Monday, August 18, 2008

Group Practice Demo Results, Questions, Policy and Song

The Disease Management Care Blog likewise extends a hearty congratulations to the participants in the Physician Group Practice Demonstration. Hat Tip to Vince Kuraitis for sharing the news and posting the link-announcement with the details. Looks like the docs got some serious coin.

The DMCB asks a) were the in-house interventions all that different from what is typically done by disease management programs? b) are the lessons in these large groups generalizable to the huge majority of physicians who are outside these kinds of practice settings? c) are the payments enough to cover the direct and indirect costs of implementing the interventions? d) are the payments to the four groups that hit the financial performance targets (translate decreased utilization) enough to cover their losses from avoided admissions and specialty care? Looks like we'll need to await the story behind the story.

But it's time to move on. As mentioned above, the challenge is to drive quality and efficiency in the nation's network of smaller independent physician practices. The details on that demo are coming to light, once again, thanks to Vince Kuraitis who has another post on the topic. It makes for very interesting reading.

Pity CMS. It would be so much simpler if the Group Practice Demo couldn't be used nationwide? If the physicians were assembled into large coordinated socialized entities that assumed regional responsibility for care? Instead, those irksome docs stubbornly cling to notions of running a business, retaining notions of independent professionalism and keeping local responsibility for the care they provide.

With apologies to Led Zeppelin:

Wanna tell you ‘bout some policy y’know
My it sound so fine
The docs only ones that we been schemin of
Maybe someday they won’t be so blind
We wanna tell em how we pay just blows
Their bills are just outta touch
We need to tell em that its outcomes that they really love

We want the doctors, go for risk all day
We want the doctors, drop one-on-one, no
We want the docs, take cap all the time
We said we want the greedy doctors to take upside risk

Sunday mornings when their offices are closed
See the uninsured standin in line
Don’t say they want no pay for their work
But when the A1c’s’ below nine
In the long term yes the payment may be low
CMS don’t wanna to be loved
We call the tune, keep-a- usin RVUs
Only payin if admits’r stayin down

We want the doctors join big groups
We want the docs not use pens no no
We want the docs, go salary big time
We said we want the doctors' mistakes to never get paid

In the halls with the men who pass the laws
Changin, schemin and regulatin’ health care
Our nifty notions are just the trick
Re-tool payment for all time
We guess there just one thing left for docs to do
If they don’t like it move outta the way

Cause we got a worried mind
Budget’s too big undermine
Outcomes savings will fix it we pray

We want the docs take episodes of care
We want the docs practice in IDS yay yay…
We want the doctors let us be in charge
We want the doctors to take R-V-Us!

(Hey hey that’s what we’ll do)

Tell the docs what to do!

(Hey Hey, That how we pay!)

Hey hey that’s what we’ll do

We got the doctors, that’s what they’ll do

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