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Bob Phillips, MD MSPH

Director

FMCC Updates from the

The Robert Graham Center

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 Center's work would include:

– research to support the Academy's 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.

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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 Estimates

Geography

All specialties Primary care

U.S.

PopNP PA Docs NP PA FP/ GPGeneral

IM

General

Peds

Urban 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%

Geographic distribution of health care professionals, 2011

http://www.ahrq.gov/research/pcworkforce.htm

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Sources:Census, AAMC 2011 State Physician Workforce Data Book, AACOM

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The Graham Center is looking to build

tools for you to be able to look at

healthcare workforce in your states….

Physician payment

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Primary Care Incentive Payments

$560 Million in 2011

But it is still

broken

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What if we used the Definition of

Primary Care for Incentives?

Primary Care

Definitional ElementsHow to measure and use for payment

first contact care

Family medicine, general internal

medicine, general pediatrics and geriatrics

(claims-based or NPI)

continuity of care

Patients who see this physician/clinic get

the plurality of their care there (claims-

based)

comprehensive careBreadth and depth of ICD-9 codes used by

physicians in Medicare claims

coordinated care

Patients who see more than 3 physicians

are seen by a PCP or PC practice at least

every 6 months

Bridges personal,

family, and

community

Undetermined

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Better Way of assigning Primary Care

Incentive Payments?

Percent of Physicians Meeting Threshold

Comprehensive

ness Continuity Coordination

All

Criteria

Non-Hospitalist

PC

FP 92% 92% 91% 80%

GIM 86% 93% 93% 77%

Geriatrics 94% 100% 95% 88%

Rural

FP 95% 88% 93% 81%

GIM 94% 90% 94% 81%

Geriatrics 61% 100% 100% 61%

GME Funding

What do we get for it?

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GME Accountability

From the 2012 HHS Budget Document

Better Align Graduate Medical Education Payments with Patient Care Costs:

gradually reducing [IME] payments by a total of ten percent, beginning in 2014.

In addition, the Secretary would have the authority to set standards for teaching hospitals receiving Graduate Medical Education Payments that encourage training of primary care residents

Coggeshall Report in 1965…

“Those responsible for medical education…will, in decades ahead, need to devote careful attention to appraising the needs of society for health care and health personnel and to developing and implementing plans to meet to those needs. Failure to do so will damage the standing of the profession and educational institutions and will invite - even make necessary - less desirable approaches to meeting the health care needs of a growing America. If those responsible for medical education fail to assume and act on a responsibility that is now 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

“Positive assumption of responsibility and

positive action – and this alone – can keep

the initiative in the hands of those best

prepared to plan the destiny of medical

education.”

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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 Accountability

Sponsoring Institution

Name State # Res % PC

% IM

Retained # GS

#

HPSA

%

Rural # RHC

Mount Sinai School of

Medicine NY 1645 26.1 44.7 48 225 7.6 5

New York Presbyterian

Hospital NY 1599 8.6 19.7 33 125 1.4 2

New York Medical College NY 1570 29.9 44.1 62 177 7.5 9

College of Medicine, Mayo

Clinic MN 1434 11.6 15.0 49 104 6.8 7

UPMC Medical Education PA 1427 17.5 36.9 19 106 7.8 10

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Only 25.2% of residency

graduates going to primary

care (includes hospitalists)

Identifying Outliers

Only 4.8% of residency

graduates serving rural

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Evaluating the

Patient Centered Medical Home

Illinois Health Connect

The Illinois Academy of Family

Physicians

Commonwealth Fund

Can the PCMH save money and

improve care?

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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 201023

http://www.graham-center.org/online/graham/home/tools-

resources/npi.html

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The Graham Center

will keep working for you