Re: AAFP SAMs or other Modules [1 Attachment]

August 9, 2011

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

August 10, 2011

I concur totally with this, and it is important. I did bring this idea up at the

last meeting and we will see where this path leads. Change is slow at this

level, but certainly not impossible.

________________________________________

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

August 16, 2011

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.