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   RE: opportunity for imps Please respond?
 From: John Brady
 To: Member Forum
 Posted: 05-11-2017 07:48
 Message: Hi Jean,
I would go for $1.50/person/day regardless of acuity of disease burden. One of the pillars of primary care is longitudinal continuity. Assuming my patients age with me, they will develop disease burden sooner or later. If you believe in primary prevention, then pay me to do my job when they have less disease burden and hopefully we can keep it that way for a while. Also, as the relationship strengthens over time, the doc is far less likely to kick the (recently) complex patient to the curb for being too costly. By my calculation, this price would not just help make practicing primary care financially possible even in "dead zones," it should achieve a level of pay equity pretty close to that of some of our colleagues (for recruitment purposes).
I agree with getting rid of all other billing--including the AWV, the CDM codes, and all the add on codes of insanity. Pay us a global fee. Let us figure out the best way to treat our patients.
HYH is fine. Like you said, free and easy to do.
If there is push back regarding MIPS, remember the PRIME registry from the ABFM. It sucks the data from the emr and automatically reports it to CMS. No extra work on the provider's part. It currently works with 108 EMRs (not yet with practice fusion) and is "in negotiations" with many others (including practice fusion). So it is another way to submit data without added burden. Whether much of that data is as worthwhile as the data gathered from HYH is a totally different discussion, but I believe it can be a helpful tool.

John Brady
The Village Doctor
Newport News VA
Original Message:
Sent: 05-10-2017 19:43
From: Jean Antonucci
Subject: opportunity for imps Please respond?

Most patients are seen about 3 times a year on avergae
 I would include the "wellness visit"  in that
 At a 99214 that is roughly 100.00 ( 98  here  113 in NJ) and wellness of 139 is it? then throw in depression and adv directive screening( and consider that you must remember it code for it etc,even if it is easy  it takes time The documenting and  the  billing )  it is about 400/yr/patient
You must however code and bill and do mips etc
Now supposing it was 1.00/day /patient but risk adjusted so that using free HowsYour health measurement high burden of disease  patients were 2.00
 If you were capitated and needed no billing time your overhead lowers. I f you are capitiated some of these folks can skip a visit because you can do on the phone or have  med ass't do
 Many people can report BPs  and bs and you could pay a  staff to outreach to  them  and sit  with them to  do HYH  once year You can extend re visit interval time and see them less often
 now, say you had 100 patients 1/3 are low risk  1.00/day ( 365 x 33)= 12,045
 and the others are high risk 2.00 day  ( 66  x  x 730)= 48,180
so that is  60,225 for 100 patients or  602.25/patient average not 400 and without coding and billing and without MIPS reporting measures
 simple fair payment and simple fair useful  quality reporting

Low over head practices can easily take care of these folks for  1 to 2 dollars a day
I have been capitated like this by one plan for many yrs. Up front payment   Check once a month( and there is an incentive plan)
 This is a proposal to   demonstrate simple fair payment for simple useful reporting
 Isn;t that  what we say we want?

Jean Antonucci
Original Message:
Sent: 05-10-2017 15:41
From: Scott Macleod
Subject: opportunity for imps Please respond?

Interesting idea.
The key is  per day ( including all days not just business week) ( and not expecting every day/anytime physical access) payment for every patient
Most of us have a mix of patients with many insurances.
So if you have 200 pure Medicare
Using  $1/ day = 73,000/yr
Most of this group would be seen about 4/ yr on average
So say you get paid for 70/visit = 56,000/yr
That works out in the positive of about 85/pt per year more.
Which is about 1 extra visit worth per year
And would not include transitional, CCM, wellness money extra you could add on to the regular system and assumes no more than 4 visits a year for these complex patients.
Yes some less paperwork but not much...still doing quality measures, etc..

So at the dollar per day it is a little thin to make much difference.
Right now you are lucky to get a  per pt per month bonus for usual quality/cost /satisfaction criteria in the single digits and that is hard to do
To get 2/pt/day would be somewhat of a miracle without requiring paperwork flow that would be at least 1/day in costs.

Like the idea but not I would be willing to jump in without knowing all the details. Like how are the patients attributed to you, etc....

Scott Macleod
Highlander Family Medicine
Woodstock VA
Original Message:
Sent: 05-09-2017 22:33
From: Jean Antonucci
Subject: opportunity for imps Please respond?

Dear IMP Community,
 For years  IMP has struggled with how we might work together to improve payment or  work on  advocacy  measures despite the fact that we are  spread out across  all the states, with each state having various initiatives around cost/quality/practice transformation efforts/programs  payment etc.We spend time telling stories about "well  what  I  do is" when  the  one listening often  has no power to utilize such stories in their environment.
Tres frustrating

 Our time has come
What we have  been unable to do is now possible
 The law called MACRA established a board or committee called PTAC (Physician Payment Technical Advisory Committee- like SO not any clever acronym but at least it has a vowel so you can  pronounce it:) )- to evaluate new methods to pay docs. Any doc or any  group can make a proposal to this group  The proposals  would be around  the structure of payment and must be  nothing  done  before, be about value over volume and measure  quality  to prove its worth

 Although IMP has been a community that supports practices in practice management, we originated in the idea  of a project that would use innovative measuring and cutting edge tech to pursue practices that were sustainable for the docs and  provide the best care for patients. Those of us that went through the IMP project  cohorts or attended IMP Camps  know the details.

A few  of us have gotten together on the iMP calls and email and agree we should make a proposal
we have a good friend on the committee who  would help us

The basics are: us simply and better
Roughly $1.00( maybe more)/patient/day  (- -  have 1,000 patients?   so-$365,000 into your practice and so say the overhead is 50%, you the doc get  $182,500.) You can take of people for 1.00/day We might risk adjust it but   for this  post we are  keepin gitismple.
2 use HowsYourHealth to measure and risk assess.
 There are details Not for this email

I need a lot of patients to do this I need a lot of docs.
 Please respond to me at if you are  interested inpartcipating
 we need you to take straight ordinary Medicare as payment would apply to them only, we need you to be willing t o use HYH   60 + surveys/yr ( its free)We  may need you to do a little work for the proposal  but I am hoping  a small steering group can  put it together .

We have a good chance this project will be  accepted( which means recommended to DHHS who may put it into action)

If you want  simple pay  better  pay and to get  out of  some of the  administrative measurement junk, please email me
I need this SOON  I need you to  be willing to recruit 1 or 2 or 10 other docs also

Frankly, why wouldn't you?

Jean Antonucci

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