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  1. #1
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    Default 10 Steps to PCMH

    Even though dated, I consider this one of the best articles ever on PCMH -http://www.aafp.org/fpm/2009/1100/p18.html



  2. #2
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    IMHO, a physician delivering 25 patient encounters daily will soon not prove viable for either his/her medical practice and/or society much longer.
    At 50-75 patient encounters/day, all can thrive:

    1. 25 patients encounters face to face with physician
    2. 25 patient encounters with members of the practice team via standardized, best practices (i.e. “nurse visits” if still fee-for-service)
    3. Up to 25 electronic encounters (at rate less than a visit co-pay or via an annual subscription)

    50-75 daily patient encounters can be revenue sources that more that cover overheads and be less work for the physician than seeing 25 patients daily in the traditional model. Physicians can actually work less in the process.

    Some advanced practices (even small, independent ones) are using Shared Medical Appointments (Group Visits) to manage even more patient encounters with proven higher quality and better outcomes.

  3. #3
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    Quote Originally Posted by roates View Post
    IMHO, a physician delivering 25 patient encounters daily will soon not prove viable for either his/her medical practice and/or society much longer.
    At 50-75 patient encounters/day, all can thrive:
    If that is true, I am concerned about the implications for patients in rural areas...you can't have a doctor if you don't have enough people for 75 encounters a day?

    Andy

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    Quote Originally Posted by ageorge View Post
    If that is true, I am concerned about the implications for patients in rural areas...you can't have a doctor if you don't have enough people for 75 encounters a day?

    Andy
    With healthcare reform and the aging population, the demands for primary care to perform more population health services will far surpass the system's ability to deliver. Fees for services will be frozen to decreasing, and payment increases will be shifting more to managing panels of patients and reporting the results.

  5. #5
    DMason
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    The Dartmouth Institute for Health Policy has their Primary Care Service Area (PCSA) Project and it's a wealth of info based upon nation/state/region/county/city/zip...including population demographic, physician supply, medicare utilization and patients' travel time to primary care. Relating to travel time, they go into details relating to specialty...average travel time from zip area to nearest children's hospital for instance.

    pcsa.dartmouth.edu/pcsa_search.php

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    Up to 25 electronic encounters (at rate less than a visit co-pay or via an annual subscription)


    I understand the need to change , but unless liabilty for electronic consultations and reimbursement change, I do not see this as a productive way of practicing medicine. The liabilty for a electronic encounter needs to be different or have different "set of rules" than an actual visit. When something goes wrong, being compared to an actual visit, a plaintiff lawyer will have a field day. Also , reimbursement needs to be the same as an actual encounter. If you spend 15 minutes of time on and electronic encounter and get reimbursed a copay, why would you want to do an electronic encounter when you can do a real visit at 3 times the rate. I do not know about your area , but in my area , a lot of primary care are completely full. So spending an hour doing encounters that are reimbursed less than and actual encounter does not seem to make sense.

    just my 2 cents

    James

  7. #7
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    Quote Originally Posted by DoctorW View Post
    Up to 25 electronic encounters (at rate less than a visit co-pay or via an annual subscription)


    I understand the need to change , but unless liabilty for electronic consultations and reimbursement change, I do not see this as a productive way of practicing medicine. The liabilty for a electronic encounter needs to be different or have different "set of rules" than an actual visit. When something goes wrong, being compared to an actual visit, a plaintiff lawyer will have a field day. Also , reimbursement needs to be the same as an actual encounter. If you spend 15 minutes of time on and electronic encounter and get reimbursed a copay, why would you want to do an electronic encounter when you can do a real visit at 3 times the rate. I do not know about your area , but in my area , a lot of primary care are completely full. So spending an hour doing encounters that are reimbursed less than and actual encounter does not seem to make sense.

    just my 2 cents

    James

    As long as the payment systems is fee-for-service, it is not prudent to substitute unpaid and low-paid electronic encounters for paid face-to-face. It is prudent to start getting paid something for services often now done over the phone (or not done) for which no payment is currently received. So, in current fee-for-service system, consider this as an extension of income producing services rather than a replacement for those in place.
    As the fee-for-service system declines, consider the implications when payments are more bundled/fixed. In this scenario, every unnecessary face-to-face visit is an added cost lowering the net income. Based on best practice guidelines and protocols, there are situations that can take far less physician time and have better outcomes. Chronic disease patients more regularly engaging/reporting status have better outcomes as well, but, the practice needs some form of payment that more than covers any/all costs. Net income to practice still needs to be greater than if patient engaged less often.
    Actually, liability can be lessened in some situations by more consistent interaction, data collection and "best practices." The goal should not be to substitute electronic interaction when face-to-face will result in higher quality outcome. Keep in mind that electronic data collection, in certain cases can equal or surpass traditional, face-to-face data collection methods. Example -
    Safety in prescribing PDE-5 inhibitors for erectile dysfunction was similar between a US-based, state-regulated Internet prescribing system and a multispecialty primary care system.
    Last edited by roates; 09-16-2013 at 07:49.

  8. #8
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    Default

    There is pain and stress with all change, good or bad. The secret is to take the pain and chaos and make something of value from it.

 

 

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