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need response asap from many of you

  • 1.  need response asap from many of you

    Posted 06-21-2018 05:38
    Hi As you may or may not know the MACRA law created a commission called PTAC where anyone can submit innovative payment ideas The proposals are reviewed by a careful process, sometimes rejected, mostly they ask clarifying questions and invite you to DC for a half day( your own expense of course) to  be further evaluated, then if looks like a sound approval, PTAC recommends to the Secretary of DHHS to implement-
     so far many approved nothing implemented  Really interesting stuff  going on
     I submitted a proposal as an individual but one o fmy back end advisors said make it come form IMP
     Anyway I have just received my three pages of clarifying questions Then we expect I go to DC in early Sept for a morning of evaluation

    I need your name to say you would be interested in participating in such a project/payment plan
     You are not committing for pete sake god knows if it will even go forward The DHHS secretary has nitpicked at every proposal sent to him but our is so simple so elegant so innovative we at least want to  begin to be heard It is a lot better than AAFP's which is convoluted  not transparent andmessy.
    They just need to know how many  docs would be  interested to do this
    I have 2 weeks to answer my  questions and tell them that yes I have 5000 medicare patietns and lots of docs who  would love to trial  this

    A while ago I had a list but then I thought  this was all going away  and I threw it out
    I need names
     here is the proposal you would say you were interested in
    I can send the  whole 30 p thing if you contact me off list

     start  with  that  85% of your patients are low and medium risk. 15% high risk( this is pretty rue across the bd  but your practice  may  vary)
    Proposal is to pay you 60.00/mo  every month prospectively for low and medium risk patients and 90/mo for high risk  Risk is determined by  the What MAtters Index of HowsYourHealth
    There would be submission of dx and cpt codes but no relation to payment just  so the payer could have data  The payment covers all outpatient visits except those that are expensive to give- vaccines/ iuds things like that
     You would use Hows you health a free internet tool patients take as a 15min. survey to measure your quality and determine the risk
      So coding for billing would be gone No arguing over claims.Prospective monthly p ayment
     quality measures are  low burden and free

    No arguing or debating the proposal please
    It is  what it is I did the work:)
    Who would be interested in trying that?( no requirements like CPC+ to embed the social worker no MIPS check boxes  This would start with Medicare patients and  hopefully be an all payer project

    (I have been paid like this for8 yrs  by one payor  Low overhead practices can manage this the  best ,higher overhead practices must look at their overhead and how much it costs them to  work Example 4 medicare visits a yr for someone is at 99213 x 2 and 99214 x 2  say=  340.00? here  in my proposal you would get  730/yr to  manage them
    One can do  phone visits care management etc Your panel size would be capped at 1500 to void having you suck in money and not be able to  do good work I suppose that  # is not cast  in stone Do the math
    thank you​

    Jean Antonucci

  • 2.  RE: need response asap from many of you

    Posted 06-25-2018 08:59

    I posted this to the AAFP small practice group.  I'd be interested, so you can put my name down.  I only have about 50 plain Medicare patients however.

    Mike Barron

  • 3.  RE: need response asap from many of you

    Posted 06-26-2018 07:39
    Unfortunately they removed my repost.  Violates recruiting prohibition.

    Michael Barron
    Barron Family Medicine
    University City MO

  • 4.  RE: need response asap from many of you

    Posted 06-26-2018 18:09
    oh  many thanks
     I found my list!!  I  saved a file though I tore up the paper  I had 28 names
    All they are asking is Jean do you know actual docs who would be interested in being paid this way( vs Jean you crackpot noone would do this)
     so thanks!!

  • 5.  RE: need response asap from many of you

    Posted 06-27-2018 16:18
         You could put me down, if you still need names.  If you also need numbers of Medicare B patients, I have 170.


    Vahe Keukjian
    Your Family Doc PC
    Ghent NY

  • 6.  RE: need response asap from many of you

    Posted 06-29-2018 04:58
    great  All I am doing is documenting hat docs would  be interested in this  THANKS!!

    Jean Antonucci

  • 7.  RE: need response asap from many of you

    Posted 07-08-2018 18:29
    As I mentioned before, the  MDVIP practices (?50-500??) would embrace this too.
    Personally, I can't see anyone w MCR patients not taking more $ for better services. The problem is changing the whole practice to capitation/DPC.

    I got a response from the AAFP site:

    Message From: Randall Rickard 

    Understanding that this is a poll , I would say our practice has the interest to say "yes".  That is a model that seems to have merit.  We might sign up.  I guess you would say we have 250-300 medicare lives.  More if medadvantage participants switched.   R Rickard

    Randall Rickard MD, FAAFP

    Peter Liepmann MD FAAFP MBA
    My mission is to fix US health care
    Bakersfield CA

  • 8.  RE: need response asap from many of you

    Posted 07-11-2018 09:50
    cool thanks

    I submitted my answers to their  questions and have a call JULY 27 1 hr then unless they boot me out I go to Dc ofr a 1/2 day session sometime early Sept. Sadly I have lots of  points with Jet Blue but cannot make their times work for a free trip :(

  • 9.  RE: need response asap from many of you

    Posted 06-28-2018 05:22

    Please clarify what you mean by " I submitted a proposal as an individual but one of my back end advisors said make it come form IMP."

    I may have interest.   I have approx 120 Medicare patients.    My guess is 1/3 of that number are in Medicare Advantage plans.  So not sure if you should use 80 or 120 as potential patients.

    Mike Safran

    Michael S. MD

  • 10.  RE: need response asap from many of you

    Posted 06-29-2018 04:57
    Thanks Mike I think I have your name on the list I found  All I am asking is would you like ot  be paid this way
     and it would not  no not be medicare advantage

    So I was told that a proposal from an individual was ok but it would look stronger if i said  I came from a group  of people working on this or working this way or there was an organization So of course IMP did not  submit this    but  I descrbe being in this group as where the working ideas for  the proposal were originated.

    Jean Antonucci

  • 11.  RE: need response asap from many of you

    Posted 06-30-2018 13:09
    Hi Jean,

    I agree IMP should FORMALLY approve this proposal.  Why not??

    Could you post the three pages of 'clarifying questions?
    I think you could tell CMMI that the tens of  thousands of MCR patients in MDVIP plans would gladly join; in one article, this was 27,000 on 2010.  (Am J Manag Care. 2012;18(12):e453-e460)

    This is actually a version of DPC.

    The DPC coalition posted a proposal on the CMMI CMS site when they asked for information on "Direct Provider Contracting."  Their QA was essentially, "Measure the patients' utilization of OUTSIDE services, and let people walk if they think they're getting poor care," rather than any reporting from the practice. (!)

    I submitted a PTAC proposal similar to yours, but paying 12% of projected total MCR costs based on their risk model- the same model used to pay Medicare Advantage plans.
    I think more risk adjustment would be prudent, but your plan is much better than the status quo.

    The AAFP proposal was sadly flawed because it used MACRA MIPS QA measures.

    Peter Liepmann MD FAAFP MBA
    My mission is to fix US health care
    Bakersfield CA

  • 12.  RE: need response asap from many of you

    Posted 07-01-2018 07:13
      |   view attached
    here you go Peter
    Wasson and  Gordon have helped me answer and I got real examples form Jim Bloomer and  LYnn Ho
    PTAC is very friendly

    Of course Head of DHHS  Azar   has declined every singleproject they  asked him to implement

    Jean Antonucci


    ptac questions=.pdf   2.14MB 1 version