Re: Forming Organized Group

[Guest guest]

A more formal group is an attractive option requiring careful

consideration. The U.S. has seen some very successful groups of

common business come together. Dairy farmers in some parts of the

U.S. came together to form cooperatives for the processing of their

milk, reducing some middleman expenses. Some cattle ranchers have a

group to market U.S. beef. We could create a group that supports the

work we do and helps us move past the one size fits all contracts we

are offered by EHR vendors, insurers, vaccine distributors and the like.

If we pursue such a group we must avoid creating another structure

that lives off of our backs and eventually crushes us. We have to

find a way to create group support with an acceptable burden.

We must avoid some of the unfortunate doctor group behavior of the

past - physicians negotiating as a group for increased payment with

no demonstrable improvement in quality. If we build such a group,

let it not re-create the guilds that negotiate only to protect income.

Let us negotiate for new payment mechanisms that better reflect the

work we can and should be doing to improve the outcomes for those we

serve. Payment mechanisms that make it affordable for us to take the

time to build the trusting relationships that are the foundation of

good health care. Payments that cover the new tools and team members

we need to perform superb outreach to patient who struggle with

follow-through, that support the measurement systems that tell us

where we have opportunities to improve our work and make it

affordable for us to make real and lasting changes to close gaps in

our performance. This " pay for structure " approach gets past

concerns regarding the dumping of sick patients or the desire to

serve populations with historically poor outcomes.

Let the key elements of structure be those that have been shown to

lead to improved population health and lower total cost of

care. These elements are not obscure. We can reliably measure them

down to the level of the individual physician. (Wasson JH,

DJ, R, , J, MacKenzie TA. Patients Report Positive

Impacts of Collaborative Care, Journal of Ambulatory Care Management

Vol 29, No 3, pp. 201-208)

The measures can point out opportunities for improvement, and we have

created a curriculum that physicians can use to close those

performance gaps. ( LG, Wasson JH, DJ, Zettek, J. The

Emergence of Ideal Micro Practices for Patient-centered Collaborative

Care. Journal of Ambulatory Care Management Vol 29, No 3, pp. 215-221)

We need new payment models and we need to adequately invest in

primary care to reduce our dependence on the costly " clean up the

mess " strategy we have pursue for so long. Excellent, caring doctors

pursue many paths to discover the means to support the kind of care

that makes them proud of their profession: we see examples of Robin

Hood practices, practices offering special services to those who

willing to pay extra, practices that must suffer the heavy yoke of

inept employers so that they may continue to serve those who might

otherwise have to join the growing legions of uninsured.

We must work towards a better system. Let us join together. Let us

stand up for those we serve, asking for a system of payment for the

right work and let us be rewarded for having in place those

components of practice known to lead to better care, but before we

ask for more money, let us show our willingness to put our houses in order.

For group negotiation to be honorable it must be in the context of

creating better outcomes that lower the total cost of health

care. There is overwhelming evidence that per capita health care

costs in the U.S. are the highest in the world yet many measures of

population health puts the U.S. on par with developing countries. In

spite of our expenditures we continue to live with health care

disparities that are the shame of our nation.

Let there be an organization that can negotiate en bloc for better

electronic systems, that can push back on outrageous policies of

insurers, employers and governments that are willing to sacrifice

population health for short term profits to satisfy wall street or

narrow special interest groups.

Before any practice steps up and demands more health care dollars,

let it demonstrate its willingness to put its house in order. Let it

demonstrate that it has and/or is implementing the key structural

elements. I willingly add my voice to those who call for such

transparency and demonstration of value.

Gordon

At 08:49 PM 1/3/2007, you wrote:

>I agree with 's comment about starting some sort of company. In

>reading the messages on this group and seeing all of the individuals

>trying to maintain low overhead, it is apparent that being organized as

>one entity in some fashion could help with bargaining power. For instance,

>getting contracts with EMR's, suppliers/vendors, appointment quest,

>instant medical history, web site maint., Updox, etc. I know this may be

>against the ideal of " solo-solo " but we all know basic economics

>(supply/demand). It reminds me of when I was getting married, I bumped

>into a girl from high school who was getting married the week before me.

>We went together to florists, photographers, limos, etc. and we got better

>prices because we told them they were getting 2 customers at the same time

>instead of 1.

>

>My two cents,

>Margaret Coughlan

>(joining a solo practice next month, hoping to adopt ideals/practices from

>this group)

>

> > Lou:

> >

> > You are right on target, but why should you have to use such energy on

> > all these activities. We need to go one step higher in our thinking

> > at providing this service to physicians who want to use it to see

> > patients. Could we somehow start a company for providing all these

> > services cost effectively so all the physician had to do was see the

> > patient, document visit, and leave the room. When this is possible,

> > waves of physicains will adopt IT and move away from traditional

> > practice.

> >

> >

> >

> > P.S. I agree with your topics. We will need to transform medicine in

> > stages.

> >

[Guest guest]

From Drain, Oregon I agree Gordon. We must BE CAREFUL. One of my old friends wrote down a natural history of consumer oriented grass-roots organizations. It was cute and took about fifteen steps, but at the end the organization was the same as the one it supplanted. Why? Well, she said "you just follow the money". When money is given to any group, sooner or later it comes with strings, gets a chairman or a leader or a board with a top man, and that man is responsible to whoever gives the money. He tends to be hired because he acts like the people with the money. He tends to create "accountability" and select people who act like him to help him. Over time there gets to be a hierarchy, and the hierarchial system is the antithesis to creative variability. Your idea of the model of the dairy cooperative is a good one. For those of you in the big city, a dairy cooperative is a group of people who create an organization which is dedicated to helping the production goals of the independant dairy man; it may have a separate store which has things for sale cheap if you are a member of the cooperative, but which sells the things at full price to the rest of the world at normal prices. Gas sells to the dairyman without the station markup. You can shop at a dairy cooperative store and be sure of finding horn weights and milking sieves...but your price will be the market price unless you are a member. If you want a horn weight, you will still be delighted, because the things are hard to find and only a dairy cooperative would bother to keep them in stock. The dairy man is even more delighted, because he is able to get the things

at low price. The dairy cooperative does not set standards, or test milk contamination. That stuff is someone elses business, or else is managed by the personal style of the dairyman. Enough of the cow perspective: if you are ever in Drain, stop by for a cup of fresh milk. Joanne MD/DVM "L. Gordon " wrote: A more formal group is an attractive option requiring careful consideration. The U.S. has seen some very successful groups of common business come together. Dairy farmers in some parts of the U.S. came together to form cooperatives for the processing of their milk, reducing some middleman expenses. Some cattle ranchers have a group to market U.S. beef. We could create a group that supports the work we do and helps us move past the one size fits all contracts we are offered by EHR vendors, insurers, vaccine distributors and the like.If we pursue such a group we must avoid creating another structure that lives off of our backs and eventually crushes us. We have to find a way to create group support with an acceptable burden.We must avoid some of the unfortunate doctor group behavior of the past - physicians negotiating as a group for increased payment with

no demonstrable improvement in quality. If we build such a group, let it not re-create the guilds that negotiate only to protect income.Let us negotiate for new payment mechanisms that better reflect the work we can and should be doing to improve the outcomes for those we serve. Payment mechanisms that make it affordable for us to take the time to build the trusting relationships that are the foundation of good health care. Payments that cover the new tools and team members we need to perform superb outreach to patient who struggle with follow-through, that support the measurement systems that tell us where we have opportunities to improve our work and make it affordable for us to make real and lasting changes to close gaps in our performance. This "pay for structure" approach gets past concerns regarding the dumping of sick patients or the desire to serve populations with historically poor outcomes.Let

the key elements of structure be those that have been shown to lead to improved population health and lower total cost of care. These elements are not obscure. We can reliably measure them down to the level of the individual physician. (Wasson JH, DJ, R, , J, MacKenzie TA. Patients Report Positive Impacts of Collaborative Care, Journal of Ambulatory Care Management Vol 29, No 3, pp. 201-208)The measures can point out opportunities for improvement, and we have created a curriculum that physicians can use to close those performance gaps. ( LG, Wasson JH, DJ, Zettek, J. The Emergence of Ideal Micro Practices for Patient-centered Collaborative Care. Journal of Ambulatory Care Management Vol 29, No 3, pp. 215-221)We need new payment models and we need to adequately invest in primary care to reduce our dependence on the costly "clean up the mess" strategy we have pursue for so

long. Excellent, caring doctors pursue many paths to discover the means to support the kind of care that makes them proud of their profession: we see examples of Robin Hood practices, practices offering special services to those who willing to pay extra, practices that must suffer the heavy yoke of inept employers so that they may continue to serve those who might otherwise have to join the growing legions of uninsured.We must work towards a better system. Let us join together. Let us stand up for those we serve, asking for a system of payment for the right work and let us be rewarded for having in place those components of practice known to lead to better care, but before we ask for more money, let us show our willingness to put our houses in order.For group negotiation to be honorable it must be in the context of creating better outcomes that lower the total cost of health care. There is overwhelming

evidence that per capita health care costs in the U.S. are the highest in the world yet many measures of population health puts the U.S. on par with developing countries. In spite of our expenditures we continue to live with health care disparities that are the shame of our nation.Let there be an organization that can negotiate en bloc for better electronic systems, that can push back on outrageous policies of insurers, employers and governments that are willing to sacrifice population health for short term profits to satisfy wall street or narrow special interest groups.Before any practice steps up and demands more health care dollars, let it demonstrate its willingness to put its house in order. Let it demonstrate that it has and/or is implementing the key structural elements. I willingly add my voice to those who call for such transparency and demonstration of value.GordonAt 08:49 PM 1/3/2007, you

wrote:>I agree with 's comment about starting some sort of company. In>reading the messages on this group and seeing all of the individuals>trying to maintain low overhead, it is apparent that being organized as>one entity in some fashion could help with bargaining power. For instance,>getting contracts with EMR's, suppliers/vendors, appointment quest,>instant medical history, web site maint., Updox, etc. I know this may be>against the ideal of "solo-solo" but we all know basic economics>(supply/demand). It reminds me of when I was getting married, I bumped>into a girl from high school who was getting married the week before me.>We went together to florists, photographers, limos, etc. and we got better>prices because we told them they were getting 2 customers at the same time>instead of 1.>>My two cents,>Margaret Coughlan>(joining a solo practice

next month, hoping to adopt ideals/practices from>this group)>> > Lou:> >> > You are right on target, but why should you have to use such energy on> > all these activities. We need to go one step higher in our thinking> > at providing this service to physicians who want to use it to see> > patients. Could we somehow start a company for providing all these> > services cost effectively so all the physician had to do was see the> > patient, document visit, and leave the room. When this is possible,> > waves of physicains will adopt IT and move away from traditional> > practice.> >> > > >> > P.S. I agree with your topics. We will need to transform medicine in> > stages.> > __________________________________________________

[Guest guest]

That was a Moo..vahlous explanation of the dairy cooperative.

I agree with not reinventing another bureaucracy. Sometime back, one

of the members of this listserv who is not a member of the AAFP asked

me what was in it for him (okay-that narrows it down to about half

the listserv). Quite honestly, I could not come up with an answer.

But perhaps, if the AAFP at some point starts to point out that not

everyone is created equal and that this group like everyone in Lake

Wobegon is above average and is starting to prove it and deserves to

get paid better for it etc. etc., would not that be something to

see. Perhaps that's a battle worth fighting.

Okay, one more --

What happened to the cow who jumped over the fence?

...... udder destruction

Okay-that's the end of my cow jokes I'll go graze now.

>

> >I agree with 's comment about starting some sort of company.

In

> >reading the messages on this group and seeing all of the

individuals

> >trying to maintain low overhead, it is apparent that being

organized as

> >one entity in some fashion could help with bargaining power. For

instance,

> >getting contracts with EMR's, suppliers/vendors, appointment quest,

> >instant medical history, web site maint., Updox, etc. I know this

may be

> >against the ideal of " solo-solo " but we all know basic economics

> >(supply/demand). It reminds me of when I was getting married, I

bumped

> >into a girl from high school who was getting married the week

before me.

> >We went together to florists, photographers, limos, etc. and we

got better

> >prices because we told them they were getting 2 customers at the

same time

> >instead of 1.

> >

> >My two cents,

> >Margaret Coughlan

> >(joining a solo practice next month, hoping to adopt

ideals/practices from

> >this group)

> >

> > > Lou:

> > >

> > > You are right on target, but why should you have to use such

energy on

> > > all these activities. We need to go one step higher in our

thinking

> > > at providing this service to physicians who want to use it to

see

> > > patients. Could we somehow start a company for providing all

these

> > > services cost effectively so all the physician had to do was

see the

> > > patient, document visit, and leave the room. When this is

possible,

> > > waves of physicains will adopt IT and move away from traditional

> > > practice.

> > >

> > >

> > >

> > > P.S. I agree with your topics. We will need to transform

medicine in

> > > stages.

> > >

>

>

>

>

>

> __________________________________________________

>