This is the second in a series of conversations I had with some open-minded colleagues who also deeply want to seen meaningful change in the U.S. healthcare system. The person I primarily responded to mentioned a chapter in Pursuing the Triple Aim. Here is what I wrote back to him: I...
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A very smart person in the healthcare benefits space wrote that family physicians can’t influence much the top 25 most costly DRGs in hospitals. Here was my response: There are many reasons this isn’t true. But it’s understandable that a benefits or administrative person would have no inkling of this, because...
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Some people think that the solution to better-supported primary care is in DPC/salaried physician payment models. I don’t think it is the best answer. I realize money is not the only motivator explaining why people perform work. Meaningful work matters too. But meaningful work that is not respected and paid for...
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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to...
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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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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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There was a nice opinion piece in JAMA Internal Medicine recently where the primary author talked about moving from the U.S. to Switzerland and his experience in both systems. Primary care physicians are allowed to bill based on time there. This includes travel time, phone work, and documentation time. What a concept!...
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The Medicare Payment Advisory Committee (MedPAC) just released its annual report on Medicare expenditures. Congress technically votes on the fees that Medicare pays, but it created MedPAC to serve as its primary advisor. If MedPAC sounds familiar to some, it may be because of reports in the past of the American...
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