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Affinity Medical Group, Marin IPA Head List of Top Performing Practices |
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The East Bay’s Affinity Medical Group, the Marin IPA, and various Permanente Medical Groups in the Bay Area were recently named "top performers" in the pay-for-performance measurement categories by the Oakland-based Integrated Healthcare Association (IHA). The IHA is a statewide organization that promotes quality improvement, accountability, and affordability of healthcare. The IHA’s pay-for-performance (P4P) program is the largest nongovernmental physician incentive program in the U.S. and includes 8 health plans (including Kaiser for reporting only) and more than 225 medical organizations with 35,000 physicians.
The top organizations are scored by calculating a composite score in each of the four measurement domains (Overall Composite = [Clinical Composite X 55%] + [Patient Experience Composite X 25%] + [Coordinated Diabetes Care Registry Score] + [IT-Enabled System Score]). The list of Northern California practices honored is below. Making the Most Gains The IHA also recognizes the physician organizations that demonstrated the most improvement over the previous year. Overall composite scores based on the four P4P measurement domains are calculated for each physician organization each year, along with a score for the amount of overall improvement the organization achieved over the previous year. The physician organization in each of eight P4P regions that scored the highest for improvement is designated as the most improved organization in that region. Here in the Bay Area and Sacramento, the organizations that showed the most improvement in scores were the Physicians Medical Group of San Jose and the Sutter Regional Medical Foundation/Solano Regional Medical Group.
The Top Performing Practices Honored Include: - Affinity Medical Group
- Marin IPA
- Mills/Peninsula Medical Group
- Palo Alto Medical Foundation, A Sutter Health Affiliate
- The Permanente Medical Group, Inc---Diablo Service Area Medical Center
- The Permanente Medical Group, Inc---Greater Southern Alameda Area Medical Center
- The Permanente Medical Group, Inc---Oakland/Richmond Medical Center
- The Permanente Medical Group, Inc---Redwood City Medical Center
- The Permanente Medical Group, Inc---San Francisco Medical Center
- The Permanente Medical Group, Inc---San Jose Medical Center
- The Permanente Medical Group, Inc---San Mateo/South San Francisco Medical Center
- The Permanente Medical Group, Inc---San Rafael Medical Center
- The Permanente Medical Group, Inc---Santa Clara/Milpitas/Campbell/Mountain View Medical Center
Sacramento and North Bay Practices Honored include:
- Humboldt/Del Norte Independent Practice Association
- Sutter Regional Medical Foundation/Solano Regional Medical Group
- Sutter West Medical Group
- The Permanente Medical Group, Inc---Napa/Solano Medical Center
- The Permanente Medical Group, Inc---North Valley/Roseville/Sacramento Medical Center
- The Permanente Medical Group, Inc---Santa Rosa Medical Center
- The Permanente Medical Group, Inc---South Sacramento Medical Center
- Woodland Healthcare
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Last Updated on Friday, 08 January 2010 14:05 |
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Lundberg's seven ways to cut medical costs now |
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"I believe that there are still many ethical and professional American physicians and many intelligent American patients who are capable of, in an alliance of patients and physicians, doing ‘the right things,’” George Lundberg wrote in The Health Care Blog. One of those ‘right things’ is cutting medical costs. He pits fee-for-service incentives as a key reason that at least 30 percent of the $2.5 trillion expended annually for American health care is unnecessary. Eliminating that waste could save $750 billion annually with no harm to patient outcomes, he estimates. And paramount to trimming that fat are these seven tenets: - Intensive medical therapy should be substituted for coronary artery bypass grafting (around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.
- The same for invasive angioplasty and stenting (around 1 million procedures per year) saving tens of billions of dollars annually.
- Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions saved here.
- Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions saved.
- CAT scans and MRIs are impressive art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by some capitated or packaged method that is use-neutral. More billions saved.
- We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.
- Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado and intensive therapy, which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.
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Last Updated on Friday, 08 January 2010 14:10 |
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Healthy Families program slashed, then rescued (maybe) |
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When the legislature and Schwarzenegger got through with the budget, one of the most glaring cuts was to the popular Healthy Families Program, the state’s children’s health insurance program that provides coverage for nearly 1 million low-income children. The program was slashed by $194 million, and the cuts would be further deepened by a loss of federal matching funds, which provide two dollars for every state dollar spent.
People quickly rallied to the defense of the program. The state’s First Five Commission committed up to $81.4 million from tobacco tax funds to support the program, which helped, but still left a $112 million shortfall. “I appreciate that First Five is willing to make the investment our state should be making, but passing the buck to them is not the answer,” says Richard Pan, M.D., a pediatrician at UC Davis and chair of the state’s first regional Children’s Health Initiative. “It’s just astonishing that a state like California would have a public official like the governor propose something so draconian.” One particular area of concern for Pan is the upcoming flu season, especially because of the H1N1 virus lurking. With the cuts to Healthy Families, rates of immunization will likely drop. “The lower the percentage of people who get vaccinated, the more likely it is to spread around the community,” said Pan. “And it’s a geometric progression in an infection like flu; the risk of transmission magnifies tremendously and when you get down to a 70 percent immunization rate, it just goes everywhere.” Like the other cuts to health care, the cuts to Healthy Families can affect the health of children not just now, but for years to come. “People think what’s the big deal if a kid doesn’t get a wellness checkup this year,” said Pan. “But it’s not just a general checkup we do in those visits, we also screen for different developmental problems, and if they’re not detected, you may miss a critical period of treatment, which would make a huge difference in the child’s health and well-being.” Stephen Shortell, Ph.D., of UC Berkeley says the effects can be even more dramatic. “There’s research now that shows that when children are lacking in nutrition or suffer abuse or otherwise have problem sustaining early in life, it can have an impact 15 or 25 years later and at great cost to the state,” he said. “It’s broader than their health; it can affect their learning ability in school, their cognitive capabilities and their emotional intelligence.” Perhaps because of research like this, the Senate Appropriations Committee just approved a measure (AB 1422) to restore the cuts and prevent more than 500,000 children from losing coverage. To offset those cuts, AB 1422 would require all participating families to pay higher copays; some families also would pay higher premiums. In addition, the measure would impose a 2 percent gross premiums tax on health plans that administer benefits for Medi-Cal. Because this in part depends on a tax increase, it will require a two-thirds majority vote in both houses.
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Last Updated on Friday, 08 January 2010 14:11 |
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CMS Offers Incentives for EMR Use |
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The Centers for Medicaid and Medicare Services (CMS) informed all 50 state Medicaid directors last week that the federal government will reimburse states for 100% of incentive payments made to health care providers who demonstrate "meaningful use" of electronic health records. The funds are coming from the American Recovery and Reinvestment Act (ARRA) and are part of the Obama Administration’s push for the use of electronic medical records (EMRs). Physicians, and hospitals, who treat a yet unstated number of Medicaid patients can apply for these incentive payments based on their "meaningful use" of electronic health records. As part of the ARRA, beginning in January 2011, financial incentives will be offered to physicians and other health care providers who are meaningful EMR users. The stick to the financial carrot is that if you’re not a "meaningful" user by 2015, there will be payment "adjustments," according to CMS. The Medicare fee schedule would be reduced by 1% in 2015, by 2% in 2016, by 3% for 2017, and by 3% to 5% in subsequent years. Hospital-based physicians who "substantially" provide their services in a hospital setting are not eligible for this funding. According to CMS, the incentive payment is equal to 75% of Medicare allowable charges for covered services furnished by the provider in a year, subject to a maximum payment in the first, second, third, fourth, and fifth years of $15,000; $12,000; $8,000; $4000; and $2,000, respectively. For early adopters whose first payment year is 2011 or 2012, the maximum payment is $18,000 in the first year. If you practice in an underserved area, incentive payments will be increased by 10%. The September 1 letter from CMS urged states to develop a State Medicaid Health IT Plan that outlines targets for promoting interoperable electronic health systems. This would include A current assessment of the state's health IT capabilities; an implementation plan for the incentive payment program; a road map for the state's health IT initiatives; and a vision for the state's health IT future. CMS said states should plan to expand statewide and regional health information exchanges with an eventual goal of achieving nationwide interoperability.
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