request input for Tom Bodenheimer call topic

[Guest guest]

IMP Call Thursday Sept. 611 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

[Guest guest]

I am not sure many of you know but we created care for your health as a 501c3 that supports a federated model of micropractices. We have my practice, a second one opening in 15 days and a third one coming n board 2013. We not only contract and bill together, we have common data collection strategies, common policies and procedures, common fundraising, common advocating and apply for grants together. This was important for us because we intentionally locate in areas where most our patients are uninsured, Medicaid and medicare (medicare being the better paying payor J) so it was important for us to be able to apply for other sources of funding. Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone Fax www.care4yourhealth.org " Don't ever let injustice go by unchallenged. " Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php From: [mailto: ] On Behalf Of leslie kernisanSent: Tuesday, August 28, 2012 11:10 AMTo: Subject: Re: request input for Tom Bodenheimer call topic 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 MPHGeriatricsTeams 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 sitesWhat 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 IMP Call Thursday Sept. 611 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? SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com-- MD ph fax No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2197 / Virus Database: 2437/5230 - Release Date: 08/28/12

[Guest guest]

Interesting article. Dr. Bodenheimer also states:"Small practices have failed to match the quality metrics of larger integrated systems." and cites this reference: http://content.healthaffairs.org/content/24/6/1543.fullThe article he cites suggests that larger groups are superior to solo practices because: 1. "Groups—particularly larger, prepaid groups—are more likely than non-group physicians to adopt evidence-based care processes. A 2004 California physician survey found that those in Permanente Medical Groups have adopted system-level care management tools more than physicians have in independent practice associations (IPAs) or “cottage-industry†practices." 2. "Large groups are also better able than small groups or solo-practice physicians to make effective use of IT. Eighty-seven percent of physicians in large groups have electronic access to test results, compared with 36 percent of solo-practice physicians. Other information technologies follow a similar pattern. Physicians in large groups are more likely than solo practitioners to use electronic medical records (EMRs), receive electronic drug alerts, use e-mail to communicate with colleagues and patients, and practice in a “high-tech†office." 3. "Also, larger groups are more likely than small groups or solo-practice physicians to practice in teams and to use performance and outcome measurement for quality improvement. Group practices are uniquely capable of coordinating care across conditions and settings, and the dissemination of knowledge and skills management is inherent in their sizable investments in the infrastructure and processes of evidence-based medicine.So to summarize, Dr. Bodenheimer believes that larger physician groups are better that solo practices since they adopt evidence-based care processes, are better with IT, and conduct care coordination and quality improvement. But don't IMPs do these things also?Frederick Elliott MDFuture IMP 2013Buffalo, NY

"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 MDForrest, IL. To: Sent: Tuesday, August 28, 2012 10:29 AM Subject: 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 sitesWhat 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. 611 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

-- MD ph fax

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Fascinating and very timely WSJ article. A pretty solid counterpunch to the large-group-practices-are-superior dogma.Frederick Elliott MDFuture IMP 2013.Buffalo, NY

,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

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

[Guest guest]

That's the real definition of 'teams'.Frederick Elliott MDBuffalo, NYOn Aug 28, 2012, at 8:24 PM, "Dr. Izquierdo-Porrera MD PhD" wrote:

I am not sure many of you know but we created care for your health as a 501c3 that supports a federated model of micropractices. We have my practice, a second one opening in 15 days and a third one coming n board 2013. We not only contract and bill together, we have common data collection strategies, common policies and procedures, common fundraising, common advocating and apply for grants together. This was important for us because we intentionally locate in areas where most our patients are uninsured, Medicaid and medicare (medicare being the better paying payor J) so it was important for us to be able to apply for other sources of funding. Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone Fax www.care4yourhealth.org "Don't ever let injustice go by unchallenged." Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> From: [mailto: ] On Behalf Of leslie kernisanSent: Tuesday, August 28, 2012 11:10 AMTo: Subject: Re: request input for Tom Bodenheimer call topic 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 MPHGeriatricsTeams 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 sitesWhat 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 IMP Call Thursday Sept. 611 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? SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com-- MD ph fax No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2197 / Virus Database: 2437/5230 - Release Date: 08/28/12