Re: Value for health care $

[Guest guest]

Perhaps the answer is in your references ... but is " excellent primary

care " essential? Is there a level below this .. such as " good enough

primary care " that will deliver effectively as good a result. I am

thinking of the law of diminishing returns. Or, is that how the

insurance companies think ?

> We know from the IMP project that the current payment models are inadequate

> to the work of excellent primary care. We must move beyond volume based

> payment models that inadequately fund the right work.

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

The good news is that we have so much room for improvement that we're a

long way from diminishing returns.(1)

There have always been exceptional docs who can pull off amazing things,

but we need (as I think you point out) improvement accessible to

all.

One key goal of our IMP project has been to make " excellence "

accessible to the average doc and not just the exceptional.

We've seen that the volunteer participants in the IMP project have been

able to test and implement a curriculum that leads to improvement (you

can download an overview of the curriculum by clicking on " Breathing

room and curriculum " on

www.IdealMedicalPractices.org).

Contrary to literature that indicates that solo and small practice docs

are unlikely (and in the opinion of many - unable and/or unwilling) to

measure and improve quality (2), we've demonstrated that solo and small

practices are more facile at adopting a quality agenda and achieving

significant improvement.(3) and (4)

We're now making the case that improved quality takes tools and time that

are inaccessible to practices running full tilt on the hamster

wheel. This is NOT due to lack of interest or desire on the part of

the physicians but due (in part) to excessive overhead, inadequate

payment, and payment policy that rewards volume at the expense of quality

and is based on documenting a set of tangential administrative trivia at

the expense of time for patient care.

Gordon

(1) McGlynn, E. A., Asch, S. M., , J., Keesey, J., Hicks, J.,

DeCristofaro, A., et al. (2003). The quality of health care delivered to

adults in the United States. The NewEngland Journal of Medicine,

348, 2635–2645.

(2) Audet AM., Doty MM., Shamasdin J., Schoenbaum SC. Measure,

Learn, And Improve: Physicians’ Involvement In Quality Improvement

Evidence that quality improvement still has not permeated the

professional culture of medicine, although progress is evident.

Health Affairs Vol 24(3): 843 (2005)

(3) , L. G., & Wasson, J. H. (2006). An introduction to

technology for patient-centered, collaborative care. Journal of

Ambulatory Care Management, July-September 2006

29(3), 195–198.

(4) LG, Wasson JH. The Ideal Medical Practice Model:

Maximizing Efficiency, Quality, and the Doctor-Patient

Relationship. Family Practice Management September 2007

pp. 20-24

At 02:48 PM 1/8/2008, you wrote:

Perhaps the answer is in your

references ... but is " excellent primary

care " essential? Is there a level below this .. such as " good

enough

primary care " that will deliver effectively as good a result. I

am

thinking of the law of diminishing returns. Or, is that how the

insurance companies think ?

On Jan 9, 2008 3:57 AM, L. Gordon

<

gmoore@...> wrote:

> We know from the IMP project that the current payment models are

inadequate

> to the work of excellent primary care. We must move beyond volume

based

> payment models that inadequately fund the right work.

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

Nobody can say it like Gordon can! Thanks

for keeping hope alive!

Ramona

Ramona G. Seidel, MD

www.baycrossingfamilymedicine.com

Your Bridge to Health

410 349-2250

polis, MD

From: [mailto: ] On Behalf Of L. Gordon

Sent: Tuesday, January 08, 2008

5:21 PM

To:

Subject: Re:

Value for health care $

The good news is that we have so much room for

improvement that we're a long way from diminishing returns.(1)

There have always been exceptional docs who can pull off amazing things, but we

need (as I think you point out) improvement accessible to all.

One key goal of our IMP project has been to make " excellence "

accessible to the average doc and not just the exceptional.

We've seen that the volunteer participants in the IMP project have been able to

test and implement a curriculum that leads to improvement (you can download an

overview of the curriculum by clicking on " Breathing room and

curriculum " on www.IdealMedicalPractices.org).

Contrary to literature that indicates that solo and small practice docs are

unlikely (and in the opinion of many - unable and/or unwilling) to measure and

improve quality (2), we've demonstrated that solo and small practices are more

facile at adopting a quality agenda and achieving significant improvement.(3)

and (4)

We're now making the case that improved quality takes tools and time that are

inaccessible to practices running full tilt on the hamster wheel. This is

NOT due to lack of interest or desire on the part of the physicians but due (in

part) to excessive overhead, inadequate payment, and payment policy that

rewards volume at the expense of quality and is based on documenting a set of

tangential administrative trivia at the expense of time for patient care.

Gordon

(1) McGlynn, E. A., Asch, S. M., , J., Keesey, J., Hicks, J.,

DeCristofaro, A., et al. (2003). The quality of health care delivered to adults

in the United States.

The NewEngland Journal of Medicine,

348, 2635–2645.

(2) Audet AM., Doty MM., Shamasdin J., Schoenbaum

SC. Measure, Learn, And Improve:

Physicians’ Involvement In Quality Improvement Evidence that quality

improvement still has not permeated the professional culture of medicine,

although progress is evident. Health

Affairs Vol 24(3): 843 (2005)

(3) , L. G., & Wasson, J. H. (2006). An introduction to technology for

patient-centered, collaborative care. Journal

of Ambulatory Care Management, July-September 2006 29(3), 195–198.

(4) LG,

Wasson JH. The Ideal Medical Practice

Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship.

Family Practice Management

September 2007 pp. 20-24

At 02:48 PM 1/8/2008, you wrote:

Perhaps the answer is in your references ... but is " excellent

primary

care " essential? Is there a level below this .. such as " good enough

primary care " that will deliver effectively as good a result. I am

thinking of the law of diminishing returns. Or, is that how the

insurance companies think ?

On Jan 9, 2008 3:57 AM, L. Gordon < gmooreidealhealthnetwork>

wrote:

> We know from the IMP project that the current payment models are

inadequate

> to the work of excellent primary care. We must move beyond volume based

> payment models that inadequately fund the right work.

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

Is there some type of dashboard software that one can use to monitor

one's practice and see how far one is away from the ideal medical

practice?

I see that you have various indicators of excellence, good etc ...

It would be great if one could feed in these metrics and get an

overview of how well one is doing financially and how well one is

doing for one's patients.

You are ranked 10/500 IMP practices who provide statistics.

>

> One key goal of our IMP project has been to make " excellence " accessible to

> the average doc and not just the exceptional.

> We've seen that the volunteer participants in the IMP project have been

> able to test and implement a curriculum that leads to improvement (you can

> download an overview of the curriculum by clicking on " Breathing room and

> curriculum " on www.IdealMedicalPractices.org).

>

> Contrary to literature that indicates that solo and small practice docs are

> unlikely (and in the opinion of many - unable and/or unwilling) to measure

> and improve quality (2), we've demonstrated that solo and small practices

> are more facile at adopting a quality agenda and achieving significant

> improvement.(3) and (4)

---

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

I don't think primary care is eating up all the health care dollars in this country. The $$s are going to hospitals, insurance companies, CEOs, pharma: anywhere but primary care. (There was a pie chart somewhere ? on the IMPcohort listserv that showed what a small slice of the total budget goes to primary care.) Excellent primary care is not expensive. Excellent primary care is cheap, much cheaper than 'specialty primary care' and the savings the country would reap from it would be huge. However, now it looks like as a whole in the country we are being paid abysmally for bad primary care. But even bad primary care (where we are now as a country) is better than no primary care (where we may be going soon). I feel sick when I think about how much I get paid for what I do and how little it is valued by society, but how valuable it really is. LynnTo: From: compkarori@...Date: Wed, 9 Jan 2008 08:48:31 +1300Subject: Re: Value for health care $

Perhaps the answer is in your references ... but is "excellent primary

care" essential? Is there a level below this .. such as "good enough

primary care" that will deliver effectively as good a result. I am

thinking of the law of diminishing returns. Or, is that how the

insurance companies think ?

On Jan 9, 2008 3:57 AM, L. Gordon <gmooreidealhealthnetwork> wrote:

> We know from the IMP project that the current payment models are inadequate

> to the work of excellent primary care. We must move beyond volume based

> payment models that inadequately fund the right work.

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

Watch “Cause Effect,” a show about real people making a real difference. Learn more

[Guest guest]

Gordon,

>

> An overview:

> LG, Wasson JH. The Ideal Medical Practice Model: Maximizing

> Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice

> Management September 2007 pp. 20-24

> We have other articles in the pipeline.

http://www.medscape.com/viewarticle/563434

Looks like I need to wait for article 3 in this series!

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

Just for comparison re: our pay and value. I saw a patient

who works for the road department last night. He was talking about

getting called out to salt roads on New Year’s Day and getting triple

time. Does anyone expect to pay their doctor for coming out at night,

weekends or holidays? Noooo. And we can’t charge more either because

it is just expected.

Oh well.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Lynn Ho

Sent: Tuesday, January 08, 2008 8:11 PM

To: practiceimprovement1

Subject: RE: Value for health care $

I don't think primary care is eating up all the

health care dollars in this country. The $$s are going to hospitals,

insurance companies, CEOs, pharma: anywhere but primary care.

(There was a pie chart somewhere ? on the IMPcohort listserv that showed what a

small slice of the total budget goes to primary care.) Excellent primary

care is not expensive. Excellent primary care is cheap, much cheaper than

'specialty primary care' and the savings the country would reap from it would

be huge. However, now it looks like as a whole in the country we are

being paid abysmally for bad primary care. But even bad primary care

(where we are now as a country) is better than no primary care (where we may be

going soon). I feel sick when I think about how much I get paid for what

I do and how little it is valued by society, but how valuable it really

is.

Lynn

[Guest guest]

No dashboard, but good feedback on how the practice is doing through "Hows Your Health," a patient generated survey that gives feedback in critical areas such as access and efficiency, also gives quality information on how well patients are educated about their chronic disease and are managing it. The copy of the powerpoint slide below looks at just a few examples of the data available:

Is there some type of dashboard software that one can use to monitorone's practice and see how far one is away from the ideal medicalpractice?I see that you have various indicators of excellence, good etc ...It would be great if one could feed in these metrics and get anoverview of how well one is doing financially and how well one isdoing for one's patients.You are ranked 10/500 IMP practices who provide statistics.On Jan 9, 2008 11:21 AM, L. Gordon <gmooreidealhealthnetwork> wrote:>> One key goal of our IMP project has been to make "excellence" accessible to> the average doc and not just the exceptional.> We've seen that the volunteer participants in the IMP project have been> able to test and implement a curriculum that leads to improvement (you can> download an overview of the curriculum by clicking on "Breathing room and> curriculum" on www.IdealMedicalPractices.org).>> Contrary to literature that indicates that solo and small practice docs are> unlikely (and in the opinion of many - unable and/or unwilling) to measure> and improve quality (2), we've demonstrated that solo and small practices> are more facile at adopting a quality agenda and achieving significant> improvement.(3) and (4)---Graham Chiuhttp://www.synapsedirect.comSynapse-EMR - innovative electronic medical records system

[Guest guest]

Kathy,

There are overtime options. For example, my children’s

pediatrics office also considers themselves to be an urgent care after 5pm and on weekends.

The copay for a visit goes from $20 to $40 (per my insurance) if you are seen

as a walk-in after hours or on weekends (they don’t have appts for these

visits). I’m not really sure this is proper contractually, but they’ve

been doing it for years. Also, the UC I work for has an added after

hours/UC fee that they bill to the insurance (as most insured patients have copays

in VA); I’m not sure if they actually recover this fee from 3rd

parties, self-payers, or those with high deductible insurance.

I also believe that government employees have benefits and pay

incentives that most employees in the private sector (not just the medical

field) do not have. I’m sure that MDs who work for the state or

federal govts have pay, benefits, and hours much preferable to MDs who are

self-employed or work in the private sector.

Straz

RE:

Value for health care $

I don't think primary care is eating up all the health

care dollars in this country. The $$s are going to hospitals, insurance

companies, CEOs, pharma: anywhere but primary care. (There was a

pie chart somewhere ? on the IMPcohort listserv that showed what a small slice

of the total budget goes to primary care.) Excellent primary care is not

expensive. Excellent primary care is cheap, much cheaper than 'specialty

primary care' and the savings the country would reap from it would be

huge. However, now it looks like as a whole in the country we are being

paid abysmally for bad primary care. But even bad primary care (where we

are now as a country) is better than no primary care (where we may be going

soon). I feel sick when I think about how much I get paid for what I do

and how little it is valued by society, but how valuable it really is.

Lynn

[Guest guest]

The power of this approach is the ease of data gathering. Validated

patient reported outcome measures can populate a dashboard of quality in

near real time and provide meaningful feedback. We're finding that

IMP participants are using their data to inform them on key practice

behaviors and making improvements based on what they see.

We are also lucky in that we can compare our results to tens of thousands

of patients from across the U.S.

Gordon

At 10:14 AM 1/9/2008, you wrote:

No dashboard, but good feedback

on how the practice is doing through

" Hows Your Health, " a patient generated survey that gives

feedback in

critical areas such as access and efficiency, also gives quality

information on how well patients are educated about their chronic

disease and are managing it.

The copy of the powerpoint slide below looks at just a few examples

of the data available:



Is there some type of dashboard

software that one can use to monitor

one's practice and see how far one is away from the ideal medical

practice?

I see that you have various indicators of excellence, good etc

....

It would be great if one could feed in these metrics and get an

overview of how well one is doing financially and how well one is

doing for one's patients.

You are ranked 10/500 IMP practices who provide statistics.

On Jan 9, 2008 11:21 AM, L. Gordon

wrote:

>

> One key goal of our IMP project has been to make

" excellence "

accessible to

> the average doc and not just the exceptional.

> We've seen that the volunteer participants in the IMP project

have been

> able to test and implement a curriculum that leads to

improvement

(you can

> download an overview of the curriculum by clicking on

" Breathing

room and

> curriculum " on

www.IdealMedicalPractices.org).

>

> Contrary to literature that indicates that solo and small

practice docs are

> unlikely (and in the opinion of many - unable and/or

unwilling)

to measure

> and improve quality (2), we've demonstrated that solo and

small

practices

> are more facile at adopting a quality agenda and achieving

significant

> improvement.(3) and (4)

---

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

No dashboard, but good feedback on how the practice is doing through

" Hows Your Health, " a patient generated survey that gives

feedback in critical areas such as access and efficiency, also gives

quality information on how well patients are educated about their chronic

disease and are managing it.

The copy of the powerpoint slide below looks at just a few examples of

the data available:

Is there some type of dashboard

software that one can use to monitor

one's practice and see how far one is away from the ideal medical

practice?

I see that you have various indicators of excellence, good etc

....

It would be great if one could feed in these metrics and get an

overview of how well one is doing financially and how well one is

doing for one's patients.

You are ranked 10/500 IMP practices who provide statistics.

On Jan 9, 2008 11:21 AM, L. Gordon

<

gmoore@...> wrote:

>

> One key goal of our IMP project has been to make

" excellence " accessible to

> the average doc and not just the exceptional.

> We've seen that the volunteer participants in the IMP project have

been

> able to test and implement a curriculum that leads to improvement

(you can

> download an overview of the curriculum by clicking on

" Breathing room and

> curriculum " on

www.IdealMedicalPra

ctices.org).

>

> Contrary to literature that indicates that solo and small practice

docs are

> unlikely (and in the opinion of many - unable and/or unwilling) to

measure

> and improve quality (2), we've demonstrated that solo and small

practices

> are more facile at adopting a quality agenda and achieving

significant

> improvement.(3) and (4)

---

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records

system