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  • 1. 5/15/2012 FMCC Updates from the The Robert Graham Center Bob Phillips, MD MSPH Director Graham Center Charge 1997• The Center would be responsible for research and analysis to inform the deliberations of the Academy in its public policy work and provide a family practice perspective to policy deliberations in Washington• The Centers work would include: – research to support the Academys policy development and advocacy efforts (research done at the direction and request of the Academy) – Center-initiated research to explore policy issues affecting the ability of family physicians to provide their services to the public at a maximum level of effectiveness. 1
  • 2. 5/15/2012 The Graham Center Team I work with some really smart, creative and cool people This talk is about their work and their ideas Dr. Andrew Bazemore Dr. Steve Petterson Dr. Imam Xierali Dr. Meiying Han Dr. Jennifer Rankin Sean Finnegan Ben Adler Dr. Laura Makaroff Bridget Teevan Kim Epperson >130 Larry A. Green Visiting Scholars AHRQ Workforce EstimatesGeographic distribution of health care professionals, 2011 All specialties Primary care U.S.Geography General General Pop NP PA Docs NP PA FP/ GP IM PedsUrban 84.4% 84.4% 89.0% 72.2% 75.1% 77.5% 89.8% 91.2% 80%Large rural 8.9% 8.8% 7.1% 11.0% 11.7% 11.1% 6.7% 6.2% 10%Small rural 3.9% 3.8% 2.6% 7.7% 6.9% 7.2% 2.4% 1.8% 5%Frontier 2.8% 3.0% 1.3% 9.1% 6.3% 4.2% 1.1% 0.8% 5% http://www.ahrq.gov/research/pcworkforce.htm 2
  • 3. 5/15/2012Sources:Census, AAMC 2011 State PhysicianWorkforce Data Book, AACOM 3
  • 4. 5/15/2012The Graham Center is looking to build tools for you to be able to look athealthcare workforce in your states…. Physician payment 4
  • 5. 5/15/2012Primary Care Incentive Payments $560 Million in 2011 But it is still broken 5
  • 6. 5/15/2012 What if we used the Definition of Primary Care for Incentives?Primary Care How to measure and use for paymentDefinitional Elements Family medicine, general internalfirst contact care medicine, general pediatrics and geriatrics (claims-based or NPI) Patients who see this physician/clinic getcontinuity of care the plurality of their care there (claims- based) Breadth and depth of ICD-9 codes used bycomprehensive care physicians in Medicare claims Patients who see more than 3 physicianscoordinated care are seen by a PCP or PC practice at least every 6 monthsBridges personal,family, and Undeterminedcommunity 6
  • 7. 5/15/2012 Better Way of assigning Primary Care Incentive Payments? Percent of Physicians Meeting Threshold Comprehensive All ness Continuity Coordination Criteria Non-Hospitalist PCFP 92% 92% 91% 80%GIM 86% 93% 93% 77%Geriatrics 94% 100% 95% 88% RuralFP 95% 88% 93% 81%GIM 94% 90% 94% 81%Geriatrics 61% 100% 100% 61% GME Funding What do we get for it? 7
  • 8. 5/15/2012 GME AccountabilityFrom the 2012 HHS Budget DocumentBetter Align Graduate Medical EducationPayments with Patient Care Costs:gradually reducing [IME] payments by a total of tenpercent, beginning in 2014.In addition, the Secretary would have theauthority to set standards for teaching hospitalsreceiving Graduate Medical Education Paymentsthat encourage training of primary care residents Coggeshall Report in 1965…“Those responsible for medical education…will, indecades ahead, need to devote careful attention toappraising the needs of society for health care andhealth personnel and to developing andimplementing plans to meet to those needs. and “Positive assumption of responsibility Failureto do so will damageand standing of the profession positive action – the this alone – can keepand educational institutions and will invite - even the initiative in the hands of those bestmake necessary - less desirable approaches tomeeting the to plan theneeds of a growing prepared health care destiny of medicalAmerica. If those responsible for medical education education.”fail to assume and act on a responsibility that isnow clearly theirs, it will be assumed by others.” • Coggeshall, Lowell T. Planning for medical progress through education; a report submitted to the Executive Council of the Association of American Medical Colleges. Evanston, Ill., Association of American Medical Colleges. 1965 8
  • 9. 5/15/2012 GME Accountability Measures • Josiah Macy Jr. Foundation funded study – Robert Graham Center & George Washington University • Qualitative Study – Should teaching hospitals be held socially accountable? – Dr. Anjani Reddy, Sonia Lazreg, Rebecca Etz • Quantitative Study – Examining the outcomes of GME institutions – Dr. Bob Phillips, Dr. Stephen Petterson, Dr. Fitzhugh Mullan, Dr. Candice Chen GME AccountabilitySponsoring Institution % IM # %Name State # Res % PC Retained # GS HPSA Rural # RHCMount Sinai School ofMedicine NY 1645 26.1 44.7 48 225 7.6 5New York PresbyterianHospital NY 1599 8.6 19.7 33 125 1.4 2New York Medical College NY 1570 29.9 44.1 62 177 7.5 9College of Medicine, MayoClinic MN 1434 11.6 15.0 49 104 6.8 7UPMC Medical Education PA 1427 17.5 36.9 19 106 7.8 10 9
  • 10. 5/15/2012 Only 25.2% of residency graduates going to primary care (includes hospitalists)Identifying Outliers Only 4.8% of residency graduates serving rural 10
  • 11. 5/15/2012 Evaluating thePatient Centered Medical Home Illinois Health Connect The Illinois Academy of Family Physicians Commonwealth Fund Can the PCMH save money and improve care? 11
  • 12. 5/15/2012 Takeaways• Significant reductions in cost: $531 million for IHC $1.53 billion for YHP• Rate of annual savings increased 2.5% in 2007 nearly 10% in 2010• Largest savings: inpatient services (-31.3%)• IHC hospitalizations fell nearly 20%, bed- days 22%• IHC ED visits declined 8% as of 2010 23http://www.graham-center.org/online/graham/home/tools-resources/npi.html 12
  • 13. 5/15/2012 The Graham Centerwill keep working for you 13