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More Disappointing News on the PCMH

1
September 6, 2017

First, I recognize that the whole PCMH experiment was not a total failure. There were some successes. The Patient Centered Primary Care Collaborative (PCPCC) puts out an annual review on PCMH demonstration sites that is always positive. On the other hand, the AAFP PCMH National Demonstration Project was mostly a failure....
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Family Physician Quality – A New Way Forward

0
August 22, 2017

Wrapping up my series on our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, (and sorry for the gap in wrapping this up), I want to share my own thoughts on a way forward. First, in our paper, we proposed very aspirational measurements such as missed days...
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Ways to Improve Family Physician Quality – Measure Other Aspects of Primary Care Capacity Associated With Better Outcomes

4
July 9, 2017

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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Ways to Improve Family Physician Quality – Measure When Physicians Do Not Order Tests or Treatments

0
June 29, 2017

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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Ways to Improve Family Medicine Quality – Target Ranges without Absolute Goals

1
June 18, 2017

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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Ways to Improve Family Medicine Quality – Shared Decision Making

1
June 7, 2017

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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Trumpocare/Obamacare – Visa/Mastercard

1
May 9, 2017

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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Industrial QI Does Not Work in Primary Care

1
March 15, 2017

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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The AAFP and Payment Reform — They’re Screwing It Up, Again, Part 5 – Population Health Management

0
March 6, 2017

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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The AAFP and Payment Reform — They’re Screwing It Up, Again, Part 4 – Care Coordination

0
February 27, 2017

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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