Go team! Or, more accurately, “Go physician-led team” was one of the battle cries of the American Medical Association House of Delegates interim meeting.
But what if there are no physicians around to lead the team? Would the AMA be willing to call for a draft where doctors are pulled from comfortable suburban practices and dragged to the rural hinterlands like a professional athlete picked by a new team in an expansion draft?
OK. No more sports analogies. But there is a definite trend of physicians calling for physician-led teams without addressing the realities of the projected physician shortage and the existing “maldistribution” of doctors.
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It's not uncommon these days for newly elected physician association leaders to hop on the social-media bandwagon, but the American Academy of Family Physicians' new president-elect, Dr. Reid Blackwelder—a.k.a. @blackweldermd—is an old pro.
Blackwelder has sent 3,429 tweets to 690 followers since joining Twitter in May 2011, but he has been on Facebook a lot longer. First elected to the AAFP board in 2009, Blackwelder is the director of the medical student educational division within the James H. Quillen College of Medicine's family medicine department at East Tennessee State University in Johnson City, Tenn. He first joined Facebook as a way of connecting with his students.
The 2004-2005 president of the Tennessee Academy of Family Physicians, Blackwelder said he stepped up his Facebook activity as he became more involved with the state and national academy chapters. Now he cross-posts everything on both Facebook and Twitter.
Blackwelder said he discovered live-tweeting while attending a meeting and seeing the AAFP's medical resident representative, Dr. Kevin Bernstein (@BernieMD31), pecking away at a keyboard. He learned that Bernstein was "taking notes in Tweet form" for the benefit of a colleague who couldn't attend that session and wanted to find out what happened.
Except for live-tweeting from an event, Blackwelder said he usually keeps to three to five tweets a day: an opening inspirational tweet, around three educational or informational tweets with links to source material, and an evening "thought for the day to allow people to wind down." The tweets are buffered so they're sent out several hours apart, which allows him to "maintain a presence" even while he's seeing patients, teaching or tending to AAFP matters.
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Noting that healthcare is in the beginning of its “Decade of Transformation,” healthcare strategist Marc Sauve told attendees at the 25th annual Healthcare Facilities Symposium and Expo in Chicago that “We are going to have to rethink everything.”
“There is going to be a lot of anger, fighting and people getting mad,” said Sauve, a consultant on healthcare provider growth strategies with Gresham Smith & Partners in Nashville. Then, quoting Dr. Seuss, he said the questions are complicated, but the answers are simple—and that these answers include shared sacrifice, compromise and negotiation.
Sauve, a perennial speaker at the symposium, noted how he successfully predicted last year that Congress wouldn't come to a meaningful agreement on deficit reduction. An easy prediction, Sauve acknowledged, but he said he also correctly predicted the Patient Protection and Affordable Care Act's personal insurance mandate would be upheld by the U.S. Supreme Court and Chief Justice John Roberts would cast the deciding vote.
“Maybe we were lucky,” he said.
For this year, Sauve predicted Congress would prevent sequestration-driven budget cuts called for in last year's Budget Control Act, but only do so by “kicking it down the road for six months.” He also predicted failure for legislative attempts to overturn the ACA.
“If you're waiting for repeal, good luck,” Sauve said, though he later praised GOP vice presidential nominee Rep. Paul Ryan for proposing Medicare reform. “At least he had has some guts to put the thing on the table.”
Each year, Sauve runs down the nation's top 15 causes of death and compares U.S. healthcare statistics with other countries. He noted how homicide fell off the list last year after a 10-year run, but countered by stating how the nation's suicide rate is “going through the roof” and how deaths from accidents are on their way up because of driving and texting. But all others are way behind the first and second causes—heart disease and cancer—despite “great strides” made in the treatment of both.
Sauve cited how the World Health Organization ranks the U.S. health system 37th out of 190 countries. While U.S. infant mortality figures are improving, he said the current rate of 6.8 deaths per 1,000 live births is “still embarrassing” and that statistics indicate the high rate is poverty related.
This link continues into adulthood as high school dropouts have a 2.5 times higher death rate than students who go onto college, he said, adding that our “28% high school dropout rate is killing us.” Education is the key to getting people out of poverty and toward a healthier lifestyle, he said.
As health systems transform, Sauve said “there needs to be a physician at the head of the table,” and he criticized how hospital CEOs are all talking about how they need “physician alignment.”
“You need physician partners—just because they're employees now doesn't mean they are cooperating,” he said, adding that nurses need to be empowered as well.
Follow Andis Robeznieks on Twitter: @MHARobeznieks.
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If the patient-centered medical home supported by per-member, per-month care-management fees becomes the standard primary-care practice model, then Oregon Health & Sciences University in Portland can claim to be its first training ground.
When the CMS announced the names of the 500 participants in its four-year Comprehensive Primary Care Initiative, the list included three OHSU primary-care clinics where residents are trained.
The CPCI begins with Medicare providing a $20 per-member, per-month care-management fee, with that sliding back to about $15 after the second year, when practices will be eligible to collect money from shared savings. Some private payers and state Medicaid programs are also participating in the CPCI, and—with Medicare, Medicaid and private payers combined—the program's goal is to have at least 60% of the participating practices' patient base covered by per-member, per-month fees. The intent is to have the practices use that money to invest in the staff and information technology necessary for care-coordination services that should help lower hospitalizations, eliminate duplicate testing and avoid other inefficiencies that drive up healthcare costs.
Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans of Grand Junction, Colo., says the program has the potential to "fundamentally change the economics of primary care."
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Like the medical research paper whose chief finding is that more research is needed, the Liaison Committee on Medical Education put Puerto Rico's San Juan Bautista School of Medicine on probation so its problems could be studied. And, after studying them, the LCME decided to keep the school on probation.
And, while on probation, it maintains its accreditation.
Why it remains on probation remains under wraps, so it's sort of a double-secret probation.
"We're not allowed to release any information," Dan Hunt, LCME secretary, told me.
"Accreditation is not guaranteed," he added. "Accreditation can be revoked."
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"You've boarded a boat, and you don't know where it's going," Dr. Donald Berwick told Harvard Medical School graduates in a speech published in the Journal of the American Medical Association, but, he added, you still made "a spectacularly good" career choice.
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