Ok, I'll start out with a cheat sheet on the important issues and "asks" that we brought to Capitol Hill today. There was a definite sense of urgency to act, and our proposals focused on opportunities to incentivize primary care, without significant budgetary increases.
1) Fix the SGR. Stop kicking the can down the road and get realistic payment stability.
2) In regards to GME, consider a model that would secure a portion of funds specifically to primary care community and out-patient residency facilities.
3) Encourage investment in Title VII funding (specifically section 747) and further support for National Health Service Corps
4) Decrease the gap that exists between primary care and specialty salaries
Now for some reflections on the issues and discussions for family medicine here in Washington, D.C. at the FMCC:
7:00am: Wow, breakfast buffet is great! The AAFP really takes care of their own. Next, I walk into a room of over 200 family doctors convened and eager to descend on Capitol hill tomorrow and breakfast becomes an afterthought. Talk about wow - I'm speechless. I wish every medical student could be here for this program and for the good of the future of medicine.
Hot issues:
Monday, 8am: Models, models, model. You'd think with all the talk of models, their would be a Paris runway close by. Then again, I wouldn't complain if some Hawaiian tropic spokespeople walked through the doors right now.
In all seriousness, there is so much talk of models and systems. I can see that this sort of dialogue is important, as a means of establishing a strong foundation. The reality is that a 400+ pg proposal has been put forward, and we are still in the comment period prior to the final product. But the frustrating aspect is that family physicians function at the ground floor of health care delivery. Its tough to listen to mostly generalized and broad goals, when we all know how important the details really are. I do very much look forward to the proverbial "meat" at the heart of these proposed systems. I am eager to move forward and to see how these models function and to see them in place.
10am: AMA question and answer forum. This session quickly turned into a soundboard for comments. This tells me that family docs know the facts, and are more prepared to have their voice heard than the need to have questions answered. The people in this room have done their homework, and family doctors are hungry for parity and a successful balance in medicine. I'm encouraged by all of this discussion.
11am: Robert Phillips, MD, Director Robert Graham Center. This man is a visionary and his poise is inspirational. He first offers the difference between "Reducing costs vs restraining costs". This a perspective that isn't often considered. Everyone is looking for ways to lower cost, when in fact we should be looking for opportunity to curb spending growth.
Workplace continues to be framed in terms of supply and demand. Figures are often thrown around at the national level that "this many tens of thousands" of physician workforce shortage. The paradigm shift on this is to consider the implications of physician distribution. In fact, when you look at physician demographics, it is apparent that the number of physicians serving in areas of excess could cover the areas that demonstrate a shortage.
That said, it seems that the focus has shifted away from workforce and on to economic impact. That is fantastic news for the primary care front - their is amazing data on the number of local jobs, the economic impact, and cost effectiveness of family physicians. Most importantly, it has been shown that an increase in family physicians in a community led to a correlative decrease in readmissions. Every other specialty showed increases in readmissions with increased workforce in community.
Thought: data, data, charts, graphs and data. Proof and facts are the name of the game in directing change.
One thing that really sticks out to me is the continual rhetoric and future tense employed by many speakers. It seems that words such as "planning", "committee" "considering" "taking suggestions" "reviewing proposals" far outweigh any directions or indication of activity. Right now its a waiting and planning, and few seem to want to take the first step. Which is counter intuitive to the needs of medicine. We have an outmoded system that is functioning on an outdated payment schedule. In order to meet the demands of the modern health care climate, we need to stop the rhetoric and start the reaction. It was clear from the medical student voice, that we demand as quick resolve to act as any group.
2pm: Panel on health reform movement. After spending the better part of the past year and a half focused on health reform, it seems that their is a general health care fatigue on Capitol Hill. On top of this, the magnitude of the funding deficit makes any movement in the positive direction extremely challenging.
Two of the COGME recommendations that struck me: to adequately meet the needs of American health care, it is recommended that the physician workforce be composed of at least 40 percent primary care. The second recommendation was to encourage enhancement in medical school social accountability in training. See my most recent post on this site for some of my thoughts that are right in line with this.
Some other random thoughts:
1). Check out Wellmed a non-hospital aco based in san antonio that is producing outlier numbers in reduced mortality, cost saving, and family physician salaries. (http://www.wellmedmedicalgroup.com/)
2). Its inspiring to meet and see all of the energetic and engaged medical students here. Debt is a huge issue, but these passionate students are willing to sacrifice for the goals of primary care. More apparent is the medical student urge for activity. We are saying, we can't wait, we can't put things off - we need to act now.
Showing posts with label ACO. Show all posts
Showing posts with label ACO. Show all posts
Saturday, 5 July 2014
Leading New Models of Practice - Accountable Care Organizations
ACO - the newest mysterious acronym from Washington. Just when most of us were getting familiar with the last big organizing acronym, PCMH. Maybe we weren't actually familiar with the 7 joint principles of the Patient-Centered Medical Home (PCMH) and their implications, but we were at least getting comfortable throwing the term around in discussions, networking sessions and conferences, hoping that no one would ever ask us: "So, what is a PCMH?" Now we've been hearing about the Accountable Care Organization (ACO)... is this just the newest street language in health policy or is there more to it than that?
Last Wednesday, I attended a full-day workshop sponsored by the Society of Teachers of Family Medicine on the ACO. We started by reviewing the basic premise of the PCMH: central places to coordinate care focused on patients’ needs and relationship-building. Industry leaders who were fed up with poor care options in America created the concept of the PCMH, which was jointly supported by all national primary care organizations. The PCMH model emphasizes a strong primary care foundation in which primary care providers take responsibility for providing, coordinating and integrating care across the health care continuum. Pilots of the PCMH have shown improvements in quality and reductions in spending when implemented in large provider settings.
The conceptualization of ACOs is separate from the PCMH but there are many parallels. ACOs are organizations that can use payments:
You may be thinking right now - this all sounds great. But what you've given me is a bunch of fancy concepts. Where are the examples? Well, the answer is that there aren't really any good examples yet. The ACO is a new model that was outlined in the Affordable Care Act. ACO rules were just released last month by the Center of Medicare and Medicaid Services (CMS). These rules are still open for comments until June 6, 2011 and then are to be implemented by January 1, 2012. Providers and hospitals at that point can apply to be ACOs.
What does this mean for family medicine and for the PCMH model that we helped develop?
It’s an opportunity to get involved! The weakness of the PCMH model is that there is no incentive for specialists and hospitals to get involved because they don’t participate in the savings. Secondly, there’s little financial incentive for even primary care doctors to get involved because the money saved on emergency room visits, tests and procedures isn’t reflected directly in the pocketbooks of primary care doctors unless payment structures are transformed from the traditional fee-for-service to more innovative payment mechanisms. The ACO model helps align these incentives to achieve much of what the PCMH model desires.
However, the ACO model makes no explicit mention of the centrality of primary care. As future primary care doctors, we must lead in the development and implementation of ACOs if we are to remain relevant in the 21st century and to continue serving our patients.
Last Wednesday, I attended a full-day workshop sponsored by the Society of Teachers of Family Medicine on the ACO. We started by reviewing the basic premise of the PCMH: central places to coordinate care focused on patients’ needs and relationship-building. Industry leaders who were fed up with poor care options in America created the concept of the PCMH, which was jointly supported by all national primary care organizations. The PCMH model emphasizes a strong primary care foundation in which primary care providers take responsibility for providing, coordinating and integrating care across the health care continuum. Pilots of the PCMH have shown improvements in quality and reductions in spending when implemented in large provider settings.
The conceptualization of ACOs is separate from the PCMH but there are many parallels. ACOs are organizations that can use payments:
- to incentivize physicians and hospitals to provide care coordination,
- to invest in infrastructure and redesign care processes and
- to provide high-quality and efficient services.
You may be thinking right now - this all sounds great. But what you've given me is a bunch of fancy concepts. Where are the examples? Well, the answer is that there aren't really any good examples yet. The ACO is a new model that was outlined in the Affordable Care Act. ACO rules were just released last month by the Center of Medicare and Medicaid Services (CMS). These rules are still open for comments until June 6, 2011 and then are to be implemented by January 1, 2012. Providers and hospitals at that point can apply to be ACOs.
What does this mean for family medicine and for the PCMH model that we helped develop?
It’s an opportunity to get involved! The weakness of the PCMH model is that there is no incentive for specialists and hospitals to get involved because they don’t participate in the savings. Secondly, there’s little financial incentive for even primary care doctors to get involved because the money saved on emergency room visits, tests and procedures isn’t reflected directly in the pocketbooks of primary care doctors unless payment structures are transformed from the traditional fee-for-service to more innovative payment mechanisms. The ACO model helps align these incentives to achieve much of what the PCMH model desires.
However, the ACO model makes no explicit mention of the centrality of primary care. As future primary care doctors, we must lead in the development and implementation of ACOs if we are to remain relevant in the 21st century and to continue serving our patients.
Subscribe to:
Posts (Atom)