Wednesday, December 23, 2015

Modern Healthcare: Obama administration's proposed insurance reforms incite industry backlash

Re: The American Academy of Family Physicians asked the CMS to go a step further and build network standards for appointment wait times. found here.

I was the "Wait Times Guy" for Veterans Health Administration and can say this is no easy task. On any given day every Veteran using a VA Hospital had on average 2.5 pending appointments. Some were for that day, some the next day, or week, or month, or months but sorting out the "wait" from when the Vet wanted the appointment, and when the Vet needed to be seen for a followup appointment got very murky.

Make tinkering with those calculations a criminal offence and you've got quite a mess.

Monday, October 12, 2015

Texas Health Physicians Group Leaders Take on the Practical Data (and Process) Challenges of Population Health | Healthcare Informatics Magazine | Health IT | Information Technology

With regard to IT development, strategically speaking, what do you need to do in the next year or two?
Adams: The Holy Grail for an IT-techie person like me—patient attribution remains one of the number-one challenges. People underestimate how hard it is to attribute patients to physicians. I think the Holy Grail is combining EMR and claims data. Because right now, we’re still in the world of, here are your gaps in care, but it’s in the EMR. So I may already have had a colonoscopy and Dr. Parsley if he’s my physician wouldn’t know it. So it’s combining outside claims data with EMR data, to provide a true picture of things. And claims data is 30-45 days behind. And in the next two to three years, it’s going to be real-time notification. We don’t have all those things in place yet. So for the next year, we’ve got to get better at patient attribution and risk stratification, and then be able to combine EMR and claims data.
Parsley: I agree: if there’s a report in an old file somewhere that shows the patient did get their colonoscopy in the timeframe needed, and if we had the payer data in a timely way.

Tuesday, August 25, 2015

Rick Wicklin:The relationship between toothlessness and income

Interesting post on the relationship between toothlessness and income.  Rick ought to throw smoking prevelance into the mix because I expect it will explain more than income would.

And of course the graphs are nice!  

Friday, August 07, 2015

Join Us At Valence Health’s Value-Based Care Conference

Needless to say, my blogs represent my views and not those of my employers past or present, but below is a plug from my current job about what I think will be a very useful conference.
 Please join us for further 2015, our annual industry conference dedicated to value-based care and reimbursement models. From clinical integration, to shared risk, to provider-sponsored health plans, further 2015 explores the financial, operational and clinical aspects of all types of value-based care and “risk-based” contracting.  Learn more about the expert-led discussions designed for provider-organization executives here:

Monday, January 19, 2015

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

Regardless of how the MOC issue is resolved, the recent focus on the ABIM has shed a bright light on how medicine is regulated in the United States. The ABIM is a private, self-appointed certifying organization. Although it has made important contributions to patient care, it has also grown into a $55-million-per-year business, unfettered by competition, selling proprietary, copyrighted products. I believe we would all benefit if other organizations stepped up to compete with the ABIM, offering alternative certification options.

More broadly, many physicians are waking up to the fact that our profession is increasingly controlled by people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice. Perhaps it's time for practicing physicians to take back the leadership of medicine.

A good start to regaining that leadership might be backing off support for the  Affordable Care Act.  Government's do-gooder effort giving us less care at greater expense.

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

There are limits to CMS's statutory authority to fund services provided to people other than Medicare or Medicaid beneficiaries, but the agency can leverage its influence beyond the payment of claims. Whereas our approaches for providers focus on enrolled or attributed populations, SIM seeks to affect broader populations

I suppose CMS can leverage but I wonder if those funding limits suggest it shouldn't extend into something its unfunded and therefore ill equipped to influence for the good.