as the doctor patient

relationship of working together torwards a lifetime of better health on a case

by case, individual basis. And taking the larger longer view as Gordon said so

well as opposed to the serverly dysfunctional and short sighted and myopic view

of measures of individual disease states might and frequently does run in

opposition to what really could and is better long term outcomes... Great data

collectors and reporters are frequently NOT the best one on one clinicians...

And great clinicians are not always the best data collectors and reporters....

So on that alone where is the great corrolations and connections of such skills

being related and tied to one another that one actually is a good predictive

measure for the other???? Because I not sure that such a set of connections

exists at a significant level but then again it is not my hypothosis or theory

to present or defend.... It is theirs to show the greater world and membership

that such things are truly worthy of becoming the new normative standard and

measure that all Certified docs must be able to attain and prove capable of. And

as of right now it seems to many of us, that they have failed pretty miserably

at all of that...

Lastly and then I promise to shut up for awhile one and all.... Because of the

large economic differences between clinics, practices hospitals no less the

larger the clinic both the more likely they are to have a larger IT budget with

a team of folks attacking these CCHIT and MU issues for them... While of the

opposite side of those same larger places is a doctor's inability to control

what is and is NOT priority or programmed into the system, which tools are

turned on or off by the IT team and the partner of Exec in charge of all of

that.... One the flip side us small guys can barely get the refills called in,

the patients seen for nice longer more high quality visits, get the billing

done, copy or print out the records and other request, go home and get some

dinner in ourselves no less our kids, family by 6-7 pm most nights... Like what

they heck is the real intent of this?

Do they really want to start weeding out what might even be a majority of their

members who can not for so many free market and other reasons be bothered or

have the resources or time to do so? Is this an IT data collection test or is

this a Board Certification process to make sure we have good, knowledgeable,

intelligent able to think on their feet doctors practicing medicine all across

the country? Because the more I think about it being combined in ANY Fashion

with Meaningless Use, the more it is starting to seem like a " Verification

Process " or even backdoor Certification Process for the Clinics, practices and

hospitals themselves.... This is as much about day to day process of charting

and data collection, EMR selection, back end tweaking and turning on and off

various options and the like and who has the best kiss up data collection clip

boards and support staff to collect such garbage in the first place, no less

then have it become " Meaningful " when crunched and presented in some fashion...

So is this checking up on and verifying, certifying my wife's ability to manage

and treat any given patient that walks thru the door or is this more of a test

of her's and her practice manager's ability to shop, choose, code and bill, be

financially viable enough to even be able to play in the first place, no less

tech savvy enough to set it up and manage it all... to then hopefully put us in

the proper place to even begin to go along with such a thing in the first

place?????

In closing IMHO it seems that perhaps the worst thing that is happening here by

blindly if ever adopting Meaningless Use and making it part of the Board

Certification process is as follows. It seems to me that the defining line

between being some sort of a regulatory body and oversight, quality control

agency that in many ways is not truly measuring the doc here but instead much of

it depends on other not easily defined and controlled for variable about the

clinic, practice, tech support, managment, EMR vendor and the like; verses a

professional and privately run BY the profession and it's professionals

themselves (Super Critical Here, like an internal Review Board too, right?)

organization that makes sure that their members meet up to and can perform at a

certain proven viable level of expertise and compentency has been has been

utterly destroyed here and it sets a a New and very frightening standard of what

it means to be tested and certified... This boundary is now severely blurred,

oblithorated practically, when in fact such a boundary needs to remain forever

extra sharp, focused and well defined. Hopefully we can now restore order back

to where it needs to be, and that these two very different goals and outcomes

desired of such vastly different kinds of organizations and agencies needs to

remain forever well defined and separated pretty darn far apart so as to never

come half as close as this to blurring the line EVER again.... We might even

need to be reminded and to set up some sort of firewall, neutral zone or DMZ

here to remind other new replacement board members that such should never, ever

be allowed to get this close, no less crossed ever again...

Honestly, how many great docs did you know who couldn't barely program a VCR

sometimes, but darn it if their clinical skills, knowledge, experience and

relationship with their patients where not some of the best and most respected

you have every seen??? And if forced to choose between horrible interpersonal

skills and doctor patient relationship, less able to problem solve and combind

concepts and ideas to reach great and insightful helpful clinical conclussions,

or a doctor like most of our IMP brothers and sisters here with stickers and

lolly pops, and cool ties and toys to play with, brings their toy dog to work

with them to entertain the patients (we do this) which doctor would you want

your own 4 year old daughter to be getting treated and cared for long term in a

Primary Care relationship??? Doctor Numbers or Doctor Lolly Pop???? I'll take

Doctor Lolly Pop each and every time, wouldn't you??? And how the heck are we

ever really going to measure Doctor Lolly Pop??? Ask Gordon and friends because

I think they are the one's who have better ideas and concepts that are getting a

whole lot closer to that better more valid concept, then did our board who

blindly adopted this, did your EMR collect the right data, can you work those

numbers correctly to prove something about a segment of your patient panel and

report them back to our Board (wasn't this what the Government was going to use

and do, make us do, to start paying us based upon supposed Quality reporting and

numbers, NOT our Board???) to gain access to the club to even be able to walk

into the locker room and get dressed, no less have the coach actually put us in

the game to play???? That's BS, it's bad enough our government wants to try and

impose this upon us as means of pay or punishment, but when our our professional

board is so blind and short sighted and feels it should start to share and

perhaps switch roles with our government agencies, then I know someone has lost

his or her mind and has jump the tracks and entered into a relm that was never

theirs to enter in the first place....

Test and probe for real professional competance, skills and knowledge base no

less critical thinking and deducting why don't you. Perhaps we could and should

start to do personality and pysch evals too, as perhaps there is or is not a

correlation between such and real world outcomes? At what point has one gone way

too far astray from their Original Mandate and their real purpose and real

implied and understood Authority? Well, here is a great clear example of doing

just that... way over stepping and over reaching and without even any real

substanciated supportable reasons no less.... And not even a bit aware or

concerned that in almost an instant they changed all of this, and are now

outside their field of play, expertise and mandate themselves.... That is very

frightening and concerning indeed and I call for an immediate stay of all of

this and to perhaps allow all previous members in good standing prior to SAM's,

and Modules and MU over the past few years to simply take a decent test and pay

their now present fees until we properly investigate and understand just what

happened here and why??? This is a board and not a police department or

licensing agency.... Knowledge and Skills, not enforcement and equipment

quality...

Check this out.... The folks that license an Electrican are not the same folks

who come to his worksite to inspect and approve of his actual work before the

sheetrockers seal up the walls. And neither of these organizations would ever

claim to be allowed to start playing in the other's park and for perfectly good,

well defined and divided up reasons. If the Government wants to start Observing

or requiring doctors to have to report such things, over sight their work, that

is completely different than their board whose job it is to set a knowledge and

skills based set with tests and procedures to prove or disprove such knowledge

and skills, to then Certify them as qualified to walk onto the contstruction

site and start reading blue prints and wiring and laying out conduit... Then the

inspector reviews their work before the job is finished and says whether it's

good enough or not... Two different organizations one run by the profession to

measure professional standards of knowledge and skills the other to oversee

actual work quality.... The board has completely over stepped its autority and

mandate here and should be held accountable for this horrible mistake. If any

tradesman could see and understand these very real differences, then why not a

Board of supposedly intelligent and well thought doctors setting standards and

policy... Oversight of actual Work was never in nor should it ever be in their

mandate...

I've gotta go and have ranted way too long already here..... Be well and let's

really start to think about what has really happened here folks....

From: Bleiweiss <hockeyref1@...<mailto:hockeyref1%40yahoo.com>>

To:

" <mailto:%40yahoogroups.\

com> "

< <mailto:%40yahoogroups.\

com>>

Sent: Tuesday, August 9, 2011 4:00 PM

Subject: Re: AAFP SAMs or other Modules

Here Here Gordon,

Well said as always.... Jim personally I have written three emails that I never

sent (See I am Learning Some Restraint... :-) because this issue has me fumming.

Why is it our Board's responsibility almost to " Certify Any of Us " as basically

being able to meet a Gov't set of requirements that as Gordon points out are not

even surely relevant??? For goodness sake, teach us, keep us abreast of upcoming

and new issues, therapies and theories, and then somehow test our Knowledge on

it. But to actually try to somehow " Test and Quantify " the quality of our work

is Insane and Unacceptable on any and all fronts. Tell me what other Board is

doing this to their Diplomats???? It is disrespectful to doubt basic competance

in clinic practice especially in something that is so people, relationship based

and oriented....

We all KNOW that Gordon et al (the Great Gang of Mentors here (and thanks to one

and all, you folks are awesome!!!) have a much better handle of these kinds of

things than any part time meeting board does as they are not influenced by Big

Medicine, Big Pharma, Hospitals and Gov't Make Myself a Self Perpetuating Job

and new dept while feeding the Super Vendors who pay and bribe their way in to

becoming " Required " . This Meaningless Use crap is not even truly proven " valid "

or " significant " and worse yet it seems to lack a certain important

transferability as well as repeatability across thousands of clinics and

providers' office across the country....

I won't even get started on some of the links I almost sent you about Amazing

Charts Newest " Meaningless Use " 6.0.9 being rushed out exactly because of stupid

deadlines and people clamoring to meet them for Incentives NO LESS

PUNISHMENT.... If you are running Windows XP, Pro even there is a 99% chance of

the E-Rx bring your entire visit and any and all refills to a crawl, where as

users have reported, one can literally watch the scan lines being rendered that

is how incredibly slow it goes to render the windows needed to write print

etc.... The free market is still struggling to get this together, many offices

have NO EMR at all! Yet Now to be Board Certified our own Board has Ignored it

members so badly or they are so deaf and out of touch that they can not hear the

clamors of struggling to catch-up, make choices, get systems up and running?

What is some small IMP or soon to retire doc wants to say, hey with only 5-10

years to go, what the heck, I'm not going to deal with all this tech

headaches.... Now it is required by the board just to remain Certified.....

But because of the first part that it is still not proven that such CCHIT, CCHIT

is even valid or worthy of the efforts no less that other members should Always

be allowed to Opt-Out of being part of this Grand and not yet proven experiment

because of all the other garbage in our Business of Medicine, that a Realist and

Connected Board would actually understand at some gut viseral level as opposed

to needing to be hit over the head with a hard Mallet or something, this is

really worst of all, " Economic Extortion " forcing all FP's to suck up and be cut

out completely. We are facing this exact problem as we speak. Ask Gordon who

practice one city away in Rochester for years, just how over bloated and Full of

themselves, our regional Engulf and Devour BC/BS Affiliate Excellus is.... They

may have as much as 70% of our market coving both regular commercial as well as

managed gov't like CHIP's, FHIP's and NY Medicaid and some Medicare as well...

They are a Monster the 800 lb gorilla in the room out here and they are

threatening to drop my wife if she doesn't " Promise " to start getting her board

certification stuff in order and get " Back on Board " !!!

These are the realities that we really do face and live in and to hold our own

Certification Hostage from us, literally threatening our Hospital affiliations

and r Credentials, both of whom what to know that the other is properly in

place as well, no less, RIGHT???? This is Extortion with our Board now acting as

the Defacto Government Screeners to make sure that all FP's are now Meaningless

Use and CCHIT certified before we can even walk on to the field and play....

And what about not wanting or believing in sharing Clinical Data for research

purposes, doesn't a doc no less the patients have a RIGHT, an American Right, to

opt-out of having their data used without their explicit knowledge? We are going

to start marketing our practice as being as properly protective and NOT Sharing

of our Patients' data refusing to even get hooked up to the regional

exchanges.... I believe this is perhaps our best marketing and patient service

approach to one day start a membership and cash only practice. We don't share if

you don't share anymore than you do yourself... Other than perhaps Rx's we can

promise to keep our end of your medical history out of this not well protected

or designed nationally connected systems.... I'm trying to find ways like lab

downloads in one direct only that I can get " E Reports " and things that make

sense to be Data Points that are trackable to see changes in patients values (we

do believe in tracking the individual patient, Population of ONE, thank-you...)

and the like but without opening up our side to the hack and wack wild west of

the www... I don't want my kids on the net nor myself or my wife's data and info

out there either..... no less our patients. Huge government controlled data

bases that contain all Americans' PHI is just so morally offensive to us both as

Civil not conservative based Libertarians... Now we have no choice to take a

stand against such things as Big Brother tries to capture all of this on us

forever, never to be removed, at best ammended... All Diagnosis good or bad,

proper or off the wall and incorrect... Patient advocating for good care and

what they want, or combative and non-compliant???? Not in My America and I wish

more of the IMP members would listen and heed this call and I have tried

to raise a few time before.... But anyway....

This meaningless use and proving of things based on clinical data that has yet

to be repeatably significant and useful, no less runs amuck of so many other

important and critical issues in today's real frontlines of practice medicine in

America and in our Specialty is so offensive to both of us, we are about ready

to try and have that fight again with the 800 lb gorilla of Central NY.... This

is Insane and so reaching beyond original scope and purpose, no less further

using the Power Vested in Them to use such unproven and hard to produce on an

equal footing between all docs and practices... Replicate and test... Did they

actually go to different Meaningless Use offices of various sizes and EMR

programs all across the country to see what it takes to collect any of the

CCHIT??? Did they even bother to try and run real tests and measures themselves

verses observed doctor patient interactions, chart notes, OUTCOMES for real, the

entire greater health of the patient, to see if such measures were even worthy

of their consideration, no less Full Adoption???? Pardon my French here, but

Like WTF were these people smoking and perhaps they need to get themselves to a

rehab and fast... Or did they simply assume and buy into the gov't and carriers

lines about all of the garbage??? I bet they did the latter and not the former.

So they don't have to really test and measure themselves in this regard to prove

the standard is valid and worthy, but nonetheless, the membership if they care

to remain Certified not economically cut off and ruined in most cases must do

and uphold to performance and levels of " Proof " that their own board does not

feel they should have to be held to likewise...

Sorry Jim, I have known you for a some time now and I really like you, admire

you and respect you, but I can not remain silent about this any longer and I

have the clarity of good perspective to see the inherent flaws and misguided

path this was created on and will continue following. It is unethical and

weakens the board's own credibility with us, and it seems a growing number of

those that they claim to represent, which they are losing it seems. If not for

the Severe Economic and Professional impact of letting one's Certification laps,

IMHO much like the AMA and the AAFP many more perhaps even a growing majority of

FP's would not be re-upping anymore when their time came to do so... The mutual

respect that comes from being connected and acting in a supportable and

provable, valid fashion, Logical and Scientific, has been lost, perhaps even

destroyed. Now staying Certified is but a PITA formality that most docs no

longer have any use or respect for.... It is another requirement and demand from

some way disconnected people who have no real idea what it is like to be

practicing their specialty on a day to day basis... That's a shame and they

should be ashamed of that. It is but another roadblock, barrier to providing

good care, another " Jump Fido " and I'll tell you when and how high as well, that

has no real meaning or connection back to what docs do in their real world

trade...

Gotta go pick up the kids from their different camps.... Sorry but I had to get

this off my chest...

From: L. Gordon

<gmoore@...<mailto:gmoore%40idealhealthnetwork.com>>

To:

<mailto:%40yahoogroups.c\

om>

Sent: Tuesday, August 9, 2011 2:36 PM

Subject: Re: AAFP SAMs or other Modules [1 Attachment]

A more important underlying issues is the degree of match between current data

sets and overall outcomes.

Most quality measurement focuses on disease and organ systems. This approach can

lead to rewarding improvements in organ system management but often fail to

address more important outcomes. The hypothesis that disease management

translates to overall improvement in care delivery has not been demonstrated.

Moreover, there is a wealth of evidence that overall population health

improvement is based on good primary care delivery. This is not the same thing

as disease management, and in fact our continued quality emphasis on disease

states and organ systems keeps our focus narrow while we miss the big picture.

Primary care is defined as the presence of four cardinal components:

First point of contact (access)

Person-focused relationship over time

Comprehensive services

Care coordination

When done well, population health outcomes improve, disease states improve,

patient experience improves, total cost of care improves.

The ABFM can help the country re-orient measurement to focus on what really

matters. Barbara Starfield laid this out very well in her FPM editorial of

2009<http://www.aafp.org/online/en/home/publications/journals/fpm/opinion.html>.

We don't give up measuring things like A1c, pneumovax, etc, but we cannot let

these small measures squeeze out measures of how well we deliver on primary care

key performance indicators (access, person-focused relationship,

comprehensiveness, care coordination).

The IMP self-assessment recognition program focuses on the broad themes, is

accessible to small independent as well as large practices, and is much more

aligned with the real value of primary care.

We should not continue to follow a broken paradigm just because it is familiar

and touted by experts.

Gordon

I agree with you and that is one of the things I brought up at my first board

meeting. I believe that we will be able to change some of this and hopefully

getting Meaningful Use as a criteria.

I see my consituents as us, the small practices who have trouble doing these due

to volume or cost. I believe we can make headway on both.

Jim

From:

<mailto:%40yahoogroups.c\

om><mailto: <mailto:%40ya\

hoogroups.com>>

[ <mailto:%40yahoogroups.\

com>] On Behalf Of

[jnantonucci@...<mailto:jnantonucci%40gmail.com>]

Sent: Sunday, August 07, 2011 7:40 AM

To:

<mailto:%40yahoogroups.c\

om><mailto: <mailto:%40ya\

hoogroups.com>>

Subject: Re: AAFP SAMs or other Modules

Jim I appreciate your work on this

PLus I get to see your face on the newsletter

It is good to see someone , an IMP, a small independent practice have a voice in

the professional organizations

The PQRi measure for ABFM is a challenge for little practices - I wasted a bunch

of time on it -turns out that many of us do ot have 30 diabetics in t he right

age range then another 30 I think to go back after review. That's a real issue

to think about out While sample size matters for measuring and for learning ; it

cut many of us out of this beneficial program

thanks

Jean

On Sat, Aug 6, 2011 at 9:19 AM, Kennedy, Jim

<jim.kennedy@...<mailto:jim.kennedy%40ucdenver.edu><mailto:jim.kennedy@\

ucdenver.edu<mailto:jim.kennedy%40ucdenver.edu>>> wrote:

Helen,

The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am

now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

Hope that helps,

________________________________________

From:

<mailto:%40yahoogroups.c\

om><mailto: <mailto:%40ya\

hoogroups.com>>

[ <mailto:%40yahoogroups.\

com><mailto: <mailto:%40y\

ahoogroups.com>>] On Behalf Of Helen Yang

[helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@hotma\

il.com<mailto:helenwyang%40hotmail.com>>]

Sent: Wednesday, July 27, 2011 8:38 PM

To: IMP Group

Subject: AAFP SAMs or other Modules

Busy with the new IMP, I have done CMEs to keep up the license, but haven't done

any of the AAFP modules since the recert. I would have to start doing the Part

II SAMs Modules and /or Part IV modules in order to stay on the 10 year track

instead of regular 8 years.

We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

Thank you very much for any input.

Helen

------------------------------------

[Guest guest]

Jim, For a slightly more abbreviated version of what is saying, below is

a copy of my message to you from 5/24, to which I did not see a response. I'm

really not trying to beat up on you, honestly. It sounds as if you have the best

of intentions and our (small practices') best interests at heart. But your

analogy likening choosing not to fly and choosing not to be board certified is

not fair. You wrote, " I can choose to put up with the TSA and fly, or I can

drive. I can choose to put up with the ABFM, or not be boarded. " I'm sure that

there are some careers where refusing to fly would be the end, but not most, and

certainly not ours. But, since insurance companies have started requiring board

certification to be on their panel of physicians, letting our board cert. lapse

is the equivalent of saying we will never participate with the major insurers

again. Certainly, I would LIKE to say that, but the awful truth is that it is

not financially feasible for most of us. I know for a fact it would spell the

end of my current practice. So, board certification is no longer a marker of

special qualifications, it is a minimum requirement to practice. And it is SO

frustrating when someone comes along and invents a whole new process that is

extremely onerous, yet necessary for us to comply with, at a time when a large

proportion of us beleaguered family docs are already feeling on the verge of

collapse. I am getting chest pain and choked up just typing this, and I guess

that's just what and I want the Board to know. If, as you say, they have

heard all this before, WHY AREN'T THEY LISTENING?!? It appears that we are not

their constituents. I read their last newsletter, in which they claimed to be

listening and responding to our needs, but nothing I saw made anything

significantly easier. I guess I would just like to know that our " insider " is

going to give them that feedback.---Respectfully, Sharlene---

Jim, Please let the Board(ABFM)know that I am absolutely

FURIOUS with them for coming up with such a ridiculously complex and

time-consuming scheme for maintenance of certification!!! Do other specialty

boards put their diplomates through this kind of ordeal? I feel that we ordinary

physicians have been completely sold out by people who must have no idea what a

struggle it is just

to survive in today's practice environment. I have no problem with reading to

keep up with the problems I encounter from day to day, earning some CME credits

of my own choosing, and taking occasional tests. In fact, I would rather take a

day-long test EVERY YEAR than keep up with this MOC!! And I'll bet there is

absolutely no evidence that doing all of this will make us better family

doctors. If I didn't have to be board certified to participate with most

insurance companies, I would absolutely let my certification lapse. And if I

ever go CASH ONLY, which it looks like I will need to, since I have no intention

of becoming part of an ACO, I will definitly drop it!---Sharlene---

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I

am now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

>

> The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From:

<mailto:%40yahoogroups.c\

om><mailto: <mailto:%40ya\

hoogroups.com>>

[ <mailto:%40yahoogroups.\

com><mailto: <mailto:%40y\

ahoogroups.com>>] On Behalf Of Helen Yang

[helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:he\

lenwyang%40hotmail.com>>]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't

done any of the AAFP modules since the recert. I would have to start doing the

Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year

track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

> ------------------------------------

>

>

[Guest guest]

Our senior partner looked at the MOC requirements and decided it isn't

worth the hassle anymore as he'll retire in a few years.

My younger but cash based partner also has little reason to keep up with

MOC modules since she's dropped commercial third party payers and her

hospital privileges.

With many of the patients around here are happily seeing midlevels with

far less training, it seems silly to jump through the MOC hoops each year.

Pierce

[Guest guest]

Sharlene and ,

Thanks for chimming in.... I too want it to be said again, This is NOT about bashing Jim our one and only ace in this fox hole probably (are there any others there with you Jim???). Please try to slug your ways thru to the bottom and read my last reply.... In the ending I feel I really start to get to the root causes of most if not almost all of this and other similar problems.... It is a trauma abuse response of compliance and buying into the horribly painful crap that your tormentor has been hitting you over the head with day after day, year after year.... An entire profession that is just about defeated and completely learned helpless (a form of enviornmentally caused depression and a model from which to better understand such a thing) by those that have the most to hide no less ill gottenly gain from all of you... us. This has been my

growing hypothesis about the lack of spine and backbone to stand up for yourself, ourselves in primary care for quite sometime now....

I believe this theory to be extremely sound and valid and would love to be able to form means of investigating and testing it's validity and significance. But if nothing else if each and everyone of you were to start to try to use this as your perspective from which to view things like P4P, Meaningless Use, Full and Required, Reward and Punishment but unproven Free Market EMR's and E-Rx'ing that is choking a very popular program and shutting it down, crashing it... And possibly because the Rx Vendor Middlemen making the big bucks in the middle are not doing their job well either (not proven but was floated as part of the problems, Rx's not being there at local places that faxes worked for the last 10 years for example). Just in general, when ever someone other than a modest sized doctor in actual practice comes up with some NEW

fango'ed HUGE, expensive has their hands in someone's and usually OURS TOO pockets, or means we work now for some promise of another "delayed" reward on the otherside... STOP!!!! Question, and wonder who is this coming from and what are they REALLY after besides my hard work and my hard earned money off of my practice and profession????

The insurance industry always finds scapegoats to blame no matter what the line of business or products.... Sure there are always some folks who try to scam the system and get away with some crap... but the vast majority of folks just want to file a claim, be helped or made whole and try to get back on with their lives again.... Most people are NOT scammers and insurance frauds.... What they do to each and every primary care doctor every day, NOW THAT IS A FRAUD and a crime of epic porportion for sure.... We are just the most visable and the most vulnerable victims to be used and abused by this Horribly Unethical Industry because the gov't set up the playing field so unlevel and unfairly.... We have almost NO power or clout and they have almost all of it, we have almost NO laws that protect our interests against them, while they have almost all of the one's that really count... They hold the purse

strings and we never do so it is Trickle down to us and beg for a meal from them.....

This is a traumatising, abusive, misuse of power and authority relationship and other players are playing into it for their own less than ideal or ethical reasons too. Like the CMS and AMA collusion to control the fees in favor of the AMA favorite children while starving out Cinderella over in the corner and beating her and emtionally abusing her as well.... But one can never break free of Gaslighting, Mobbing and other forms of emotional abuse if and until they are really able to see, accept it for what it is, and then have their eyes open so they can never again see things the old way... And as with all abuse victims one of the hardest parts to swallow was your own part in the dysfunctional dance you were engaged in with your abuser and tormentor... It is hard to accept and hard to swallow and that pain keeps many abuse victims in denial...

And so it is my firm belief that we are suffering from a profession wide form of gaslighting, mobbing and abuse.... And one of the Red Flags of Mobbing is that the person singled out by the group for the abuse (like mass work place abuse of one person usually started by someone who is competing with them, or is their boss or one who the victim is in charge of yes, both ways...) is usually pretty darn GOOD at what they do, there really is very little merit to what is happening to them once the surface crap is peeled away.... This is the work of someone or someones who want or feel the need to ruin someone to get them out of the way for one reason or another....

And so primary care gets to wear the dunce cap and the Cone of Shame, be the sacrificial lamb and the scapegoat for all these other "Stakeholders" and greedy leeches... Think about and let me know what you think.... I believe those of you here are independent enough thinkers to give this a fair shake... Take care and Be Well.... And Jim I do respect you very, very much... I really do. Unfortunately because of the board's disconnect, you are our only means of communicating with them.... That is part of the larger problem.... no conversation, no meetings across the country, no comment and feedback period, no long defendable, presentable research project to present showing just how Great and Valid it is and how wonderful they really are.... Those with great stuff tend to come out and talk, Show their faces... While those who are affraid and not sure of themselves, or are not coming from a good, ethical

or defendable place, those kind of folks tend to stay removed and hide... Play Exhaulted Leader... Demi-God.

To: Sent: Thursday, August 11, 2011 8:14 PMSubject: Re: AAFP SAMs or other Modules

Jim, For a slightly more abbreviated version of what is saying, below is a copy of my message to you from 5/24, to which I did not see a response. I'm really not trying to beat up on you, honestly. It sounds as if you have the best of intentions and our (small practices') best interests at heart. But your analogy likening choosing not to fly and choosing not to be board certified is not fair. You wrote, "I can choose to put up with the TSA and fly, or I can drive. I can choose to put up with the ABFM, or not be boarded." I'm sure that there are some careers where refusing to fly would be the end, but not most, and certainly not ours. But, since insurance companies have started requiring board certification to be on their panel of physicians, letting our board cert. lapse is the equivalent of saying we will never participate with the major insurers again. Certainly, I would LIKE to say that, but the awful truth is that it is not financially

feasible for most of us. I know for a fact it would spell the end of my current practice. So, board certification is no longer a marker of special qualifications, it is a minimum requirement to practice. And it is SO frustrating when someone comes along and invents a whole new process that is extremely onerous, yet necessary for us to comply with, at a time when a large proportion of us beleaguered family docs are already feeling on the verge of collapse. I am getting chest pain and choked up just typing this, and I guess that's just what and I want the Board to know. If, as you say, they have heard all this before, WHY AREN'T THEY LISTENING?!? It appears that we are not their constituents. I read their last newsletter, in which they claimed to be listening and responding to our needs, but nothing I saw made anything significantly easier. I guess I would just like to know that our "insider" is going to give them that feedback.---Respectfully,

Sharlene--- Jim, Please let the Board(ABFM)know that I am absolutely FURIOUS with them for coming up with such a ridiculously complex and time-consuming scheme for maintenance of certification!!! Do other specialty boards put their diplomates through this kind of ordeal? I feel that we ordinary physicians have been completely sold out by people who must have no idea what a struggle it is justto survive in today's practice environment. I have no problem with reading to keep up with the problems I encounter from day to day, earning some CME credits of my own choosing, and taking occasional tests. In fact, I would rather take a day-long test EVERY YEAR than keep up with this MOC!! And I'll bet there is absolutely no evidence that doing all of this will make us better family doctors. If I didn't have to be board certified to participate with mostinsurance companies, I would absolutely let my certification lapse. And if I

ever go CASH ONLY, which it looks like I will need to, since I have no intention of becoming part of an ACO, I will definitly drop it!---Sharlene---> Helen,> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am

pushing to give credit for doing Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.> > The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get everyone ready for them being on the recertification exam by 2014.> > The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I even learned a little.> > There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you

are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.> > BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things

coming in the next few years.> > Hope that helps,> ________________________________________> From: <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>> [ <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>] On Behalf Of Helen Yang [helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:helenwyang%40hotmail.com>>]> Sent: Wednesday, July 27, 2011 8:38 PM> To: IMP Group> Subject: AAFP SAMs or other Modules> > Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular 8 years.> > We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect> > Could any of you who have done these modules please

share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?> > Thank you very much for any input.> > Helen> > ------------------------------------> >

[Guest guest]

Jim, how is the recert exam created?  I took it last month and thought it was way off track.  Too many  of the questions dealt with topics that are rarely encountered and that I havent thought about since medical school.  What were the goals of the creators of the exam?

 

 

Sharlene and ,

    Thanks for chimming in.... I too want it to be said again, This is NOT about bashing Jim our one and only ace in this fox hole probably (are there any others there with you Jim???). Please try to slug your ways thru to the bottom and read my last reply.... In the ending I feel I really start to get to the root causes of most if not almost all of this and other similar problems.... It is a trauma abuse response of compliance and buying into the horribly painful crap that your tormentor has been hitting you over the head with day after day, year after year.... An entire profession that is just about defeated and completely learned helpless (a form of enviornmentally caused depression and a model from which to better understand such a thing) by those that have the most to hide no less ill gottenly gain from all of you... us. This has been my growing hypothesis about the lack of spine and backbone to stand up for yourself, ourselves in primary care for quite sometime now....

 

    I believe this theory to be extremely sound and valid and would love to be able to form means of investigating and testing it's validity and significance. But if nothing else if each and everyone of you were to start to try to use this as your perspective from which to view things like P4P, Meaningless Use, Full and Required, Reward and Punishment but unproven Free Market EMR's and E-Rx'ing that is choking a very popular program and shutting it down, crashing it... And possibly because the Rx Vendor Middlemen making the big bucks in the middle are not doing their job well either (not proven but was floated as part of the problems, Rx's not being there at local places that faxes worked for the last 10 years for example). Just in general, when ever someone other than a modest sized doctor in actual practice comes up with some NEW fango'ed HUGE, expensive has their hands in someone's and usually OURS TOO pockets, or means we work now for some promise of another " delayed " reward on the otherside... STOP!!!! Question, and wonder who is this coming from and what are they REALLY after besides my hard work and my hard earned money off of my practice and profession????

 

The insurance industry always finds scapegoats to blame no matter what the line of business or products.... Sure there are always some folks who try to scam the system and get away with some crap... but the vast majority of folks just want to file a claim, be helped or made whole and try to get back on with their lives again.... Most people are NOT scammers and insurance frauds.... What they do to each and every primary care doctor every day, NOW THAT IS A FRAUD and a crime of epic porportion for sure.... We are just the most visable and the most vulnerable victims to be used and abused by this Horribly Unethical Industry because the gov't set up the playing field so unlevel and unfairly.... We have almost NO power or clout and they have almost all of it, we have almost NO laws that protect our interests against them, while they have almost all of the one's that really count... They hold the purse strings and we never do so it is Trickle down to us and beg for a meal from them.....

 

This is a traumatising, abusive, misuse of power and authority relationship and other players are playing into it for their own less than ideal or ethical reasons too. Like the CMS and AMA collusion to control the fees in favor of the AMA favorite children while starving out Cinderella over in the corner and beating her and emtionally abusing her as well.... But one can never break free of Gaslighting, Mobbing and other forms of emotional abuse if and until they are really able to see, accept it for what it is, and then have their eyes open so they can never again see things the old way... And as with all abuse victims one of the hardest parts to swallow was your own part in the dysfunctional dance you were engaged in with your abuser and tormentor... It is hard to accept and hard to swallow and that pain keeps many abuse victims in denial...

 

And so it is my firm belief that we are suffering from a profession wide form of gaslighting, mobbing and abuse.... And one of the Red Flags of Mobbing is that the person singled out by the group for the abuse (like mass work place abuse of one person usually started by someone who is competing with them, or is their boss or one who the victim is in charge of yes, both ways...) is usually pretty darn GOOD at what they do, there really is very little merit to what is happening to them once the surface crap is peeled away.... This is the work of someone or someones who want or feel the need to ruin someone to get them out of the way for one reason or another....

 

And so primary care gets to wear the dunce cap and the Cone of Shame, be the sacrificial lamb and the scapegoat for all these other " Stakeholders " and greedy leeches... Think about and let me know what you think.... I believe those of you here are independent enough thinkers to give this a fair shake... Take care and Be Well.... And Jim I do respect you very, very much... I really do. Unfortunately because of the board's disconnect, you are our only means of communicating with them.... That is part of the larger problem.... no conversation, no meetings across the country, no comment and feedback period, no long defendable, presentable research project to present showing just how Great and Valid it is and how wonderful they really are.... Those with great stuff tend to come out and talk, Show their faces... While those who are affraid and not sure of themselves, or are not coming from a good, ethical or defendable place, those kind of folks tend to stay removed and hide... Play Exhaulted Leader... Demi-God.

 

To: Sent: Thursday, August 11, 2011 8:14 PM

Subject: Re: AAFP SAMs or other Modules

 

Jim, For a slightly more abbreviated version of what is saying, below is a copy of my message to you from 5/24, to which I did not see a response. I'm really not trying to beat up on you, honestly. It sounds as if you have the best of intentions and our (small practices') best interests at heart. But your analogy likening choosing not to fly and choosing not to be board certified is not fair. You wrote, " I can choose to put up with the TSA and fly, or I can drive. I can choose to put up with the ABFM, or not be boarded. " I'm sure that there are some careers where refusing to fly would be the end, but not most, and certainly not ours. But, since insurance companies have started requiring board certification to be on their panel of physicians, letting our board cert. lapse is the equivalent of saying we will never participate with the major insurers again. Certainly, I would LIKE to say that, but the awful truth is that it is not financially feasible for most of us. I know for a fact it would spell the end of my current practice. So, board certification is no longer a marker of special qualifications, it is a minimum requirement to practice. And it is SO frustrating when someone comes along and invents a whole new process that is extremely onerous, yet necessary for us to comply with, at a time when a large proportion of us beleaguered family docs are already feeling on the verge of collapse. I am getting chest pain and choked up just typing this, and I guess that's just what and I want the Board to know. If, as you say, they have heard all this before, WHY AREN'T THEY LISTENING?!? It appears that we are not their constituents. I read their last newsletter, in which they claimed to be listening and responding to our needs, but nothing I saw made anything significantly easier. I guess I would just like to know that our " insider " is going to give them that feedback.---Respectfully, Sharlene---

Jim, Please let the Board(ABFM)know that I am absolutely FURIOUS with them for coming up with such a ridiculously complex and time-consuming scheme for maintenance of certification!!! Do other specialty boards put their diplomates through this kind of ordeal? I feel that we ordinary physicians have been completely sold out by people who must have no idea what a struggle it is just

to survive in today's practice environment. I have no problem with reading to keep up with the problems I encounter from day to day, earning some CME credits of my own choosing, and taking occasional tests. In fact, I would rather take a day-long test EVERY YEAR than keep up with this MOC!! And I'll bet there is absolutely no evidence that doing all of this will make us better family doctors. If I didn't have to be board certified to participate with most

insurance companies, I would absolutely let my certification lapse. And if I ever go CASH ONLY, which it looks like I will need to, since I have no intention of becoming part of an ACO, I will definitly drop it!---Sharlene---

> Helen,> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

> > The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get everyone ready for them being on the recertification exam by 2014.

> > The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I even learned a little.

> > There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

> > BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

> > Hope that helps,> ________________________________________> From: <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>> [ <mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com>>] On Behalf Of Helen Yang [helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:helenwyang%40hotmail.com>>] > Sent: Wednesday, July 27, 2011 8:38 PM> To: IMP Group> Subject: AAFP SAMs or other Modules> > Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular 8 years

[Guest guest]

Actually, I do not believe I saw your post, but have seen it now. I don't feel

that any of you are beating up on me,and I appreciate all of your issues with

the board. I do not have any other answers for you now, but will continue to try

to understand how they come up with the questions-often esoteric- why the MOC's

are set the way the are, and why they charge so much. Most other Boards are

moving to continuous MOC, it is not just FM. I had actually planned to not do

the boards again myself, but have to maintain them to be on the board.

I did ring up some of the issues that you all had sent before. they say their

surveys are much in favor of the direction they are moving. I brought up the

expense issue, and way told they are trying to find a way to make it more

affordable, or to have some assistence. I will carry your concerns to the next

meeting.

________________________________________

From:

[ ] On Behalf Of sharkinn

[sharkinn@...]

Sent: Thursday, August 11, 2011 6:14 PM

To:

Subject: Re: AAFP SAMs or other Modules

Jim, For a slightly more abbreviated version of what is saying, below is

a copy of my message to you from 5/24, to which I did not see a response. I'm

really not trying to beat up on you, honestly. It sounds as if you have the best

of intentions and our (small practices') best interests at heart. But your

analogy likening choosing not to fly and choosing not to be board certified is

not fair. You wrote, " I can choose to put up with the TSA and fly, or I can

drive. I can choose to put up with the ABFM, or not be boarded. " I'm sure that

there are some careers where refusing to fly would be the end, but not most, and

certainly not ours. But, since insurance companies have started requiring board

certification to be on their panel of physicians, letting our board cert. lapse

is the equivalent of saying we will never participate with the major insurers

again. Certainly, I would LIKE to say that, but the awful truth is that it is

not financially feasible for most of us. I know for a fact it would spell the

end of my current practice. So, board certification is no longer a marker of

special qualifications, it is a minimum requirement to practice. And it is SO

frustrating when someone comes along and invents a whole new process that is

extremely onerous, yet necessary for us to comply with, at a time when a large

proportion of us beleaguered family docs are already feeling on the verge of

collapse. I am getting chest pain and choked up just typing this, and I guess

that's just what and I want the Board to know. If, as you say, they have

heard all this before, WHY AREN'T THEY LISTENING?!? It appears that we are not

their constituents. I read their last newsletter, in which they claimed to be

listening and responding to our needs, but nothing I saw made anything

significantly easier. I guess I would just like to know that our " insider " is

going to give them that feedback.---Respectfully, Sharlene---

Jim, Please let the Board(ABFM)know that I am absolutely

FURIOUS with them for coming up with such a ridiculously complex and

time-consuming scheme for maintenance of certification!!! Do other specialty

boards put their diplomates through this kind of ordeal? I feel that we ordinary

physicians have been completely sold out by people who must have no idea what a

struggle it is just

to survive in today's practice environment. I have no problem with reading to

keep up with the problems I encounter from day to day, earning some CME credits

of my own choosing, and taking occasional tests. In fact, I would rather take a

day-long test EVERY YEAR than keep up with this MOC!! And I'll bet there is

absolutely no evidence that doing all of this will make us better family

doctors. If I didn't have to be board certified to participate with most

insurance companies, I would absolutely let my certification lapse. And if I

ever go CASH ONLY, which it looks like I will need to, since I have no intention

of becoming part of an ACO, I will definitly drop it!---Sharlene---

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I

am now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

>

> The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From:

<mailto:%40yahoogroups.c\

om><mailto:%40yahoogroups.com><mailto:@y\

ahoogroups.com<mailto:%40yahoogroups.com><mailto:Practiceimp\

rovement1%40yahoogroups.com>>

[ <mailto:%40yahoogroups.\

com><mailto:%40yahoogroups.com><mailto:@\

yahoogroups.com<mailto:%40yahoogroups.com><mailto:Practiceim\

provement1%40yahoogroups.com>>] On Behalf Of Helen Yang

[helenwyang@...<mailto:helenwyang%40hotmail.com><mailto:helenwyang@...<mailto:he\

lenwyang%40hotmail.com>>]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't

done any of the AAFP modules since the recert. I would have to start doing the

Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year

track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

> ------------------------------------

>

>

[Guest guest]

There was a survey at the end of the exam when I took it two yrs ago. I recall becasue it disappeared almost right away or some other   quirk and I  was not able to input one thing:) I then used the center- dispensed keep-them-visible- tissues  to cry

 

Thanks, Jim, for all you are trying to do for us. BUT, I definitely don't remember receiving a survey! Of course, survey results depend on how the questions are worded. If you ask the question, are you in favor of having the option to take recertifying exams every 10 years instead of 7, everyone will say " Yes. " Having a full understanding of what that other option entails is another thing entirely! I am not a lazy person, and I do want to stay up-to-date. I read about the problems I am currently encountering in my practice nearly every day, because I want to give my patients the best care I can. I intended to stay on the 10-year track, but started preparing to open my solo practice 3.5 years ago. No time to do the SAMs, so I slipped off the 10-year plan and have absolutely no idea how I will manage to do what it takes to stay on the 7-year plan. Not all of us get evenings, weekends, and paid CME time off! OK, I think I am done weighing in on this topic...Sharlene

> > Helen,

> > The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

> >

> > The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to get everyone ready for them being on the recertification exam by 2014.

> >

> > The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think I even learned a little.

> >

> > There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

> >

> > BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

> >

> > Hope that helps,

> > ________________________________________

> > From: <mailto:%40yahoogroups.com><mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com><mailto:%40yahoogroups.com>> [ <mailto:%40yahoogroups.com><mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com><mailto:%40yahoogroups.com>>] On Behalf Of Helen Yang [helenwyang@<mailto:helenwyang%40hotmail.com><mailto:helenwyang@<mailto:helenwyang%40hotmail.com>>]

> > Sent: Wednesday, July 27, 2011 8:38 PM

> > To: IMP Group

> > Subject: AAFP SAMs or other Modules

> >

> > Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular 8 years.

> >

> > We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

> >

> > Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

> >

> > Thank you very much for any input.

> >

> > Helen

> >

> > ------------------------------------

> >

> >

[Guest guest]

Thank you for someting concrete. I must confess that it is hard for me to ead all of what you post. I get 60-150 emails a day, and anything more than a paragraph or more is difficult to handle. I will read the rest of what you wrote before at some point.

From: [ ] On Behalf Of Bleiweiss [hockeyref1@...]

Sent: Friday, August 12, 2011 10:37 AM

To:

Subject: Re: Re: AAFP SAMs or other Modules

Jim,

I've think I have a very solid suggestion that should cut to the chase of all of this. 1) make sure you are " The Man " in charge of a new group in charge of " connecting back to the Membership " . 2) Poll ALL FP's board certified

or not.... 3) Especially create a separate questionaire or set of questions that only apply to those who drop-out of Certification like my wife and Sharlene, and those who are considering doing likewise. Include probing questions about how and why this happened,

opinions of the board and it's connectedness to ALL FP's and the person themselves, what would be the kind of things to influence their staying on board or choosing to leave. And make sure to ask if NOT for insurance carrier panel and PAR consideration, how

likely would you be to stay certified, and under which circumstances would influence such choices once the economic factor, threat was removed..... And free hand, suggestions and explainations must be made very welcome and appreciated, so as to possibly find

new paths and concepts not even considered by even those of us here...

Jim, Gordon, et al; might any of you be willing to help me compile such a truth and fact finding kind of survey? I have some but not enough experience as a Psych Undergrade taking good Methods and Stats classes,

and what was APA writing style and format back in the early 90's.... Not sure I would be able to get my own questionaire answered and responded to well, well recieved, no less the output work published as just some schelp Practice Manager on my own. But with

one or two of you more respected " doctor's " in the authorship bi-line with me, I bet it just might.... We could use one of those On-line survey formats that could be easily emailed and answered in their own free time on-line. I believe some of them are even

free to use... I have an account set-up that I have yet to make a finished product on.....

Again, this is no longer a Professional Group testing and granting their membership a Certificate of Approval Based Upon Proving a certain level of basic Competence anymore... This has now become the basic enterance fee

just to be able to get on the Toll Road and play, drive.... It was not this way only a few years ago if I am not mistaken. And to have a board that is so removed as to pretend that such is not their concern or under their control (which to some extent it is

NOT, but) but to ignore the actual real world facts that what they do and how they do it has real world, life long, profession wide, financial survival or death connected to it, speaks so strongly to their complete lack of Valid Authority from their base,

it is truly mind boggling.... This is disconnected abuse of power and over reach, plain and simple.... As Tom Learah said about Verner Von Brown.... it's this completely inappropriate, and wrong, proves you are NOT worthy of the position that you hold disconnect

or Don't Give a CCHIT.... " Vonce zah Rockets Go Up, Who Cares Vhere zhey Come Down.... Tis NOT My Department says Verner Von Brown.... " I know that this is BullCCHIT, everyone else Knows that such is BullCCHIT and so do they as well.... But someone has to

have the NUTS and the access to these guys to call their BULL, BULL to their face....

Hey when and where do you folks actually Meet???? Could members and other Licensed FP's attend a meeting and lobby, speak to their board? Might it actually be a good idea not to go offical and simply Crash the Party,

pretending NOT to know you at all????? Somehow, something has to Pop Fantasy Bubble of Denial, that removed people and organizations like this frequently build up and prop-up around themselves..... We are so wonderful and are doing such a great job and the

majority of our members Love us or support us..... yeah right and I have a Deed to a Bridge in Brooklyn to sell them too....

To:

Sent: Friday, August 12, 2011 10:13 AM

Subject: Re: Re: AAFP SAMs or other Modules

There was a survey at the end of the exam when I took it two yrs ago. I recall becasue it disappeared almost right away or some other quirk and I was not able to input one thing:) I then used the center- dispensed keep-them-visible- tissues to cry

On Fri, Aug 12, 2011 at 10:07 AM, sharkinn

wrote:

Thanks, Jim, for all you are trying to do for us. BUT, I definitely don't remember receiving a survey! Of course, survey results depend on how the questions are worded. If you ask the question, are you in favor of having the option to take recertifying

exams every 10 years instead of 7, everyone will say " Yes. " Having a full understanding of what that other option entails is another thing entirely! I am not a lazy person, and I do want to stay up-to-date. I read about the problems I am currently encountering

in my practice nearly every day, because I want to give my patients the best care I can. I intended to stay on the 10-year track, but started preparing to open my solo practice 3.5 years ago. No time to do the SAMs, so I slipped off the 10-year plan and have

absolutely no idea how I will manage to do what it takes to stay on the 7-year plan. Not all of us get evenings, weekends, and paid CME time off! OK, I think I am done weighing in on this topic...Sharlene

> > Helen,

> > The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I am now on the ABFP, I can tell you that the board is working to make Part IV modules more meaningful. For instance giving credit for PQRI, and I am pushing to give credit for doing

Meaningful use. This is very difficult to actualize, since the behind the scenes work is huge and expensive, but I do believe it will happen.

> >

> > The Part !! modules really don't take too much time, if you know how to work through them. It is much more cost effective to do the 10 year cert than the lesser, and you will have to change eventually anyway. The purpose of the Patient simulations is to

get everyone ready for them being on the recertification exam by 2014.

> >

> > The way I take the SAM's is to just take the test, if you miss a question, you will directed to the resource where the answer is found and you can review those questions and then answer them again. Took me a couple of hours to do the last one, and I think

I even learned a little.

> >

> > There is a Part IV module now that sort of replicates the Meaning Use data collection. You get to pick several areas of data that you are already, hopefully, collecting for Meaningful Use and you can use the data already collected. The others, such as the

DM one, does take time, about 3 months to complete, since you have to survey your records, make an improvement and then resurvey the patients to see if you made any improvements.

> >

> > BTW,The website was recently changed and is much better. The other thing I can tell you is the ABFP, as opposed to the AAFP, is really on your side, and has tremendous resources to help you. Don't be afraid to call or communicate with the help line.I met

the folks that run this and they are top notch and committed to helping you work through the recert process. The mission of the ABFP is the be sure that the american public can be certain that the family docs who care for them are competent, and now that I

have seen the way the board works, I believe it is a dedicated effort, and not just a punitive process. There are more and better things coming in the next few years.

> >

> > Hope that helps,

> > ________________________________________

> > From:

<mailto:%40yahoogroups.com><mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com><mailto:%40yahoogroups.com>>

[ <mailto:%40yahoogroups.com><mailto:%40yahoogroups.com><mailto: <mailto:%40yahoogroups.com><mailto:%40yahoogroups.com>>]

On Behalf Of Helen Yang [helenwyang@<mailto:helenwyang%40hotmail.com><mailto:helenwyang@<mailto:helenwyang%40hotmail.com>>]

> > Sent: Wednesday, July 27, 2011 8:38 PM

> > To: IMP Group

> > Subject: AAFP SAMs or other Modules

> >

> > Busy with the new IMP, I have done CMEs to keep up the license, but haven't done any of the AAFP modules since the recert. I would have to start doing the Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year track instead of regular

8 years.

> >

> > We use Kereo as the PM system which could track the diagnosis codes (was told so), but could not provide details such as how many DM with A1C at goal, ect

> >

> > Could any of you who have done these modules please share your thoughts about these modules and how much time it may take to get them done? Any thoughts on the PPMs MMIMs NTRIC, PORI modules?

> >

> > Thank you very much for any input.

> >

> > Helen

> >

> > ------------------------------------

> >

> >

[Guest guest]

This is what I know now, as I find out more I will let you know. We met the

psychometrician who is responsible for reviewing and scoring the tests. He is

happy to talk to anyone about the process, this is his hobby and job. They also

look at every question, both before and after the test, and use a much validated

way to determine which questions are valid and which are not. The questions come

from a panel who writes them and they are all reviewed and then used in

experimental tests. Since the statistics are driven by a range of questions,

there are some that are " easy " and some " very difficult " -as in they don't expect

anyone to get them correct. This is the only way to sort out the spread of

" knowledge. " (we can argue again about whether testing on individual items is a

valid way to find out if you are a good family doc later-I am jsut reporting on

how its done.) These questons are not only reviewed once, but each time they are

given, they are reviewed again to be sure the question is asking the correct

thing, and whether the confounders (the incorrect answers are right.) This is

all statistical psychometric talk, but basically they are trying to be sure that

the question are fair, not whether they are too hard or too easy.

Then they array the answers on one axis and the test takers on the other and

look to see whether the results are what they expect. They rank the test takers

from top to bottom and exam every question and likewise can examine every taker

against every question. If they see that those who finish at the top all miss

one question they look to see if the question is valid or if something is wrong

with the question. They will then change the questions for the next time or even

throw out a question. I told that i was worried about newest knowledge and how

that works. For instance, the use of aspirin in DM has recently changed and the

test might contain a question that says it should be used, when information

after the test says no. Due to the detail in their evaluation, they will see

that everyone has the wrong answer, and will look at the question. If the data

and publications have changed they can change the answer and everyone will now

be credited with the right answer.

So, we can argue about whether the test measures what we do, but I now believe

the structure of the test is sound. The other thing they are fairly sure of, but

all the data is that studying for the test is not helpful, since it tests your

thought process more that strick knowledge. Don't forget, passing is only set at

a score of 390, and much of the focus of the test, is to help you know your

weaknesses and where to get more data. For many years the non physicians who

assembled the test believed they could past since they had seen most of the

questions. they finally let them take it and none of them scored more than 5%

correct.

I am not a psychometrcian and do not pretend to know how all this works or plays

into testing what they want to test, but after talking these guys, I felt that

they are giving the best test they can. Now we just need to figure how to also

test for the other things that we fell are more important.

More on that soon.

________________________________________

From:

[ ] On Behalf Of

[edwardsronaldj@...]

Sent: Thursday, August 11, 2011 9:54 PM

To:

Subject: Re: Re: AAFP SAMs or other Modules

Jim, how is the recert exam created? I took it last month and thought it was

way off track. Too many of the questions dealt with topics that are rarely

encountered and that I havent thought about since medical school. What were the

goals of the creators of the exam?

On Thu, Aug 11, 2011 at 10:16 PM, Bleiweiss

> wrote:

Sharlene and ,

Thanks for chimming in.... I too want it to be said again, This is NOT about

bashing Jim our one and only ace in this fox hole probably (are there any others

there with you Jim???). Please try to slug your ways thru to the bottom and read

my last reply.... In the ending I feel I really start to get to the root causes

of most if not almost all of this and other similar problems.... It is a trauma

abuse response of compliance and buying into the horribly painful crap that your

tormentor has been hitting you over the head with day after day, year after

year.... An entire profession that is just about defeated and completely learned

helpless (a form of enviornmentally caused depression and a model from which to

better understand such a thing) by those that have the most to hide no less ill

gottenly gain from all of you... us. This has been my growing hypothesis about

the lack of spine and backbone to stand up for yourself, ourselves in primary

care for quite sometime now....

I believe this theory to be extremely sound and valid and would love to be

able to form means of investigating and testing it's validity and significance.

But if nothing else if each and everyone of you were to start to try to use this

as your perspective from which to view things like P4P, Meaningless Use, Full

and Required, Reward and Punishment but unproven Free Market EMR's and E-Rx'ing

that is choking a very popular program and shutting it down, crashing it... And

possibly because the Rx Vendor Middlemen making the big bucks in the middle are

not doing their job well either (not proven but was floated as part of the

problems, Rx's not being there at local places that faxes worked for the last 10

years for example). Just in general, when ever someone other than a modest sized

doctor in actual practice comes up with some NEW fango'ed HUGE, expensive has

their hands in someone's and usually OURS TOO pockets, or means we work now for

some promise of another " delayed " reward on the otherside... STOP!!!! Question,

and wonder who is this coming from and what are they REALLY after besides my

hard work and my hard earned money off of my practice and profession????

The insurance industry always finds scapegoats to blame no matter what the line

of business or products.... Sure there are always some folks who try to scam the

system and get away with some crap... but the vast majority of folks just want

to file a claim, be helped or made whole and try to get back on with their lives

again.... Most people are NOT scammers and insurance frauds.... What they do to

each and every primary care doctor every day, NOW THAT IS A FRAUD and a crime of

epic porportion for sure.... We are just the most visable and the most

vulnerable victims to be used and abused by this Horribly Unethical Industry

because the gov't set up the playing field so unlevel and unfairly.... We have

almost NO power or clout and they have almost all of it, we have almost NO laws

that protect our interests against them, while they have almost all of the one's

that really count... They hold the purse strings and we never do so it is

Trickle down to us and beg for a meal from them.....

This is a traumatising, abusive, misuse of power and authority relationship and

other players are playing into it for their own less than ideal or ethical

reasons too. Like the CMS and AMA collusion to control the fees in favor of the

AMA favorite children while starving out Cinderella over in the corner and

beating her and emtionally abusing her as well.... But one can never break free

of Gaslighting, Mobbing and other forms of emotional abuse if and until they are

really able to see, accept it for what it is, and then have their eyes open so

they can never again see things the old way... And as with all abuse victims one

of the hardest parts to swallow was your own part in the dysfunctional dance you

were engaged in with your abuser and tormentor... It is hard to accept and hard

to swallow and that pain keeps many abuse victims in denial...

And so it is my firm belief that we are suffering from a profession wide form of

gaslighting, mobbing and abuse.... And one of the Red Flags of Mobbing is that

the person singled out by the group for the abuse (like mass work place abuse of

one person usually started by someone who is competing with them, or is their

boss or one who the victim is in charge of yes, both ways...) is usually pretty

darn GOOD at what they do, there really is very little merit to what is

happening to them once the surface crap is peeled away.... This is the work of

someone or someones who want or feel the need to ruin someone to get them out of

the way for one reason or another....

And so primary care gets to wear the dunce cap and the Cone of Shame, be the

sacrificial lamb and the scapegoat for all these other " Stakeholders " and greedy

leeches... Think about and let me know what you think.... I believe those of you

here are independent enough thinkers to give this a fair shake... Take care and

Be Well.... And Jim I do respect you very, very much... I really do.

Unfortunately because of the board's disconnect, you are our only means of

communicating with them.... That is part of the larger problem.... no

conversation, no meetings across the country, no comment and feedback period, no

long defendable, presentable research project to present showing just how Great

and Valid it is and how wonderful they really are.... Those with great stuff

tend to come out and talk, Show their faces... While those who are affraid and

not sure of themselves, or are not coming from a good, ethical or defendable

place, those kind of folks tend to stay removed and hide... Play Exhaulted

Leader... Demi-God.

>

To:

<mailto: \

>

Sent: Thursday, August 11, 2011 8:14 PM

Subject: Re: AAFP SAMs or other Modules

Jim, For a slightly more abbreviated version of what is saying, below is

a copy of my message to you from 5/24, to which I did not see a response. I'm

really not trying to beat up on you, honestly. It sounds as if you have the best

of intentions and our (small practices') best interests at heart. But your

analogy likening choosing not to fly and choosing not to be board certified is

not fair. You wrote, " I can choose to put up with the TSA and fly, or I can

drive. I can choose to put up with the ABFM, or not be boarded. " I'm sure that

there are some careers where refusing to fly would be the end, but not most, and

certainly not ours. But, since insurance companies have started requiring board

certification to be on their panel of physicians, letting our board cert. lapse

is the equivalent of saying we will never participate with the major insurers

again. Certainly, I would LIKE to say that, but the awful truth is that it is

not financially feasible for most of us. I know for a fact it would spell the

end of my current practice. So, board certification is no longer a marker of

special qualifications, it is a minimum requirement to practice. And it is SO

frustrating when someone comes along and invents a whole new process that is

extremely onerous, yet necessary for us to comply with, at a time when a large

proportion of us beleaguered family docs are already feeling on the verge of

collapse. I am getting chest pain and choked up just typing this, and I guess

that's just what and I want the Board to know. If, as you say, they have

heard all this before, WHY AREN'T THEY LISTENING?!? It appears that we are not

their constituents. I read their last newsletter, in which they claimed to be

listening and responding to our needs, but nothing I saw made anything

significantly easier. I guess I would just like to know that our " insider " is

going to give them that feedback.---Respectfully, Sharlene---

Jim, Please let the Board(ABFM)know that I am absolutely

FURIOUS with them for coming up with such a ridiculously complex and

time-consuming scheme for maintenance of certification!!! Do other specialty

boards put their diplomates through this kind of ordeal? I feel that we ordinary

physicians have been completely sold out by people who must have no idea what a

struggle it is just

to survive in today's practice environment. I have no problem with reading to

keep up with the problems I encounter from day to day, earning some CME credits

of my own choosing, and taking occasional tests. In fact, I would rather take a

day-long test EVERY YEAR than keep up with this MOC!! And I'll bet there is

absolutely no evidence that doing all of this will make us better family

doctors. If I didn't have to be board certified to participate with most

insurance companies, I would absolutely let my certification lapse. And if I

ever go CASH ONLY, which it looks like I will need to, since I have no intention

of becoming part of an ACO, I will definitly drop it!---Sharlene---

> Helen,

> The SAM's come from the ABFP, the AAFP has nothing to do with these. Since I

am now on the ABFP, I can tell you that the board is working to make Part IV

modules more meaningful. For instance giving credit for PQRI, and I am pushing

to give credit for doing Meaningful use. This is very difficult to actualize,

since the behind the scenes work is huge and expensive, but I do believe it will

happen.

>

> The Part !! modules really don't take too much time, if you know how to work

through them. It is much more cost effective to do the 10 year cert than the

lesser, and you will have to change eventually anyway. The purpose of the

Patient simulations is to get everyone ready for them being on the

recertification exam by 2014.

>

> The way I take the SAM's is to just take the test, if you miss a question, you

will directed to the resource where the answer is found and you can review those

questions and then answer them again. Took me a couple of hours to do the last

one, and I think I even learned a little.

>

> There is a Part IV module now that sort of replicates the Meaning Use data

collection. You get to pick several areas of data that you are already,

hopefully, collecting for Meaningful Use and you can use the data already

collected. The others, such as the DM one, does take time, about 3 months to

complete, since you have to survey your records, make an improvement and then

resurvey the patients to see if you made any improvements.

>

> BTW,The website was recently changed and is much better. The other thing I can

tell you is the ABFP, as opposed to the AAFP, is really on your side, and has

tremendous resources to help you. Don't be afraid to call or communicate with

the help line.I met the folks that run this and they are top notch and committed

to helping you work through the recert process. The mission of the ABFP is the

be sure that the american public can be certain that the family docs who care

for them are competent, and now that I have seen the way the board works, I

believe it is a dedicated effort, and not just a punitive process. There are

more and better things coming in the next few years.

>

> Hope that helps,

> ________________________________________

> From:

<mailto:%40yahoogroups.c\

om><mailto:%40yahoogroups.com<mailto:%25\

40yahoogroups.com>><mailto: <mailto:Practicei\

mprovement1%40yahoogroups.com><mailto:%40yahoogroups.com<mai\

lto:%2540yahoogroups.com>>>

[ <mailto:%40yahoogroups.\

com><mailto:%40yahoogroups.com<mailto:%2\

540yahoogroups.com>><mailto: <mailto:Practice\

improvement1%40yahoogroups.com><mailto:%40yahoogroups.com<ma\

ilto:%2540yahoogroups.com>>>] On Behalf Of Helen Yang

[helenwyang@...<mailto:helenwyang%40hotmail.com<mailto:helenwyang%2540hotmail.co\

m>><mailto:helenwyang@<mailto:helenwyang@>...<mailto:helenwyang%40hotmail.com<ma\

ilto:helenwyang%2540hotmail.com>>>]

> Sent: Wednesday, July 27, 2011 8:38 PM

> To: IMP Group

> Subject: AAFP SAMs or other Modules

>

> Busy with the new IMP, I have done CMEs to keep up the license, but haven't

done any of the AAFP modules since the recert. I would have to start doing the

Part II SAMs Modules and /or Part IV modules in order to stay on the 10 year

track instead of regular 8 years.

>

> We use Kereo as the PM system which could track the diagnosis codes (was told

so), but could not provide details such as how many DM with A1C at goal, ect

>

> Could any of you who have done these modules please share your thoughts about

these modules and how much time it may take to get them done? Any thoughts on

the PPMs MMIMs NTRIC, PORI modules?

>

> Thank you very much for any input.

>

> Helen

>

> ------------------------------------

>

>

[Guest guest]

Jim maybe it got lost in the sheer volume of emails that you receive, but I sent you an email with a few attachments showing how HYH would work as a module with demonstration numbers and explaining the problem with validation " evidence based" as they term it on the application on the application, and asking if you had any ideas as to how to phrase the evidence based parts of the application.Let me know if I should re send.thanksLynn HoTo: From: jim.kennedy@...Date: Mon, 15 Aug 2011 22:16:39 -0600Subject: RE: AAFP SAMs or other Modules

Gordon,

I got some response to my questions about hyh as part IV. Two things. Mike says that they were working with Starfield before she died, to determine how to create a part IV, and they want to know if HYH is validated. Secondly, there is a big push to create self-directed improvement modules by the end of the year, so I believe there is reason to think this could happen. Give me more information on validation, and whether you were thinking about this would work as a module. I will pass it on.

________________________________________

From: [ ] On Behalf Of L. Gordon [gmoore@...]

Sent: Tuesday, August 09, 2011 12:36 PM

To:

Subject: Re: AAFP SAMs or other Modules [1 Attachment]

A more important underlying issues is the degree of match between current data sets and overall outcomes.

Most quality measurement focuses on disease and organ systems. This approach can lead to rewarding improvements in organ system management but often fail to address more important outcomes. The hypothesis that disease management translates to overall improvement in care delivery has not been demonstrated. Moreover, there is a wealth of evidence that overall population health improvement is based on good primary care delivery. This is not the same thing as disease management, and in fact our continued quality emphasis on disease states and organ systems keeps our focus narrow while we miss the big picture.

Primary care is defined as the presence of four cardinal components:

First point of contact (access)

Person-focused relationship over time

Comprehensive services

Care coordination

When done well, population health outcomes improve, disease states improve, patient experience improves, total cost of care improves.

The ABFM can help the country re-orient measurement to focus on what really matters. Barbara Starfield laid this out very well in her FPM editorial of 2009<http://www.aafp.org/online/en/home/publications/journals/fpm/opinion.html>.

We don't give up measuring things like A1c, pneumovax, etc, but we cannot let these small measures squeeze out measures of how well we deliver on primary care key performance indicators (access, person-focused relationship, comprehensiveness, care coordination).

The IMP self-assessment recognition program focuses on the broad themes, is accessible to small independent as well as large practices, and is much more aligned with the real value of primary care.

We should not continue to follow a broken paradigm just because it is familiar and touted by experts.

Gordon