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   RE: opportunity for imps Please respond?
 From: Jean Antonucci
 To: Member Forum
 Posted: 05-16-2017 12:32
 Message: thanks Kathy
 IANAL!!:)
Yeah  What Peter understands is scary

I have recruited most of the 5,000 minimum I need( 5000 patients) to   w rite a letter of intent and go ahead with this
  I would like more patients  and docs.

 I am talking to my   advisors on Thursday and Friday to flesh out details  to work on  Hoping I can understand
But if you look at the AAFP proposal although  it is ull of MIPS and percentages, I mean we can do this!!
 2.00/day/patient/month and 3.00 for higher risk patietns
 HYH 60 a year ON the straight medicare folks
 I think we can prove our worth as improving care and reducing costs If so  and the pilot is successful at this  then we have grounds to ask other payers and medicare in a wider   distribution to  offer this paymetn model.
or
at least it will amuse me for a whhile
I think we ask it t o be a two yr project.
Jean

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Jean Antonucci
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Original Message:
Sent: 05-16-2017 08:45
From: Kathy Saradarian
Subject: opportunity for imps Please respond?

IANAL - I am not a lawyer.  ("anal" seems appropriate-JOKE!!)

PCMH is one of the things I want to work on,    This could work with Jean's idea for a model.  If we can change "recognition" model away from NCQA.  They are opening up the model ideas.  It's my next resolution that I need to write soon.

I have not been able to digest everything Peter wrote yet.

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Kathleen Saradarian, MD
Branchville, NJ
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Original Message:
Sent: 05-15-2017 10:29
From: Jean Antonucci
Subject: opportunity for imps Please respond?

Peter wrote in italics:
"My head is spinning  but IANAL"

WHAT IS  IANAL?
.
That would mean the plan would need less risk exposure to have "more than nominal" risk. It doesn't actually make much difference, because the risk in the PCMH program is 3% vs. 8%, of the total paid by Medicare, as a maximum loss.

What PCMH program and risk?? PCMH is a model...
I am thinking that the risk is the capitation amnt With a  stop loss thing that happens for outliers if they need like a whole body transplant Still learning



My reading of the rules is that in order to get out of MIPS, you have to be in an "Advanced APM."
yes

First, in order to use HYH as a 'quality measure similar to MIPs', it either has to be registered by NQF (hasn't happened,AFAIK) or have been submitted for consideration by NQF, (which I believe Dr Wasson did,) OR it has to be "endorsed by a consensus-based entity" and be evidence-based, reliable and valid. HYH is undoubtedly evidence-based, reliable and
 If we include it in our proposal and they support the  proposal I thought we were good.

 

The general standard is 8%; the PCMH risk amount is 3% for 2018.

From where what? I cannot understand this Never heard htis


One option would be to submit 'claims' on all the enrolling patients, with all their diagnoses, a few months before the start, so CMS can calculate HCC, and use the same claim to enroll the person in this AAPM, to start at some future date.  Medicare could assign some code for this, e.g., 'G-Assign', with a minimal payment to cover the cost of extracting all that information.

I think that is sort of what  was suggested t o me so far

I do NOT think you should require practices to be IMPs-that would severely limit the applicability, (and reduce the chance PTAC would approve it) for no compelling reason.
well  IMPs are doing the work that  will support the  project What  do you mean by requiring imps? Imps are supposed to have superb access continutiy care coordiantion and comprehensive care The lowwer the overhead, the  better they will do but that is n ot mine to  talk about  I am looking for a demonstration project to pay us simply and fairly and with   reduced burden reporting that  is the reporting that matters.


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Peter Liepmann MD FAAFP MBA
My mission is to fix US health carewww.PCMHpcc.com
Bakersfield CA
5183026006
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10.  RE: opportunity for imps Please respond?

Posted 14 hours ago
Amen, Michael!!

I also posted this on the AAFP small/solo practice MIG:

I think one other feature we ought to include in this program  is allowing MCR members to opt out on a month's notice, so they're protected against deliberate undertreatment. "Stinting" in the words of CMS:

"We assess all APM designs for possible perverse incentives and the potential for care stinting activities prior to implementation. We agree that we should continually monitor for perverse incentives and behaviors such as care stinting, and we actively perform these assessments now. We believe that both the inclusion of payment based on performance on quality measures in the Advanced APMs and the ongoing monitoring and evaluations conducted on all APMs are mechanisms for identifying whether appropriate care is withheld to save costs."

While problems with 'care stinting' would show up in HYH, there's no harm in further protecting patients, and making this easier for MCR to approve.

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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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11.  RE: opportunity for imps Please respond?

Posted 2 days ago
Jean, this is a SPECTACULAR idea!!
If you're open to suggestions for improvements, I'd like to work on this.
You probably saw the AAFP Advanced Alternate Payment Method (AAPM) proposal to PTAC. I posted a link to it a few weeks ago. It has great intro and background info, which you could probably borrow for another AAPM. (I'll ask.) I'll cross post on the small groups MIG.

I think you're selling yourself cheap, especially for the Medicare population.
AAFP proposed 12% of the expected gross costs to go to primary care.  The annual per capita Medicare spending  for folks over 65 is $9972.
$9972 *0.12/12=  $99.72 PMPM.  The current primary care spend, IIRC, is about 5%, so that would be ~$40 PMPM. They need to spend more to get truly comprehensive primary care.  IIRC, 2/3 of Medicare patients have >2 chronic conditions, so would  currently qualify for the ~$42 pmpm FFS CCM fee, which hasn't taken off because CMS decided the deductible/copay had to be applied.  No need for that in a capitated model.


That $99.72 PMPM is the average for primary care.  Primary care spending is highly skewed, though not as skewed as total spending, and can partly be predicted by 'disease count' and various other measures. There's about twice as much skewness for total costs as primary care, (look at slide 4) so we could use the publicly available HHS-HCC (HHS's tool to estimate costs for MA) averaged with the mean cost to make an estimate of primary care costs, risk-adjusted for disease.

I'm pretty sure you'd want this to be an AAPM, which has some very specific requirements.  I'll go check on these and post more later.
But in any case, this is a GREAT idea!!!


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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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Jean Antonucci
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Original Message:
Sent: 05-13-2017 13:55
From: Peter Liepmann
Subject: opportunity for imps Please respond?

Jean, this is a SPECTACULAR idea!!
If you're open to suggestions for improvements, I'd like to work on this.
You probably saw the AAFP Advanced Alternate Payment Method (AAPM) proposal to PTAC. I posted a link to it a few weeks ago. It has great intro and background info, which you could probably borrow for another AAPM. (I'll ask.) I'll cross post on the small groups MIG.

I think you're selling yourself cheap, especially for the Medicare population.
AAFP proposed 12% of the expected gross costs to go to primary care.  The annual per capita Medicare spending  for folks over 65 is $9972.
$9972 *0.12/12=  $99.72 PMPM.  The current primary care spend, IIRC, is about 5%, so that would be ~$40 PMPM. They need to spend more to get truly comprehensive primary care.  IIRC, 2/3 of Medicare patients have >2 chronic conditions, so would  currently qualify for the ~$42 pmpm FFS CCM fee, which hasn't taken off because CMS decided the deductible/copay had to be applied.  No need for that in a capitated model.


That $99.72 PMPM is the average for primary care.  Primary care spending is highly skewed, though not as skewed as total spending, and can partly be predicted by 'disease count' and various other measures. There's about twice as much skewness for total costs as primary care, (look at slide 4) so we could use the publicly available HHS-HCC (HHS's tool to estimate costs for MA) averaged with the mean cost to make an estimate of primary care costs, risk-adjusted for disease.

I'm pretty sure you'd want this to be an AAPM, which has some very specific requirements.  I'll go check on these and post more later.
But in any case, this is a GREAT idea!!!


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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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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:
1.pay 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  jnantonucci@gmail.com 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

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Jean Antonucci
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