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I went to Washingotn to present the payment proposal

  • 1.  I went to Washingotn to present the payment proposal

    Posted 09-16-2018 15:12

    read this?
    this is important I think to primary care doctors
    Would someone cross post to the AAFP list serv for me ?
    thank you
    Last week I went to Washington DC
    ( free flight due to cr card points, stayed with Gordon Moore IMP #1 so  cheap:)   )
    when the law about Macra and  MIPS was enacted, Congress enabled a  committee called physicians technical advisory committee - PTAC- to review proposals for innovative payment reform
    some of you may know that I wrote up a model
    had some help from a few people
    -although it was still an amateur deal.
    What I proposed was a prospective monthly  payment based on risk      risk to be determined by Hows your health
    most practices  have  15% of people that are high-risk; low and medium is to be paid a dollar a day prospectively paid monthly; high risk three dollars a day; withhold 15%- if you don't meet benchmarks 15% of tota annual payment is withehld
    how's your health would measure, risk would also be the measurement,
    So I was prepared to be eviscerated and sent home and that's too bad-- had I been more confident when I went I would've started out more strongly
    however the bottom line is they loved it
    it was a really positive experience
    because I am not in Academy of family practice or have armies of risk management and data analysts behind me that's what made it somewhat amateurish
    however they loved it
    they thought it was incredibly innovative and debated a lot how  to push this forward
    I'll stop there
    it's unclear where this will go and John Wasson  of HYH  is also working behind the scenes to see how we could push this forward

    I have a list of about 30 doctors whose names were emails I've kept  form posting  before and asking about interest.
    It may become extremely important
    They thought noone was interested because noone commented on their web site
    PCPs  do not know about their   web site  and/or unfortunately always say they are too busy.(I   did not even myslef know about the open comment period or I  would have  begged people to comment_
    if this would go to a trial project.I  going to ask you  here, ask  at AAFP list serve, iask you all to  bring it to your state or county or  your friends or wherever, to ask  whether they be interested in a pilot
    your panels would be capped at 1500 patients
    you would be required to meet certain benchmarks in  hows your health, especially about  access, confidenc,e and so forth
    you would have to have hyh incorporated into your flow so that patient took it  before their yearly preventative visit
    so at least  you'd have to do 60 to 100hyh surveys in the first few months then 50% of your practice/yr understanding that noone ever gets 100% of patients to do anything
      I'm happy to say more
    please get back in touch with me as soon as possible
    I may be getting In touch with some of you whose names I have
    to see if you'd still be interested
    you would need to have a minimum number of Medicare patients if you have five Medicare patients or if you have only advantage plans this does not count
    straight Medicare you really need to have about 100 Medicare patients to be in the project but many of you do
    I had a good time in Washington DC although it was hotter than hell
      there are people in Washington who really know they've got to do something about primary care so there's a little bit of encouragement
    get in touch with me if you need to
     phone 207 778 3313

    Jean Antonucci

  • 2.  RE: I went to Washingotn to present the payment proposal

    Posted 09-17-2018 11:40
    Way to go Jean

  • 3.  RE: I went to Washingotn to present the payment proposal

    Posted 09-17-2018 12:57
    I just want to clarify
     cross post to AAFP please
     the payment in the proposal is 2.00/day for low and medium risk patietns   about 85% of a panel of 1500
    1275 patients= 930,750.00/yr
    and 3.00/day for high risk the other 225= 246,375

    total medicare revenues/yr= 1,177,125
     assume overhead 50% or higher= income 588,562

    This seems like alot of money ACtually it allows you to  integrate  some behav health andd pay for space  or hire another nurse to do outreach and tune up your e visits and IT etc.

    I made a clear case that
    A. in a world that tolerates ortho making 3 times  what PCPs can possibly make, we have to  be careful about   criticizing PCPs for "asking for a raise
    " what we actually want is to reduce the burden of being paid
     we want NO NEW CODES
     we want to be paid for  work  we do

     I also got the feedback about capped panel sizes reducing access, and capitation  -oh well docs will sit back and take money and stint on care  You cannot stint on care  with HYH doing the measuring as it is the patietn who says whither they  have access or not and i said look
     We do not cap panel sizes now  but the number of minutes in a day is capped People are being sent ot the ER for a uti  Capping panel size will not reuce access any worse that  it does now
     and they get that

    Jean Antonucci

  • 4.  RE: I went to Washingotn to present the payment proposal

    Posted 09-19-2018 06:20


    This is great stuff. I am impressed by your efforts.  I have about 150 or so medicare patients and ask all patients do HYH before PEs (not sure how many of these responses are medicare, we have about 2000 active patients) ...I'd say we have about 300 or so responses per year and close to 10 years of data if that would be in any way helpful.  However...we are a medicare opt-out practice, so not sure if we can be of any benefit.  For sure....if this came to fruition and resulted in meaningful bonus payments without additional work (ie relied on HYH data) it might obviate the need to opt out in the first place!


    Jim Bloomer