scholarly journals Development, Value, and Implications of a Comprehensive Primary Care Payment Calculator for Family Medicine

2019 ◽  
Vol 51 (2) ◽  
pp. 185-192
Author(s):  
Aaron George ◽  
Neha Sachdev ◽  
John Hoff ◽  
Stanley Borg ◽  
Thomas Weida ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Family Medicine ◽  
The United States ◽  
Fee For Service ◽  
Quantitative Methodology ◽  
Current State ◽  
Health Quality ◽  
Definition Of ◽  
Payment Models

Background and Objectives: Fee for service (FFS), the dominant payment model for primary care in the United States, compensates physicians based on volume. There are many initiatives exploring alternative payment models that prioritize value over volume. The Family Medicine for America’s Health (FMAHealth) Payment Team has developed a comprehensive primary care payment (CPCP) model to support the move from activity- and volume-based payment to performance-based payment for value. Methods: In 2016-2017, the FMAHealth Payment Team performed a comprehensive study of the current state of primary care payment models in the United States. This study explored the features, motivations, successes, and failures of a wide variety of payment arrangements. Results: The results of this work have informed a definition of comprehensive primary care payment (CPCP) as well as a CPCP calculator. This quantitative methodology calculates a base rate and includes modifiers that recognize the importance of infrastructure and resources that have been found to be successful in innovative models. The modifiers also incorporate adjustments for chronic disease burden, social determinants of health, quality, and utilization. Conclusions: The calculator and CPCP methodology offer a potential roadmap for transitioning from volume to value and details how to calculate such an adjustable comprehensive payment. This has impact and interest for all levels of the health care system and is intended for use by practices of all types as well as health systems, employers, and payers.

Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches

2015 ◽  
Vol 63 (5) ◽  
pp. 963-969 ◽  
Author(s):  
Bruce Leff ◽  
Christine M. Weston ◽  
Sarah Garrigues ◽  
Kanan Patel ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Quality Improvement ◽  
The United States ◽  
Current State ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals The Resurgence of Home-Based Primary Care Models in the United States

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 41 ◽  
Author(s):  
Mattan Schuchman ◽  
Mindy Fain ◽  
Thomas Cornwell
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
Institutional Care ◽  
Target Population ◽  
The United States ◽  
Community Services ◽  
Fee For Service ◽  
Home Based Primary Care ◽  
Home Based

This article describes the forces behind the resurgence of home-based primary care (HBPC) in the United States and then details different HBPC models. Factors leading to the resurgence include an aging society, improved technology, an increased emphasis on home and community services, higher fee-for-service payments, and health care reform that rewards value over volume. The cost savings come principally from reduced institutional care in hospitals and skilled nursing facilities. HBPC targets the most complex and costliest patients in society. An interdisciplinary team best serves this high-need population. This remarkable care model provides immense provider satisfaction. HBPC models differ based on their mission, target population, geography, and revenue structure. Different missions include improved care, reduced costs, reduced readmissions, and teaching. Various payment structures include fee-for-service and value-based contracts such as Medicare Shared Savings Programs, Medicare capitation programs, or at-risk contracts. Future directions include home-based services such as hospital at home and the expansion of the home-based workforce. HBPC is an area that will continue to expand. In conclusion, HBPC has been shown to improve the quality of life of home-limited patients and their caregivers while reducing health care costs.

scholarly journals Advancing Primary Care Through Alternative Payment Models: Lessons from the United States & Canada

2018 ◽  
Vol 31 (3) ◽  
pp. 322-327 ◽  
Author(s):  
Andrew Bazemore ◽  
Robert L. Phillips ◽  
Richard Glazier ◽  
Joshua Tepper
Keyword(s):  
United States ◽  
Primary Care ◽  
The United States ◽  
Payment Models

scholarly journals Education and Attitudes on Medical Cannabis in Family Medicine Residency Programs

2020 ◽  
Vol 52 (10) ◽  
pp. 730-735
Author(s):  
Ann M. Philbrick ◽  
Christine Danner ◽  
Abayomi Oyenuga ◽  
Chrystian Pereira ◽  
Jason Ricco ◽  
...  
Keyword(s):  
United States ◽  
Family Medicine ◽  
The United States ◽  
Clinical Experiences ◽  
Medical Cannabis ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Medicine Resident ◽  
Current State ◽  
Research Alliance

Background and Objectives: Medical cannabis has become increasingly prevalent in the United States, however the extent of family medicine resident education on this topic remains unknown. The objective of this study was to ascertain the current state of medical cannabis education across this population and identify patterns in education based on state legality and program director (PD) practices. Methods: Survey questions were part of the Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey from May 2019 to July 2019. PDs from all Accreditation Council for Graduate Medical Education (ACGME)-accredited US family medicine residency programs received survey invitations by email. Results: A total of 251 (40.7%) PDs responded, with 209 (83.6% [209/250]) reporting at least 1 hour of didactic curriculum regarding cannabis. The most common context was substance misuse (mean 3.0±4.1 hours per 3 years), followed by pain management (2.7±3.4 hours), and management of other conditions (2.1±2.7 hours). Thirty-eight programs (15.2% [38/250]) offered clinical experiences related to medical cannabis, and PDs who had previously prescribed or recommended medical cannabis were more likely to offer this experience (P<.0001). Experiences peaked after 3 to 5 years of medical cannabis legality. PD confidence in resident counseling skills was low overall, but did increase among programs with clinical experiences (P=.0033). Conclusions: The current trajectory of medical cannabis use in the United States makes it likely that residents will care for patients interested in medical cannabis, therefore it is important residents be prepared to address this reality. Opportunities exist for improving medical cannabis education in family medicine residency programs.

scholarly journals Rural Workforce Years: Quantifying the Rural Workforce Contribution of Family Medicine Residency Graduates

2020 ◽  
Vol 12 (6) ◽  
pp. 717-726
Author(s):  
Peter Meyers ◽  
Elizabeth Wilkinson ◽  
Stephen Petterson ◽  
Davis G. Patterson ◽  
Randall Longenecker ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Family Medicine ◽  
The United States ◽  
Measurement Tool ◽  
Matched Cohort ◽  
Family Medicine Residency ◽  
Rural Primary Care ◽  
Rural Workforce ◽  
Primary Care Workforce

ABSTRACT Background Rural regions of the United States continue to experience a disproportionate shortage of physicians compared to urban regions despite decades of state and federal investments in workforce initiatives. The graduate medical education system effectively controls the size of the physician workforce but lacks effective mechanisms to equitably distribute those physicians. Objective We created a measurement tool called a “rural workforce year” to better understand the rural primary care workforce. It quantifies the rural workforce contributions of rurally trained family medicine residency program graduates and compares them to contributions of a geographically matched cohort of non-rurally trained graduates. Methods We identified graduates in both cohorts and tracked their practice locations from 2008–2018. We compared the average number of rural workforce years in 3 cross sections: 5, 8, and 10 years in practice after residency graduation. Results Rurally trained graduates practicing for contributed a higher number of rural workforce years in total and on average per graduate compared to a matched cohort of non-rural/rural training tack (RTT) graduates in the same practice intervals (P < .001 in all 3 comparison groups). In order to replace the rural workforce years produced by 1 graduate from the rural/RTT cohort, it would take 2.89 graduates from non-rural/RTT programs. Conclusions These findings suggest that rural/RTT-trained physicians devote substantially more service to rural communities than a matched cohort of non-rural/RTT graduates and highlight the importance of rural/RTT programs as a major contributor to the rural primary care workforce in the United States.

The Impact of Healthcare Information Technology on Patient Outcomes

2018 ◽  
Vol 3 (2) ◽  
pp. 39-56
Author(s):  
Edward T. Chen
Keyword(s):  
United States ◽  
Information Technology ◽  
Relevant Literature ◽  
State Level ◽  
The United States ◽  
Fee For Service ◽  
Professional Networks ◽  
Current State ◽  
Wide Scale ◽  
The Impact

The purpose of this article is to review the existing literature on health information technology (HIT), specifically electronic health records (EHR) and life-long patient records, in order to provide a broad assessment of the current state of this technology in the United States. Relevant literature was reviewed to determine whether key hypotheses were validated. Areas for additional research and development were identified, and a potential path forward was proposed. HIT adoption is a worthwhile effort in the United States, and it is possible for us to enact an interoperable central records system within our current fee-for-service healthcare system. Wide scale adoption will require subsidies and regulatory involvement at the state level, but professional networks may be exploited to speed the rate of adoption. A four-tier architecture with autonomic security systems, properly validated, can provide the infrastructure necessary.

Populism and Liberal Democracy

2019 ◽  
Author(s):  
Takis S. Pappas
Keyword(s):  
United States ◽  
Liberal Democracy ◽  
The United States ◽  
Comprehensive Theory ◽  
The People ◽  
Original Definition ◽  
Key Issues ◽  
Great Relevance ◽  
Definition Of

Based on an original definition of modern populism as “democratic illiberalism” and many years of meticulous research, Takis Pappas marshals extraordinary empirical evidence from Argentina, Greece, Peru, Italy, Venezuela, Ecuador, Hungary, the United States, Spain, and Brazil to develop a comprehensive theory about populism. He addresses all key issues in the debate about populism and answers significant questions of great relevance for today’s liberal democracy, including: • What is modern populism and how can it be differentiated from comparable phenomena like nativism and autocracy? • Where in Latin America has populism become most successful? Where in Europe did it emerge first? Why did its rise to power in the United States come so late? • Is Trump a populist and, if so, could he be compared best with Venezuela’s Chávez, France’s Le Pens, or Turkey’s Erdoğan? • Why has populism thrived in post-authoritarian Greece but not in Spain? And why in Argentina and not in Brazil? • Can populism ever succeed without a charismatic leader? If not, what does leadership tell us about how to challenge populism? • Who are “the people” who vote for populist parties, how are these “made” into a group, and what is in their minds? • Is there a “populist blueprint” that all populists use when in power? And what are the long-term consequences of populist rule? • What does the expansion, and possibly solidification, of populism mean for the very nature and future of contemporary democracy? Populism and Liberal Democracy will change the ways the reader understands populism and imagines the prospects of liberal democracy.

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