Re: Article on Medical Home

[Guest guest]

I've been watching and reading the NCQA approach to office practice

quality measurement with interest.

I'm glad that there is a framework for office practice quality (wrapped

up in medical home lingo). It is an important and helpful effort

that advances the field of office pratice quality.

I worry that the burden of measurement in this paradigm is likely to be

high and I've yet to see any payment that even comes close to the costs

involved in measuring and reporting in this format. I worry that

this will be another unfunded mandate, another nail in the coffin of

primary care.

Let's take the example of measuring access.

NCQA framework:

http://web.ncqa.org/tabid/631/Default.aspx (click on

PPC-PCMH Summary )

Under " Standard 1: Access & Communication " we find

" must pass " elements:

A. Has written standards for

patient access and patient

communication**

B. Uses data to show it meets its standards for patient

access and communication**

These are quite reasonable on their face, as elimination of

barriers to access can improve patient follow through on chronic

conditions and preventive health.

The problem I have is that the proof of " A. Has written

standard... " is a written standard. Why waste the

time? The meaningful data is all in " B. Uses data to

show it meets the standard " Yet a practice must have A or it

loses 4 out of 9 points. The ultimate data is patient experience of

care. Patients report if they have good access. I use

HowsYourHealth to get this information, though practices could chose any

structured and validated instrument.

Why should I have to prove " a written standard " when 77.78%

report " very easy access " in my practice in 2007? I know

that it is simple to cook up a written standard, but when will we stop

chasing administrative trivia?

Even though we have many examples of process improvement failing to lead

to improved outcomes, the NCQA approach is rich with process measures

that are laborious and costly to track. We must have means of

measurement accessible to solo and small practices or once again we

disenfranchise 50% of the practices in the U.S.

Where patient report has been validated, let that be the quality metric

of choice.

I want to spend my time improving patient care and less time chasing data

that are weak indicators of the work I do.

I want to improve patient experience of care and clinical outcomes and

spend less time in the exhausting administrative trivia contests inherent

in the current approaches to pay for performance.

Gordon

At 09:18 PM 12/23/2007, you wrote:

You have received this Elsevier

Health Periodicals email from:

Charlie Vargas

vargasca1@...

Hi, Yall, and Merry Christmas,

I read this article and wanted to share it with you. There are some

criteria that I think our IMP model is well suited to accomodate. What do

you think about this and other criteria that we have discussed?

It is doable, but I have some work to do, still.

Thanks,

Charlie Vargas

lin, NC

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

Abstracts are available to the general public:

Metrics Chart Plan for Medical Home

by

Family Practice News (Vol. 37, Issue 23,

Page1)

http://www.familypracticenews.com/article/PIIS0300707307713828/abstract?source=aemf

Note: Abstracts may be read by the general public. Full-text articles may

be read by subscribers and individuals who purchase access to the

individual article. Instructions on how to activate your subscription or

purchase this individual may be found by clicking the Full Text link in

the upper right corner of any abstract at the website.

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

Elsevier Health Periodicals respects your privacy and does not disclose

or sell your personal information to any unaffiliated third parties

without your consent. Our privacy policy may be viewed at .

Please do not reply to this message. For all inquiries, problems or

suggestions regarding this service, please contact us.

Elsevier Inc.

[Guest guest]

Written policy -- pt calls and gets appt or doc sends to er, call goes to whom in the office

Data showing that calls result in appts or refills or treatments?

If this is the "future" of primary care, I'm sure that more and more health care dollars can be spent "monitoring the process" and developing datapoints.

Just like "pay for Performance" articles have shown, so far, that the cost to a practice is GREATER THAN the premium delivered to the practice for the care to DO THE PROJECT.

Does this really really help?

Does NCQA really really think this will IMPROVE the process? Or lead to development of more computerized tracking systems to show the process.

Shouldn't something be broken before you have to prove how to "do it right?"

Is this process going to "improve" access to care?

Gordon -- you're in the academic community, tell me how favorable these NCQA guidelines will be received?

Matt in Western PA

Re: Article on Medical Home

I've been watching and reading the NCQA approach to office practice quality measurement with interest.I'm glad that there is a framework for office practice quality (wrapped up in medical home lingo). It is an important and helpful effort that advances the field of office pratice quality.I worry that the burden of measurement in this paradigm is likely to be high and I've yet to see any payment that even comes close to the costs involved in measuring and reporting in this format. I worry that this will be another unfunded mandate, another nail in the coffin of primary care.Let's take the example of measuring access.NCQA framework: http://web.ncqa.org/tabid/631/Default.aspx (click on PPC-PCMH Summary )Under "Standard 1: Access & Communication" we find "must pass" elements:A. Has written standards for patient access and patientcommunication**B. Uses data to show it meets its standards for patientaccess and communication**These are quite reasonable on their face, as elimination of barriers to access can improve patient follow through on chronic conditions and preventive health.The problem I have is that the proof of "A. Has written standard..." is a written standard. Why waste the time? The meaningful data is all in "B. Uses data to show it meets the standard" Yet a practice must have A or it loses 4 out of 9 points. The ultimate data is patient experience of care. Patients report if they have good access. I use HowsYourHealth to get this information, though practices could chose any structured and validated instrument.Why should I have to prove "a written standard" when 77.78% report "very easy access" in my practice in 2007? I know that it is simple to cook up a written standard, but when will we stop chasing administrative trivia?Even though we have many examples of process improvement failing to lead to improved outcomes, the NCQA approach is rich with process measures that are laborious and costly to track. We must have means of measurement accessible to solo and small practices or once again we disenfranchise 50% of the practices in the U.S.Where patient report has been validated, let that be the quality metric of choice. I want to spend my time improving patient care and less time chasing data that are weak indicators of the work I do. I want to improve patient experience of care and clinical outcomes and spend less time in the exhausting administrative trivia contests inherent in the current approaches to pay for performance.GordonAt 09:18 PM 12/23/2007, you wrote:

You have received this Elsevier Health Periodicals email from:Charlie Vargasvargasca1verizon (DOT) netHi, Yall, and Merry Christmas,I read this article and wanted to share it with you. There are some criteria that I think our IMP model is well suited to accomodate. What do you think about this and other criteria that we have discussed?It is doable, but I have some work to do, still.Thanks,Charlie Vargaslin, NC--------------------------------------------------------------Abstracts are available to the general public:Metrics Chart Plan for Medical Homeby Family Practice News (Vol. 37, Issue 23, Page1) http://www.familypracticenews.com/article/PIIS0300707307713828/abstract?source=aemf Note: Abstracts may be read by the general public. Full-text articles may be read by subscribers and individuals who purchase access to the individual article. Instructions on how to activate your subscription or purchase this individual may be found by clicking the Full Text link in the upper right corner of any abstract at the website.--------------------------------------------------------------------------Elsevier Health Periodicals respects your privacy and does not disclose or sell your personal information to any unaffiliated third parties without your consent. Our privacy policy may be viewed at .Please do not reply to this message. For all inquiries, problems or suggestions regarding this service, please contact us. Elsevier Inc.

[Guest guest]

Only time will tell how well these metrics will be received .

G

At 12:25 PM 12/30/2007, you wrote:

Written policy --

pt calls and gets appt or doc sends to er, call goes to whom in the

office

Data showing that calls result in appts or refills or

treatments?

If this is the " future " of primary care, I'm sure

that more and more health care dollars can be spent " monitoring the

process " and developing datapoints.

Just like " pay for Performance " articles have

shown, so far, that the cost to a practice is GREATER THAN the premium

delivered to the practice for the care to DO THE PROJECT.

Does this really really help?

Does NCQA really really think this will IMPROVE the

process? Or lead to development of more computerized tracking

systems to show the process.

Shouldn't something be broken before you have to prove how

to " do it right? "

Is this process going to " improve " access to

care?

Gordon -- you're in the academic community, tell me how

favorable these NCQA guidelines will be received?

Matt in Western PA

Re: Article on Medical

Home

I've been watching and reading the NCQA approach to office practice

quality measurement with interest.

I'm glad that there is a framework for office practice quality

(wrapped up in medical home lingo). It is an important and helpful

effort that advances the field of office pratice quality.

I worry that the burden of measurement in this paradigm is likely to

be high and I've yet to see any payment that even comes close to the

costs involved in measuring and reporting in this format. I worry

that this will be another unfunded mandate, another nail in the coffin of

primary care.

Let's take the example of measuring access.

NCQA framework:

http://web.ncqa.org/tabid/631/Default.aspx (click on

PPC-PCMH Summary )

Under " Standard 1: Access & Communication " we find

" must pass " elements:

A. Has written standards for

patient access and patient

communication**

B. Uses data to show it meets its standards for patient

access and communication**

These are quite reasonable on their face, as elimination of barriers

to access can improve patient follow through on chronic conditions and

preventive health.

The problem I have is that the proof of " A. Has written

standard... " is a written standard. Why waste the

time? The meaningful data is all in " B. Uses data to

show it meets the standard " Yet a practice must have A or it

loses 4 out of 9 points. The ultimate data is patient experience of

care. Patients report if they have good access. I use

HowsYourHealth to get this information, though practices could chose any

structured and validated instrument.

Why should I have to prove " a written standard " when 77.78%

report " very easy access " in my practice in 2007? I know

that it is simple to cook up a written standard, but when will we stop

chasing administrative trivia?

Even though we have many examples of process improvement failing to

lead to improved outcomes, the NCQA approach is rich with process

measures that are laborious and costly to track. We must have means

of measurement accessible to solo and small practices or once again we

disenfranchise 50% of the practices in the U.S.

Where patient report has been validated, let that be the quality

metric of choice.

I want to spend my time improving patient care and less time chasing

data that are weak indicators of the work I do.

I want to improve patient experience of care and clinical outcomes

and spend less time in the exhausting administrative trivia contests

inherent in the current approaches to pay for performance.

Gordon

At 09:18 PM 12/23/2007, you wrote:

You have received this Elsevier Health Periodicals email from:

Charlie Vargas

vargasca1@...

Hi, Yall, and Merry Christmas,

I read this article and wanted to share it with you. There are some

criteria that I think our IMP model is well suited to accomodate. What do

you think about this and other criteria that we have discussed?

It is doable, but I have some work to do, still.

Thanks,

Charlie Vargas

lin, NC

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

Abstracts are available to the general public:

Metrics Chart Plan for Medical Home

by

Family Practice News (Vol. 37, Issue 23, Page1)

http://www.familypracticenews.com/article/PIIS0300707307713828/abstract?source=aemf

Note: Abstracts may be read by the general public. Full-text articles

may be read by subscribers and individuals who purchase access to the

individual article. Instructions on how to activate your subscription or

purchase this individual may be found by clicking the Full Text link in

the upper right corner of any abstract at the website.

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

Elsevier Health Periodicals respects your privacy and does not

disclose or sell your personal information to any unaffiliated third

parties without your consent. Our privacy policy may be viewed at

..

Please do not reply to this message. For all inquiries, problems or

suggestions regarding this service, please contact us.

Elsevier Inc.