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Posts Tagged ‘ payment reform ’

The High Costs of Hospitalists

1
October 9, 2017

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

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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

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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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The AAFP and Payment Reform — They’re Screwing It Up, Again, Part 2 – A Poor Foundation

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January 26, 2017

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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The AAFP and Payment Reform — They’re Screwing It Up, Again, Part 1- Background and a Brief History

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January 16, 2017

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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Family Physician Payment – A Lesson from Switzerland

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June 27, 2016

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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MedPAC Calls for More Primary Care Support — Again

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April 25, 2016

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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CMS Billing Rules Subjugate Family Medicine – Incentives to Over-Test

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July 14, 2014

I’m continuing my series on the reasons there are so few family physicians in the U.S. and why the Center for Medicare and Medicaid Services (CMS) is a root cause of this deficit. My conclusions are based on recent research on the topic. This specific issue is a detail that actually...
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CMS Billing Rules Subjugate Family Medicine – Payment for Complexity and Time

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July 6, 2014

I’m continuing my series on the reasons there are so few family physicians in the U.S. and why the Center for Medicare and Medicaid Services (CMS) is a root cause of this deficit. My conclusions are based on recent research on the topic. If you hired an accountant to do your...
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CMS Billing Rules Subjugate Family Medicine – No Payment for Convenient Care

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June 23, 2014

I’m continuing my series on the reasons there are so few family physicians in the U.S. and why the Center for Medicare and Medicaid Services (CMS) is a root cause of this deficit. My conclusions are based on recent research on the topic. Have you ever wondered why doctors tell you...
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