In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Our national useless dialogue on the future of healthcare in the U.S. continues. Trumpocare has a long way to go before it potentially becomes law, so no one knows  what it will finally look like. Obamacare is in a death spiral anyway. I’ve written about it before, and still believe this...
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Traditional industrial QI does not work in primary care. A recent publication brilliantly makes this case on both theoretical and practical levels ;-). On a theoretical level, primary care is best thought of as a complex adaptive system, not a simple linear mechanical system. Think of complex adaptive systems as kind...
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In the AAFP’s Advanced Primary Care Alternative Payment Model document, the concept of population health management is a little more muddled, but it keeps rearing its head in different places in the document with different descriptors. From the definition of the primary care medical home, the phrase Planned Care and Population...
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First, I’ll quote the statement in the AAFP’s Alternative Payment Model document that deals with care coordination: “rimary care is best positioned to coordinate care across settings and among physicians in most cases. Primary care medical homes work closely with patients’ other health care providers to coordinate and manage care transitions,...
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Sorry for the delay in posts. My day job and another side project have taken up a lot of my time recently. Onward and upward. From the AAFP Principles to Support Patient-Centered Alternative Payment Models (APMs): Principle #1: APMs Must Provide Longitudinal, Comprehensive Care The principle is fine. The devil is...
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The AAFP’s recent statement on Advanced Primary Care calls for adopting the “five key functions of the Comprehensive Primary Care Plus Initiative.” This was an experiment under Obamacare where CMS tried to create innovative primary care payment approaches, which was mostly patterned after NCQA PCMH thinking. It started in 2012. Mathematica Policy...
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Over my career, the American Academy of Family Physicians, my primary professional society, has made some colossal mistakes in what it has chosen to advocate for. It has learned from its past mistakes, but only a little. They’re about to screw it up again with their call for payment reform, but...
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This post is based on a friend of a friend situation. Important details have been changed to protect anonymity, but not the basic realities I want to discuss. A 49-year old man was diagnosed with a rare form of lung cancer about a year and a half ago. This sad situation...
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