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Help Is on the Way for Primary Care Doctors (Wink, Wink)

Help is on the way “very soon” for family physicians, internists, and pediatricians in the form of a final rule for accountable care organizations (ACOs).

Based on extensive feedback on the proposed ACO rule, changes are coming that primary care physicians are going to like, Dr. Nancy Nielsen said.

The preliminary  rule  “was met with – how shall I say? – an underwhelming response by the medical community,” said Dr. Nielsen, Senior Advisor of the Center for Medicare & Medicaid Innovation established as part of Centers for Medicare and Medicaid Services (CMS) by the Affordable Care Act.

“We have a few code words we have to work out here so I don’t get into trouble, but you get what I am trying to say,” Dr. Nielsen said at the American Academy of Family Physicians Congress of Delegates. For example, if I tell you ‘it has been suggested to us,’ that is REALLY important and it may be coming out, but I can’t announce anything yet,” said Dr. Nielsen, an internist and former president of the American Medical Association.

Regarding ACOs, Dr. Nielsen said, “Very soon the final rule will come out. Very soon. CMS has listened to the feedback:”

“It has been suggested to us that 65 quality measures are way too many.”

“It has been suggested to us that the mechanism for the shared savings ought to be done differently.”

“And it clearly has been suggested to us that hospitals have the ability to come up with the capital to start an ACO, but it’s really tough for doctors. So it has been suggested to us that we give advanced payment. I am here to say that very soon you will see that, and very soon you will like what you see.”

Although doctors have always been accountable for the care of patients, now they also will be accountable for resource expenditures, and the Center for Medicare & Medicaid Innovation plans to help, Dr. Nielsen said. There will be new expectations and new tools given to primary care physicians. “I will tell you that never once in my 23 years of practice did I see data showing me what it cost when I ordered an x-ray. Do you know what it costs when you write a prescription for an antibiotic? Do you get that data? No, you have never seen that.”

“But you must help us achieve this … when the [internal] warfare within the house of medicine begins,” Dr. Nielsen said. “I have a pet peeve. It really makes me crazy when people talk about people who do primary care as ‘primary care physicians’ and all the other docs as ‘specialists.’” She said that family physicians, internists, and pediatricians should stand together and say ‘We are specialists, just like you are specialists. We have a critical role to play and we need to have the tools to help us play that role.”

“Stay tuned. A lot of things you are going to, like, have been suggested to us.”

Dr. Nielsen’s comments were streamed live on the Internet during the congress and are available as archived video.

–Damian McNamara

@MedReporter on Twitter


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Filed under Blognosis, Family Medicine, IMNG, Internal Medicine, Pediatrics, Physician Reimbursement, Practice Trends

I’m Not Just a Doctor, I’m Also a Candidate


Nothing is more American than winning. It’s so central to the American ethos that the Founding Fathers didn’t even bother to scribble it into the Bill of Rights. An amendment enshrining our right to strive for victory likely would’ve elicited a collective “Well, duh” by our bewigged forefathers. You might as well have guaranteed 18th-century citizens the right to breathe air or to wear jaunty tricornered hats. Thomas Jefferson didn’t begin the Declaration of Independence by announcing to King George III that “We hold this truth to be self-evident: Just win, baby.” He didn’t need to – Lexington, Concord, and Bunker Hill had demonstrated that the ancestors of future Boston Red Sox fans were in it to win it.

photo courtesy of Terry Rudd

Despite our national addiction to sports, it’s victory within the arena of politics – those recurring, well-funded bar brawls to decide who’s in charge – that most enthralls, unifies, and divides the nation. And even the shrine to the faith of apolitical science, the House of Medicine, enjoys intramural bouts of political pugilism.

Case in point: the campaign for leadership posts – particularly the job of president ‑ during last week’s American Academy of Family Physicians’ Congress of Delegates in Denver.

All the signs and symptoms of the American obsession with political victory were there – the ardent campaign supporters, the Technicolor campaign buttons, the sea of slick, sophisticated campaign brochures and origami-esque candidate cards that likely denuded many an Oregon hillside. The three-way race to be AAFP President-Elect even spawned a cliffhanger runoff election that ended in victory for a family physician from the state of Washington. And the aftermath of the presidential election featured the requisite shock, disappointment, and grumbling failure analysis within the ranks of the politically defeated.

But what came next were phenomena all too rare in America’s favorite blood sport: graciousness and a unifying patriotism.

 The magnanimous winners were almost literally overcome with emotion. They offered up acceptance speeches seasoned with the type of teary-eyed anecdotes usually served up by scenery-chewing Oscar winners right before the music cuts short their pathos and cues a commercial. The losers were no less generous and prone to edge-of-weepy acknowledgements during an open-mic session. And each and every one professed a shared love of their career country: family medicine.

 In victory and defeat, the AAFP political competitors’ push for victory was tempered by Abraham Lincoln’s “better angels of our nature.” At that moment, those better angels of American medicine, family physicians, embodied Abe’s selfless ideal of political healing.

At least at that moment.

During a postelection stroll through a chic Denver dining district, one family physician was overheard declaring to his dinner companions, “They kicked him to the curb in favor of some slacker from Washington.”

 Apparently, even America’s better angels prefer winning.

 –Terry Rudd (on twitter @FamilyPracNews)

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Filed under Family Medicine, Health Policy, health reform, IMNG