Tuesday, December 30, 2008

Anybody Want To Be A Pilot For A Medical Home?

I just received this email from my state's family practice association asking for volunteers to be a medical home in its pilot program. They are planning a 3-year effort to implement the "medical home" model in 10-20 primary care practices from across the state beginning early next year. Three years for 10 -20 practices? That should be the first clue that they made this whole thing too complicated.

The subject of the email was entitled "Maine PCMH Pilot Seeking Practices to Participate". After a few paragraphs detailing some recent meetings, they ended the email with the following:

Among other requirements, primary care practices interested in participating in the pilot project are asked to commit to the following:

• To participate in the full duration of the Pilot, anticipated to be a 6-month pre-Pilot "Ramp Up" period, the 3-year Pilot, and a 3-month post-Pilot practice reassessment as part of the overall Pilot evaluation. Participation of Pilot practice sites means active participation of all health care professionals and staff in the practice.

• To complete an application for Patient Centered Medical Home certification using the National Committee for Quality Assurance's "Physician Practice Connection-Patient Centered Medical Home" assessment tool within four months (or sooner) of being notified of selection as a Pilot site and aiming to achieve "Level 1" certification within six months of being selected.

• To complete 1-2 additional tools assessing practice culture, such as the Practice Staff Questionnaire Microsystems Assessment Tool.

• To submit an authorization for release of claims data to PCMH Pilot staff and evaluation team for analysis of cost and quality measures both at baseline and over the course of the Pilot.

• To track and report the full set of Pilot clinical measures (yet to be determined) using the practice's electronic medical record or registry and to report clinical outcomes to the PCMH Pilot staff and evaluation team monthly.

• To fully implement the PCMH model, including achieving all PCMH "Core Commitments" within 12 months of beginning participation in the Pilot.

• To identify a "Leadership Team" within the practice to serve as champions for PCMH improvement efforts and to attend PCMH Learning Sessions. The Leadership Team at the practice must include (at a minimum) a lead physician or nurse practitioner, a practice administrator, and a clinical support staff.

• To participate in the PCMH Learning Collaborative, including consistent attendance by all members of the practice Leadership Team at 1-day Learning Sessions three times per year for the duration of the Pilot.

• To continually assess and improve care processes and structures within the practice, working in partnership with a Pilot Quality Improvement Coach.

• To participate actively in collaborative learning with other Pilot practices through sharing learning with other teams in Learning Sessions and participating in PCMH Pilot listserv discussions and Leadership Team conference calls.

• To negotiate and sign a contract amendment outlining the PCMH Pilot payment model with each payer participating in the Pilot.

• To participate in post-Pilot evaluation activities, including surveys and interviews with the evaluation team, to be completed within three months of completion of the Pilot.

It is anticipated that applications would be submitted by February 28, 2009. The exact number of practices participating in the Pilot will depend upon how many practices the health plans and MaineCare agree to support. It is anticipated the payment model for the Pilot will consist of a combination of fee for service, a per member per month fee, and shared savings. The health plans participating in the Pilot have not agreed on a uniform model of payment.

Wow. Who wouldn't want to volunteer for that? Sounds delish. I put the red highlights in to show some of the most outlandish parts. I could have made the whole thing red. I have blogged and written about the "medical home" concept before. This is not new. The above is just an example of how the higher ups in our medical organizations are getting involved and don't know what they are doing. They love this stuff. Of course it entails much more work by the doctor but that really doesn't matter. As long as it involves meetings and rules and standards, these "committee" people get orgasmic over it.

Putting aside how ridiculous and complicated they are making the "medical home" thing, there is something else that needs to be explored. These people in charge have NO clue how to sell their idea. One of the basic tenets of selling is the WIIFM or "what's in it for me?" philosophy. If you read this email, you won't find it. When you are peddling a ware you need to show an overt benefit to the customer. Where is the overt benefit above? How about some reasons to believe it is good for me and my practice? How will it make my life better? How about some dramatic examples of why it is a good thing? Hell, I would even take a testimonial or some anecdotal stories. This email is laughable and will fall on deaf ears or go into the trash bin. What they should be asking, and paying for, is someone to help them sell the concept. Since they won't do that, they will have to rely on the good old fashioned method of bullying doctors into it.


Stella Fitzgibbons MD said...

Wow, Doug, you really ARE good with the medical humor. Ummm...this IS a joke, isn't it? Please tell me that you made it up. Please, please!!

mamadoc said...

Nope, he and it are serious as a heart attack. The point is we shouldn't take it seriously. They haven't "agreed on payment" or "clinical measures" and yet they think anybody would want to sign up....Hopefully there won't be enough people who've drunk the KoolAde (er, bought the AAFP line) and they'll have to get back to you when/if they've actually thought it through and made it worthwhile.

tradingfours said...

We actually ran a medical home practice in Boston in the 80s. It was great. Then people got interested in it...tweaked with the model, held sensitivity training sessions...multiple touchy feely meetings and guess what...it all disappeared

Anonymous said...

wow doctors who don't want to participate in quality or clinical trials without getting paid for it?

The What's in it for mentality is why our health care system is failing. Why we lack general surgeons but have ob gyn's doing Botox.

There are more then enough people willing to go into medicine for reasons other then wealth.

Greedy Greedy Doctors will be moving to the side soon.

drbobbs said...

This is insanity. How nightmarishly complicated is this if it requires half a year to "ramp up" to full implementation? It sounds like it would take a lot of time away from seeing patients.

While I'm a skeptic of the whole medical home concept, this sort of sales pitch would turn most true believers into atheists in short order.

How about a "ramp up" period of 1 week with 3 weeks to full implementation? How about $1000 a month to the pilot practices? If that sounds like a lot, consider that a busy solo practice can bill out well over $2000 a day. As an alternative, how about a significant tax break for the pilot practices?

What medical practices need are less paperwork, less expense, and fewer hassles. The medical home sounds like it offers the exact opposite. Here's an alternative medical home concept:

Any patient who sues the doctor and/or practice and loses has to pay the practice's (and the practice's malpractice insurance's) legal bills.

Prior authorizations for drugs? Precertifications for imaging studies? That'll be $50 per authorization/precertification, please.

Offer a large one time tax break to any practice that goes from paper to electronic medical records.

Tell your state medical society that when they come up with a medical home model that will actually make medical practices more efficient and profitable, you'd love to hear back from them.