Re: request input for Tom Bodenheimer call topic [1 Attachment]

[Guest guest]

,Thanks for sharing that article from WSJ; I hadn't seen it, although, of course, have lived it.  Just last week I went on the Anthem website for patients using their pricing widget to see how much various doctors average reimbursement for colonoscopy was (turning 50 in October).  The range was vast.  And hard for me to sort out which facility a given doctor may be at on a given day (some have outpatient surgery centers affiliated and not affiliated with a hospital).  If we, who live this, can't figure it out, even with the new " transparency " of prices on the insurer's website, how will a patient who doesn't work in health care even know what questions to ask?

Anyway, thanks to all for lots of good discussion topics for the call with Tom B.

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

[Attachment(s) from Dr. Brady included below]

Here is an article in the WSJ discussing exactly what Ben was mentioning. Seems like when hospital systems buy us out, prices soar and patients suffer. As I read the article, I can’t help but think that independents selling out to hospitals cannot possibly result in overall cost savings.

  

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

Sent: Tuesday, August 28, 2012 2:03 PMTo: Subject: Re: request input for Tom Bodenheimer call topic

   Exactly my fear of the aggregation.  It makes immense sense on one level but the experience is noxious.  The combined experience with aggregation on this listserv indicates high risk, lots of pain, worse outcomes overall (this is conjecture based on aggregate anecdote not careful study, so take it with a grain of salt).

 On the one hand there is good published literature linking quality with size of practice, but I question a lot of that literature because the definition of quality suits large systems and may actually have little to do with real quality.  (E.g. HEDIS or Meaningful Use or NCQA's PPC-PCMH are often cited as quality indicators but each and all are quite poor reflections of important outcomes.)

 So I guess my question to Dr. B would be: if good primary care = doing a good job on the basic elements of primary care (first point of access, relationship over time, comprehensive care, coordination), then what about that stipulates aggregation as a necessary step and if it is necessary, how do we combat the often toxic nature of being consumed by systems that seem to work at cross purposes with good primary care?

 G

   

" If small practices are to survive and provide high-quality care, they must become part of an aggregating organization "

 My rural health clinic practice in Illinois was aggregated to join about 6 others.

 The local hospital raised prices about 30% after they bought my place. 

More patients are applying for charity care because there is no way they can afford what the hospital is charging.

 They added staff and overhead.

Now they want to change my EMR to NextGen which is difficult for me to input data into.

 The hospital hasn't pushed production much and so far they've left me alone to practice as I see fit at 15-20/day.

But, after 2-3 years in, some friction is developing over the EMR and their pricing for services.  

 I find myself thinking about solo practice business plans again.

 reluctantly aggregated,

 Ben Brewer MD

Forrest, IL. 

  

  

To: Sent: Tuesday, August 28, 2012 10:29 AMSubject: Re: request input for Tom Bodenheimer call topic

   Take a look at an editorial Dr. Bodenheimer wrote in 2008.

 Particularly  his " Lesson 6 " Small practices need support.  

My question would be:  How do you maintain the benefits of small practices while aggregating them into larger units?

Gordon

  i second for teams. also am wondering if Tom might be able to tell us anything about how small practices are expected to team effectively with others for the ACO concept.

-- Kernisan, MD MPHGeriatrics

Teams please  Because we  have had a fair amnt of work at Camp and  on calls about coaching and becasue I think that material is  readily available on many sites

What Dr B might bring to  the call  about using teams is to help us as IMPS in quite unique practices to focus his ideas  for use in our practices. His " nosotros " not  top down ideas are great but  translating them into  implementation in little  innovative practice s is a tool we have not yet heard  much about  and  whicih  many of us might beneft from, as times are a changin

Jean 

  IMP Call Thursday Sept. 6

11 PT, noon MT, 1 CT, 2 ET 

Topics as offered by Tom: 

We could 1) do a discussion of teams, or 2) do health coaching (we have done alot of work on training of MAs, community health workers, patients to be health coaches to address understanding of patients' chronic diseases, understanding meds, med adherence counseling, behavior change counseling). 

 Preferences?

 Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

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