Day 1 - Family Medicine Congressional Conference

tweetyturt Heidi Meyer
ACA requires ACOs form, but how can we make it more patient
centered and protect docs. COMMENTS PLEASE! #aafpfmcc @aafp
#ACO #fmrevolution
3 minutes ago Favorite Undo Retweet Reply
#aafpfmcc #ACO @aafp from the floor: these rules are complex,
even the docs are lost; independent doc is at risk of getting screwed
again
5 minutes ago Favorite Retweet Reply
MAFPadvocacy MAFP Advocacy

@
@mdstudent31 He's holding up ok. Getting the full frustration of the
audience for sure though. Glad he's here. #aafpfmcc
mdstudent31 Kevin Bernstein, MMS
@
@MAFPadvocacy Agreed. Don't destroy the messenger! We should
appreciate his patience and the information he has provided us.
#aafpfmcc
4 minutes ago Favorite Reply Delete
@
MT @tweetyturt @AAFP wants your comments on ACOs ASAP!
Include #ACO in tweet & send to @AAFP #aafpfmcc #hcr #pcmh
#mdchat #FMRevolution
Give Deputy Administrator at CMS Johnathan Blum credit for coming

to talk about ACOs. Audience treating him like it's his idea...
#aafpfmcc
AAFP wants your comments on ACOs ASAP! Our response letter will
go to st chaps end of May- Include #ACO in tweet & send to @aafp
#aafpfmcc

You need to submit comments IN WRITING to CMS Re: #ACO
implementation by 6 June 2011 http://1.usa.gov/kqzpmY #aafpfmcc
#hcr #pcmh
@aafp #aafpfmcc comments for ACO rules: ensure patient memory

for ACO assignment so that 1 visit/yr counts!
I'm having a feeling that this talk about #ACO is going to lead to a
roast of our speaker... #aafpfmcc
Antitrust concerns re: ACO's? Proposed rules trigger audit once 30%
of market share reached (rural exception). #aafpfmcc #FMrevolution

@AAFP Leaders Respond to Member Concerns, including RUC, At
Town Hall Meeting http://bit.ly/iYmkpV #FMRevolution
@AmerMedicalAssn #aafpfmcc
#aafpfmcc ACO proposed rules online

http://www.cms.gov/MLNProducts/downloads/ACO_NPRM_Summary
_Factsheet_ICN906224.pdf comments til 6/6/11
drkkyu Kim Yu, MD, FAAFP
(@ Blue Ocean Seafood Restaurant) eating dim sum but still keeping
up with #aafpfmcc thx to tweets from DC
Now listening to Jonathan D. Blum, Deputy Administrator, Center for

Medicare about Implementation of the Affordable Care Act #aafpfmcc
#ACA
familydocwonk Jay W Lee MD MPH
Muhahaha...RT @maverickmd2012: @MAFPadvocacy DC is the

perfect place for plotting in dark rooms! Viva la #FMRevolution
#aafpfmcc

@
@MAFPadvocacy Yep! All of our Pennsylvania students are
FamMedPAC Student Club George w/ 1 at Physician Club George & 1
@ Lincoln #aafpfmcc
FamMedPAC - we don't give to D's, we don't give to R's, we give to I's:

Incumbents whose votes support Family Medicine - Lets' go!
#aafpfmcc
Proud to say Michigan's student member at #aafpfmcc Leanne

Lawwell of Wayne State University is a FamMed PAC Club George
(student) member
Most residents and students have given to FamMedPAC today at

#aafpfmcc Let's go physicians, step up to the plate!
1 hour ago Favorite Reply Delete
#aafpfmcc Pomeroy: tips to asks: 5 pick battles carefully 6 don't

underestimate partisanship
#aafpfmcc Pomeroy: tips to asks: 3 - perfection can be the enemy of

the good. 4- Keep gotta-haves in do-able category
#aafpfmcc Pomeroy: tips to asks: 2 - never underestimate

congressional inertia
#aafpfmcc Pomeroy: tips to asks: 1 keep it simple, really simple,

direct, concise, basic
#aafpfmcc Pomeroy: Congress ready to listen to frontline

practitioners... in most cost-effective way - the way family med knows
how to do
#aafpfmcc Pomeroy: The republican party, excited about the

government, has done the same thing we did.
JudyYChoi Judy Choi
Love the FMCC updates, Kevin! RT @mdstudent31: Socioeconomic

disparities dramatically reduced with proper amount of primary care
#aafpfmcc
1 hour ago Favorite Retweet Reply
JudyYChoi Judy Choi
RT @mdstudent31: Health outcomes and cost are optimized in

nations & regions where 40-50% of workforce is primary care
#aafpfmcc
JudyYChoi Judy Choi
Agreed. RT @tweetyturt: MedPAC commission chair Glenn

Hackbarth: "the training system is not producing what society needs."
#aafpfmcc
Pomeroy: the role family physicians play has swung front and center,
your profile has never been higher #aafpfmcc
Next topic: Meeting the Constituents by Former U.S. Representative

Earl Pomeroy (D-ND) #aafpfmcc
MedPAC commission chair Glenn Hackbarth: "the training system is

not producing what society needs." #aafpfmcc
Isn't THC concept included in #HCR to modernize primary care

training? Response: we support THC, but not Medicare moderniz. tool
#aafpfmcc
These only adjust reg requirements in keeping w/ Congressional intent

established in 1997. #HCR did not modernize #aafpfmcc
Pushback: Didn't #hcr take care of paying for training in community

setting? Response yes, but ... #aafpfmcc
Primary care physicians are a critical piece of the physician workforce

- key to caring for Medicare beneficiaries #aafpfmcc
Strengthening primary care workforce promotes ambulatory and

preventive care - all assoc w/ decr. hospitalizations & ER use
#aafpfmcc
Why should Medicare pay for this kind of training? Response:

MedPAC & COGME believe we're not getting product we need (# and
kind) #aafpfmcc

AAFP ask: a 5 yr pilot of a medicare $ GME carve out, budget neutral,
dedicated to training primary care residents #aafpfmcc
Pilot - budget neutral, 5 yrs, 4 organizational modes tested (2 each),

robust payment amounts #aafpfmcc
New model needs to have Primary Care specific GME funding that
goes directly to primary care residency #aafpfmcc
Currently, GME out of Medicare Part A Trust Fund goes to hospital,

then they send or don't send $ to training and varies #aafpfmcc
STFM_FM STFM_FM
Currently more than 7 million people rely on NHSC clinicians for care
every year yet 9,000 family medicine slots remain unfilled. #aafpfmcc
Costs and needs of training need to be identified at paid for by

Medicare GME #aafpfmcc
Education has to be modernized. PC training in nonhospital settings,

funding delinked from inpatient hospital services #aafpfmcc
Why? Hospital-based, outmoded, primary care physicians need to

train in the COMMUNITY. #aafpfmcc
STFM_FM STFM_FM
Currently more than 7 million people rely on NHSC clinicians for care
every year yet 9,000 family medicine slot remain unfilled. #aafpfmcc
Ask3: Modernizing GME for PC Training - intro legislation to establish

pilot to test new models of GME financing for PC production
#aafpfmcc
Reponse: Today over 9000 vacancies at NHSC approved sites,

funding inadequate to fill slots. 7 million people rely on NHSC docs
#aafpfmcc
How Canada fixed its PCP shortage: http://www.bcmj.org/mds-

be/solving-primary-care-crisis—-proposed-strategy-physician-
allocation #aafpfmcc
Ask $418.5 million for @NHSCorps . Pushback: Generally supported

program, but "too costly" #aafpfmcc
STFM_FM STFM_FM
If we don't increase primary care production now, we won't be able to

address increased health care costs & poorer health outcomes
#aafpfmcc
Pushback: These Programs are Ineffective Response: IOM pointed to

drastic decline Title VII funding-these progs "undervalued asset
#aafpfmcc
Invest in PC now for future budget gains and better health outcomes
#aafpfmcc
2 hours ago Favorite Reply Delete
Pushback: Too Costly. Response: If we don't increase PC production

now, we won't be able to address increased health care costs
#aafpfmcc
Enhanced funding is needed to help address increased primary care

needs. Program has kept up w/ times addressing workforce needs
#aafpfmcc
Asks: Appropriate $140 mill for Health Professions Program - Primary

care training and enhancement #aafpfmcc
Kruse - when Canada recognized problems w/ primary care - payment

and medical school reform occurred real quick... and it worked
#aafpfmcc
You need to go to your medical school leaders and tell them you're
interested in helping lead changes for primary care #aafpfmcc
widfm WI Family Medicine
RT @mdstudent31: Health outcomes and cost are optimized in

nations & regions where 40-50% of workforce is primary care
#aafpfmcc #fammed
2 hours ago Favorite Retweet Reply
Kristin Welch, Senate Finance cmte, Lobbying 101: data, data, data
#aafpfmcc Prove your ask is valid. #FM revolution
widfm WI Family Medicine
Following the discussion at #aafpfmcc

»
From the floor - Will Public Service Loan Forgiveness Program be

around in 10 yrs to truly make a difference? Promotion for PC?
#aafpfmcc
From the floor: Medicare - is it an entitlement if you've paid into it?

Contrast vs Medicaid #aafpfmcc
Jerry Kreuse, MD. Data shows strong Pri Care workforce may save as
much as $2000 per medicare beneficiary #aafpfmcc

@
MT @blackweldermd "As human beings, greatness lies not so much
in being able to remake world as in being able to remake ourselves"
#aafpfmcc
lori_heim Lori Heim
Bipartisan support for GME but might be collateral damage if x board

cuts #aafpfmcc
Dramatic change in TItle VII funding from 1960's and 70's vs 80's til
now. VERY dramatic #aafpfmcc
Title VII - achieving its legislative intent #aafpfmcc


Title VII Facts - Physicians who train w/ Title VII funds more likely to
practice CHC's and NHSC service sites #aafpfmcc
drmikesevilla Mike Sevilla, MD
RT @lori_heim Including PC, OB residents over estimates workforce

available. Truth in #'s needed. Jerry Kruse #aafpfmcc
A small increase in primary care from 2007-2009 resulted in a small

increase in primary care choice (more matched into fam med)
#aafpfmcc
Income ratio - 0.7 to 0.8 ratio will result in primary care choice of about
35% of medical students #aafpfmcc

Med students planning primary care specialties (AAMC) 2000-2003
50% decrease. 2010 - only 15% planning career in primary care
#aafpfmcc
STFM_FM STFM_FM
STFM President Elect Jerry Kruse, MD, talks about the 20th COGME
report. #aafpfmcc
Socioeconomic disparities dramatically reduced with proper amount of

primary care #aafpfmcc
Health outcomes and cost are optimized in nations & regions where
40-50% of workforce is primary care #aafpfmcc

Now listening to COGME's 20th Report's 5 Recommendations - Music
to my ears. http://bit.ly/fZq2CQ #aafpfmcc
rliumd Robyn Liu
And we're tired of them punting. RT @mdstudent31 House, Sen,

Repub, Dem - tired of hearing about health care. That's a shame!
#aafpfmcc
Now listening to Jerry Kruse, MD - Chair of SIU Dept of Family Med,

Served on Council of COGME/author 20th report, STFM Prez-Elect
#aafpfmcc
SGR - the one thing that has to happen first before looking at anything
else. #aafpfmcc
lori_heim Lori Heim

Care will chg, delivery, finance & pay. KristenWelsh - Sen Hatch on
GME & training. Debate if there is enough money in system now
#aafpfmcc
The main issue that needs to be addressed/at forefront for legislators

is "doc fix" - SGR #aafpfmcc
House, Senate, Republicans, Democrats - people are tired of hearing

about health care. That's a shame! #aafpfmcc
If we're going to change it and it will cost money, we need to find it and
have a good reason to take from somewhere else #aafpfmcc

3 Financing - not the first hurdle - must deal with 1 and 2. That way we
know if there is already enough, not enough, or too much #aafpfmcc
2 Are the slots appropriate? Are they in the right places? #aafpfmcc
1 How is the structure currently in place, does it need to change?

Obviously a huge push for primary care - that is appropriate
#aafpfmcc
Learning more about HOW physicians are trained. Are we trained the
right way? Looking at continuum of care, technology, etc #aafpfmcc

IME over-funded, covering more than actual cost of care. IME shift
towards GME? Probably not the answer. #aafpfmcc
Care - delivery, funding/financing is going to be changed. #aafpfmcc

We're not going to balance the budget by cutting GME funding. That's
not an issue. Care must be provided in a different way #aafpfmcc
Now listening to Kristin Welsh - Health Policy Advisor for Senate

Finance Committee Ranking Member Orrin Hatch #aafpfmcc
If we need to cut $30 billion - it's difficult to take from primary care
before looking at other specialties #aafpfmcc
Next FY-House: adoption of budget resolution to set framework on tax

legislation, appropriations, target for $30 billion reduction #aafpfmcc
MaverickMD2012 Andrew Lutzkanin
@MAFPadvocacy DC is the perfect place for plotting in dark rooms!

Viva la #FMRevolution @familydocwonk #aafpfmcc
Half of this went to programs to educate health professionals in these

areas #aafpfmcc
Prevention Public Health Fund $500 million last yr, $750 mill this year,
$1 bill next yr to improve prevention and public health #aafpfmcc
Listening to David Reich, Minority Staff, House Labor/HHS

Appropriations Subcommittee at #aafpfmcc
#aafpfmcc
http://www.bipartisanpolicy.org/news/articles/2011/05/medicaid-facts
Family Medicine: The Rx for a Healthy Democracy #FMRevolution

#aafpfmcc http://twitpic.com/4vjrdx
INFamDocs IAFP
*Shocker* RT: @mdstudent31: #aafpfmcc Graham Center - MOC

studies at 10 yrs show 17% gen internal med residents actually
entering workforce
@aafp Bring back Julie Barnes to EVERY #aafpfmcc

Julie Barnes, now wrapping up her stand-up routine at #aafpfmcc. A

lawyer who can joke about health reform. Priceless.
#aafpfmcc Julie Barnes, dir of health policy of bipartisan policy ctr,

great stuff. http://www.bipartisanpolicy.org/projects/health-project
Another way to track the #aafpfmcc tweets. See the #FMRevolution

starting right before your eyes http://tweetchat.com/room/aafpfmcc
INFamDocs IAFP
Second! RT: @drmikesevilla: Encouraging other #aafpfmcc

participants to tweet it up! What's your opinion? Let your voice be
heard :)
RussellKohl Russell Kohl
#aafpfmcc My rural practice didn't get the incentives- because too

high of procedures. Business logic- refer more. FM logic- continuity
RT @MAFPadvocacy Made it to #aafpfmcc Beautiful day in DC.... to

be in a dark hotel conference room plotting the #FMRevolution
Made it to #aafpfmcc. Beautiful day in the nation's capitol... to be in a

dark hotel conference room plotting the #FMRevolution.
RT @andybaldwin Family Med peeps! Follow #aafpfmcc today &

tomorrow for live updates from Family Medicine Congressional
Congress in DC @AAFP
Family Medicine: The Rx for a Healthy Democracy

http://twitpic.com/4vjrdx #FMRevolution #aafpfmcc
RichmondDoc Mark Ryan

@
@mdstudent31 Thanks for the info stream coming from #aafpfmcc.
Critically important information.

@
@andybaldwin Thanks for the shout out! We'll keep you all up to
speed on all of this great info! #aafpfmcc
@
Fix RUC MT @amednews High debt, low compensation drive young
doctors from general internal med http://bit.ly/luiOzS #aafpfmcc
#FMRevolution
serendipidoc Rachel Friedman, MD
Thanks @medstudent31, enjoying the #aafpfmcc vicariously via ur

posts!
andybaldwin Dr. Andy Baldwin
Family Med peeps! Follow #aafpfmcc today & tomorrow for live
updates from Family Medicine Congressional Congress in Wash D.C.
@AAFP
@serendipidoc Shout out to #nhconf2011 from the #aafpfmcc in DC!

GREAT presentation (as always) by Robert Phillips, MD MSPH,

Director of the Robert Graham Center!! #aafpfmcc
Less: Cost, variation in access/quality, production of a workforce we

don't need, sketchy evidence for pushback #aafpfmcc Graham
Center
More: incentive, payment scope, distribution, accountability, Graham

Center research and tool building #aafpfmcc Graham Center -
#aafpfmcc Graham Center -2009, nearly 10% growth above GME,

85-90% were subspecialty. 2-4 yrs later, only 25.8% still primary
care/gen surg
#aafpfmcc Graham Center - Resident Physician Shortage Reduction

Act of 2009. Criteria - hospital 10 or more positions above GME cap
(wow)
#aafpfmcc Graham Center - Plug for Med School Mapper

http://www.medschoolmapper.org/ How does your school REALLY
produce primary care docs?
#aafpfmcc Graham Center - MedPac says GME "unaccountable",

ACA assigned education/GME accountability measure to COGME
#aafpfmcc Graham Center - In Australia, you can make up to 50%

more if you go to a shortage area
#aafpfmcc Graham Center - Need more visible, tangible bonus or

loan repayment to get physicians where they are needed (and
quickly!)
#aafpfmcc Graham Center - Needs to focus goal of improving phys

distribution and Medicare access, NOT accounting/regional practice
cost diff
#aafpfmcc Graham Center - Geographic Practice Cost Index (GPCI)

could reduce Medicare payment as much as 10% (negating HPSA
bonus) thanks!

#aafpfmcc Graham Center - MORE funding for #PrimaryCare means
LESS overall cost. Period.
#aafpfmcc Graham Center - Evidence building that return on

investment is high.
ACOs and #hcr will only work if there is shared responsibility for cost
and quality by ALL physicians #aafpfmcc
#aafpfmcc Graham Center - Large enough: moving Primary care fro

4-6% to 10-12% of total health care spending

#aafpfmcc Graham Center - Need to make sure incentive is large
enough to change behavior and practice
#aafpfmcc Graham Center - INcentives MUST support BROAD-

SCOPE family medicine
#aafpfmcc Graham Center - Now working with @AAFP Govt

Relations to make case for increasing the size of incentive
#aafpfmcc Graham Center - CMS changed the rule, making 25,000

more FPs eligible ($50-100 million more)

#aafpfmcc Graham Center - Able to demonstrate that broader scope
of practice associated w/ Lower Medicare costs
#aafpfmcc Graham Center - Showed that definition for "primary care"

too narrow - most rural family physicians were not eligible
#aafpfmcc Graham Center - Distribution - change the purpose of the

Geographic Practice Cost Index (Part of SGR), increase HPSA bonus
#aafpfmcc Graham Center - COGME to come up with accountability

measures

#aafpfmcc Graham Center - HRSA investing $250 million in PC
expansion, THCs, COGME/MedPAC weigh in on payment and funding
reform
#aafpfmcc Graham Center - #ACA help? Payment - incentive

payment, medicare/aid parity, expanded NHSC, CNHCs, revised
shortage designation
And if you put together a care plan with patient, you get extra $200 for
the first visit and $100/visit after that #aafpfmcc
#aafpfmcc Graham Center - Growing evidence of primary care

importance to cost and quality, especially family medicine

#aafpfmcc Graham Center - If you're going to build an #ACO,
WellMed is a great example
#aafpfmcc Graham Center - WellMed is in Texas by the way (San

Antonio) and almost no turnover... good luck finding a job there
natefavini Nate Favini
RT @mdstudent31 #aafpfmcc Graham Center - Now discussing

http://bo.st/k0X23M Family physicians tied to lower readmissions
#aafpfmcc Graham Center - WellMed - improving preventive care w/

IT systems (made their own) that monitor & manage pt population

New model from Maryland blues: take top 10% patients based on
costs and pay family docs 12% more to take care of them #aafpfmcc
#aafpfmcc Graham Center - WellMed Up to 140% income bonus

2010= $260k-$550 for a PRIMARY CARE PHYSICIAN
#aafpfmcc Graham Center - WellMed avg physician panel size < 500,
backed by robust teams and disease management
#aafpfmcc Graham Center - Is WellMed the future? Primary Care-

based #ACO (no hospital).Reduced bed days by 60%! Mortality rate
decreased 50%

#aafpfmcc Graham Center - #Primarycare 4-6% of total cost, more
robust primary care in ACO= +7%, cost investment and more is
covered!
RT @aafp: Follow #aafpfmcc today & tomorrow for live updates from
the Family Medicine Congressional Congress in Washington, DC.
#aafpfmcc Graham Center - Geisinger able to convert 2 hospitals into

outpatient outreach centers due to cost savings from #PCMH and
#ACO
#aafpfmcc Graham Center - 7-10% reduction in total costs, reduction

in hospital admissions, 30-40% reduction in ED

RT @mdstudent31: SGR formula created by Congress.... only
Congress can fix it (duh). It has to take path to long term resolution
#aafpfmcc
#aafpfmcc Graham Center - plug for @PCPCC and UCSF for

evidence of #PCMH and #ACO demos
RT @mdstudent31: Goertz: Unless the silos are broken down w

payment, you can't get to savings and will not get to the next phase
#aafpfmcc
#aafpfmcc Graham Center - Avoidable hospitalizations does not

bottom out as # family docs in area increases. Continues to decrease
RT @mdstudent31: Sounds like C Brown & @AmerMedicalAssn get

that RUC got primary care wrong - what are we waiting for to right it?
#aafpfmcc
#aafpfmcc Graham Center - 80 to 100,000 is about magic number for

best $ beneficiary for Medicare cost
RT @mdstudent31: Cindy Brown asks for time to get RVUs right. 20+
years & still wrong. More time? Med students aren't waiting
#aafpfmcc
#aafpfmcc Graham Center - Medicare costs decrease as number of

family physicians in an area increases
#aafpfmcc Graham Center - Guess what? Family physicians reduce

readmissions for pneumonia, heart attack and CHF.
RT @tweetyturt: #aafpfmcc 10 year SGR freeze has pricetag of

$300B. Doc payment costs $40B/yr. Changing payment not enough to
fix SGR.
#aafpfmcc Graham Center - Now discussing http://bo.st/k0X23M

Family physicians tied to lower readmissions
#aafpfmcc Graham Center - Need to fix physician income gap and

lack of investment in physician practice redesign
RT @drmikesevilla: Here's diff way to monitor #aafpfmcc. What

onscreen twitter stream would look like at mtgs http://ow.ly/4QmOW
#aafpfmcc Graham Center - Physician distribution problem about to

be compounded by newly insured. Distribution incentives too weak to
help
Lesson from new payment models: FFS has a place but must be
balanced with P4P and care coordination fees #aafpfmcc
#aafpfmcc Graham Center - Now discussing Dr. Sroka's article in NY

Times - Family Doc Can't Give Away Solo Practice
http://nyti.ms/g2cS5z
#aafpfmcc Graham Center - More Gap in relative income = Less

primary care doctors
#aafpfmcc Graham Center - Primary care can't replace itself. Down to

22% primarycare production by GME
RT @tweetyturt: @cmsinnovates Follow CMS Innovation or tweet

your ideas for care models to them! #aafpfmcc #pcmh
#aafpfmcc Graham Center - MOC studies at 10 yrs show 17% of

general internal medicine residents actually entering the workforce
aafp AAFP
Follow #aafpfmcc today & tomorrow for live updates from the Family
Medicine Congressional Congress in Washington, DC.
RT @mdstudent31: Clever comment by Kevin Burke: Believe it or not,

we're not at a meeting of the @AmerMedicalAssn #aafpfmcc
#FMRevolution
RT @mdstudent31: We're stepping up efforts in #hcsm one family

physician at a time. A big #FMRevolution welcome to @kemiwo
#aafpfmcc
#aafpfmcc Graham Center - Student interest to primary care: 2% gen

internal med, 2.7% med/peds
#aafpfmcc Graham Center - What influences student/resident career

interests... guess what? Physician payment gap! @AmerMedicalAssn
RT @maverickmd2012: Taking the family medicine message to

Capitol hill. #aafpfmcc #fmrevolution @drmikesevilla @mdstudent31
@familydocwonk
#aafpfmcc Graham Center - Family med was nearly 25% of this (not
bad for a workforce that is about 13% of total)
RT @tweetyturt: #aafpfmcc #fmrevolution Take partnership pledge &

you can improve outcomes @cmsinnovates http://ow.ly/4Qms5
#aafpfmcc Graham Center - 2008, 62% of 1.1 billion ambulatory care

visits were made to primary car delivery sites
#aafpfmcc Graham Center - Need 50,000 primary care physicians by

2025. At current rate.... we have a problem
#aafpfmcc Graham Center - Can we meet the growing demand,

especially in 2014? Need at least 10,000 more distributed evenly?
#aafpfmcc Graham Center - see Mass. for problems w/ distribution

when implementing coverage for all
#aafpfmcc Graham Center - It's not a primary care SHORTAGE, it's

primary care DISTRIBUTION that is a problem
#aafpfmcc Graham Center - 5000 areas w/ shortage, 1668 areas with

surpluses. # Excess is 34,479. # Needed is about the same
#aafpfmcc Graham Center - if we were distributed evenly, we would

have 1 primary care provider for every 1000 people in US
#aafpfmcc Graham Center - half of NPs and 43% of PAs go into

primary care. But these numbers are lower from PA numbers, inflated
by NP orgs
84,613 Family docs. 222,308 PC physicians in 2010 - one for every

1358 IF we were evenly distributed #aafpfmcc Graham Center
#aafpfmcc Graham Center - Who and How much? 262,000 PC

physicians x multipliers actually 222,000
Encouraging other #aafpfmcc participants to tweet it up! What's your

opinion? Let your voice be heard :)
#aafpfmcc Graham Center - sometimes when you send a "naive"

student to the hill, it's amazing what they will tell them
Bob Phillips, MD MSPH presentation from Robert Graham Center:

Evidence About Your Value (and return on investment) #aafpfmcc
Replace SGR formula w/ 5 yrs to rates that are 2% higher for PC

#aafpfmcc Increase primary care bonus to 20%, make permanent
Medicaid parity
Primary care does not necessarily reduce costs, it reduces the

GROWTH in costs - Restraining and controlling costs #aafpfmcc
Pushback - Too expensive! #aafpfmcc Response: investment in

primary care is essential to controlling health care costs
Medicaid often deals w/ younger population for whom PC and

prevention will be MOST important and beneficial #aafpfmcc
Focuses Medicaid program on primary care and prevention. Some

states, pay for primary care services is half what Medicare pays
#aafpfmcc
Ask #3: Medicaid Parity With Medicine Needs to be permanent

#aafpfmcc
It is also only for SOME Medicare services. Reports of very low

payment amounts. #aafpfmcc
Answer - on average 25% of FP patients are Medicare. The incentive

is pegged to allowable charges, which exclude pt payments
#aafpfmcc
Pushback - We already valued primary care - now you're asking for

more money. First PCIP checks just went out #aafpfmcc
It is not about creating more money for primary care. It is about

rebalancing the system to value and pay for health care #aafpfmcc
There is > 100% payment disparity between primary care and

subspecialty medicine. This contributes to #primarycare shortage
#aafpfmcc
Needed system - encourages coordination, values quality, primary

care-based #aafpfmcc
Ask #2 - Valuing Primary Care #aafpfmcc Current system fosters

fragmentation, rewards volume undervalues primary care #aafpfmcc
The formula is unsustainable, it is driving primary care out of business,

will only make delivery more expensive, do it NOW #aafpfmcc
SGR formula created by Congress.... only Congress can fix it (duh).

Congress has to take the path to long term resolution #aafpfmcc
RT @mdstudent31 SGR repeal too costly? Will only get more

expensive. Do it now! PHysicians currently paid at 2001 rates
#aafpfmcc
Response: Medicare payment problem preceded this sensitivity - over

8 years old! #aafpfmcc
Pushback 2 - nation sensitive to increasing national debt. how do you

propose we pay to fix it? #aafpfmcc
Yes, yes, yes! RT @mdstudent31 Ask #1 at #aafpfmcc: SGR - It is

time to repeal the dysfunctional formula
Small businesses need predictability, patients need stability, primary

care health system will control cost curve over time #aafpfmcc
Too costly? Will only get more expensive. Do it now! PHysicians

currently paid at 2001 rates. #aafpfmcc
Ask #1 at #aafpfmcc: SGR - It is time to repeal the dysfunctional

formula
Jerry Kruse MD, MSPH just handed me a hard copy of COGME's 20th
Report - Advancing #PrimaryCare.This is now my bible #aafpfmcc
#FMRevolution
Clever comment by Kevin Burke: Believe it or not, we're not at a

meeting of the @AmerMedicalAssn #aafpfmcc #FMRevolution

@
RT @pcmh @hillhealthwatch #Medicaid may be a better [political]
target for [GOP] cuts than #Medicare http://goo.gl/hT5eB #hcr
#aafpfmcc
#ACO focuses on savings. If physicians save money, we need to

share the PAYMENT - directly to physicians, not the network
#aafpfmcc
RT @mdstudent31 We're stepping up efforts in #hcsm one family

physician at a time. A big #FMRevolution welcome to @kemiwo
#aafpfmcc
We're stepping up efforts in #hcsm one family physician at a time. A

big #FMRevolution welcome to @kemiwo #aafpfmcc
Goertz: Invest in us the way a company retools an assembly line. We

provide the savings already. #aafpfmcc
Goertz: Unless the silos are broken down w/ payment, you can't get to
the savings and will not get to the next phase #aafpfmcc
pcmh TransforMED
@
Thanks for the great tweet! RT @mdstudent31 Cohen/CMS Innovation
Center just put in a plug for TransforMED #aafpfmcc
ElinSilveous Elin Silveous
MT @drmikesevilla: RT @mdstudent31 A specialist can go anywhere

they want but a primary care doc can only be part of one #ACO.
#aafpfmcc
RT @mdstudent31 A specialist can go anywhere they want but a

primary care doc can only be part of one #ACO. There's a problem
here #aafpfmcc
FQHC designations - incentive should not be all or nothing - stepped

incentives for Level 1, 2, and 3, not just level 3 #aafpfmcc #hcr #ACO
Family docs need to meet 30% Medicare/Medicaid - News Flash -

family docs see all stages and ages #aafpfmcc
A specialist can go anywhere they want but a primary care doc can
only be part of one #ACO. There's a problem here #aafpfmcc
It sounds like Cindy Brown & @AmerMedicalAssn gets that the RUC
got primary care wrong - what are we waiting for to get it right?
#aafpfmcc
RVU's never addressed outputs, only what it costs to provide the

service #aafpfmcc #fmrevolution @AmerMedicalAssn
@mdstudent31 at the mic at #aafpfmcc I joined the military because I

don't believe the civilian world will ever get pri care paymt right
rliumd Robyn Liu
Word. RT @mdstudent31: Brown asks for time to get RVUs right. 20+
years, still wrong. MD students aren't waiting #aafpfmcc
Cindy Brown, VP at AMA re: the RUC: we ended up with a formula

that didn't reward the value that primary care brings to the system
#aafpfmcc
rliumd Robyn Liu
XLNT news. RT @lori_heim: CMI has program to support PCMH at

FQHC- approx 1/3 of them. Good start.#aafpncsc #aafpfmcc
Cindy Brown asks for time to get RVUs right. 20+ years and still
wrong. How much more time? Med students aren't waiting #aafpfmcc
#aafpfmcc A 10 year SGR freeze has a pricetag of $300 billion. Phys

payment costs $40B/yr. Changing payment is not enough to fix SGR.
lori_heim Lori Heim
Relative to NCSC resolution, CMI has program to support PCMH

projects at FQHC- approx 1/3 of them. Good start.#aafpncsc
#aafpfmcc
aabayasekara Allison Abayasekara
Check out the stream for @aafp Fam Med Congressional Conference
#aafpfmcc. Preview on @drmikesevilla blog:
http://tinyurl.com/aafpfmcc2011

Taking the family medicine message to Capitol hill. #aafpfmcc
#fmrevolution @drmikesevilla @mdstudent31 @familydocwonk
A doc fix is expensive but a new approach to payment makes sense

#aafpfmcc
John O'Shea, MD - give at least several years of increased payment

to PC to showcase specialty to #medstudents #aafpfmcc Good luck!
#aafpfmcc 800k docs in US, about 1/3 in pri care, by 2015 shortage
of 20k PCP's

@
MT @tweetyturt Dr Jonathan Jaffrey: I would be curious to hear how
the AAFP feels about RVU's and PC payment #aafpfmcc
@AmerMedicalAssn

@
@tweetyturt Really?? I would love to hear how the @AAFP feels
about RVUs and primary care payment too! #aafpfmcc
Dr Jonathan Jaffrey: I would be curious to hear how the AAFP feels

about RVU's and primary care payment #aafpfmcc
RussellKohl Russell Kohl
#aafpfmcc
joecody5 Joe Cody

FMCC is underway. CAFM and AAFP members learning how
important advocacy is to family medicine #familymedicine #aafpfmcc
Cindy Brown, Vice President for Government Affairs American Medical

Association #aafpfmcc @AmerMedicalAssn
SGR discussion with a panel of 3 influential people: Chris Dawe,

Professional Staff Member Senate Finance Committee #aafpfmcc
Now we will talk about our first issue we will bring to the Hill tomorrow
- SGR #aafpfmcc

@cmsinnovates We are looking for care and delivery models that
save cost #aafpfmcc #pcmh
IllinoisAFP Illinois FPs
Submit your ideas for innovation for Medicare/Medicaid and CHIP at

www.innovations.cms.gov. #aafpfmcc.
STFM_FM STFM_FM
Partnership for Patients supports safer care & better transitions from
hospitals to other settings. http://tinyurl.com/6465loo #aafpfmcc
Here's a different way to monitor #aafpfmcc today. What an on screen

twitter stream would look like at mtgs http://tinyurl.com/aafpfmcc2011

#fmrevolution #aafpfmcc Cohen of CMS: We know investing in
primary care saves money.

@
@IllinoisAFP Impressive delegation! Hoping that you have many med
students as well! We are 4 students strong at PA table! :) #aafpfmcc
@familydocwonk steps up to the microphone re: bogey payments -if

you need to beat your bogey from yr before ->diminishing return?
#aafpfmcc
Once again, #MedStudents leading by example in contributing to

FamMedPAC - physicians - step it up! #aafpfmcc
TXFamilyDocs TAFP
Partnership for Patients, focused on quality. Launched w/AAFP as a
key partner #aafpfmcc via @KansasAFP @mdstudent31
http://1.usa.gov/gj8iFV
15 minutes Q and A w/ Mandy Cohen, MD - CMS Innovation Center

#aafpfmcc
#aafpfmcc #fmrevolution Take the partnership pledge and you can

improve outcomes http://partnershippledge.healthcare.gov/
@cmsinnovates
Healthcare is local, clinicians need a common set of targets and

common business model, all patients should benefit #aafpfmcc

NewsFlash: Transition to different care settings MUST involve primary
care. #aafpfmcc
Partnership for Patients: $500 million funding to community-based

orgs partnering w/ eligible hospitals for care transition svcs #aafpfmcc
Partnership for Patients: Better Care, Lower Costs, Model for Future
Work #aafpfmcc
2 - help patients heal w/o complications (by 2013)... good luck!

#aafpfmcc

Goals: Keep patients from getting injured/sicker (decrease
preventable hosp-acquired conditions by 40% by 2013 compared to
2010) #aafpfmcc
Partnership for Patients CMS and @AAFP - founding supporter .. We

can do much better - and WE MUST http://1.usa.gov/gj8iFV
#aafpfmcc
CMS Innovation Center will release guidance on alternative models of

#ACO in future #aafpfmcc
#ACO - even CMS has no idea what will happen. Lowering costs,
sharing savings? ..... hmmm #aafpfmcc

Hospital rounds done. In office hours. Let's do this today! Shout out to
#aafpfmcc in DC. Go get um!
MSSP Goals - reduce fragmentation, improve population health,

lowering overall growth of expenditures using #ACO; estab by
Jan2012 #aafpfmcc
Medicare Shared Savings Program(MSSP) - mandated by Sect 3022

of #ACA. #aafpfmcc
Now onto #ACO should be interesting #aafpfmcc


Federally Qualified Health Center #FQHC Advanced Primary Care
Practice Demonstration: finding evidence of #pcmh in 500 FQHCs
#aafpfmcc
Medicaid Health Home State Plan Option, Federal Coordinated Health

Care Office State Demonstrations to 15 states(dually elig. pop)
#aafpfmcc
Multipayer Advanced #PrimaryCare Practice Model (MAPCP)

#aafpfmcc
CMS Innovation Center - valuing primary care! Many initial projects....

#aafpfmcc

@cmsinnovates Follow CMS Innovation or tweet your ideas for care
models to them! #aafpfmcc #pcmh

@
@lori_heim add #aafpfmcc to add to our conference conversation!
Cohen/CMS Innovation Center just put in a plug for TransforMED

(@PCMH ) #aafpfmcc
CMS innovation - hosting electronic community of innovators through

innovations.cms.gov #aafpfmcc

CMS Innovation - Spreading successful models - expanding the
models, spreading/sharing results w/ public: web-based, calls, etc
#aafpfmcc
3 - Assess appropriate duration, scope, conditions, and populations for

the models #aafpfmcc
2 - Conduct rigorous evaluation of models and modify #aafpfmcc

CMS Innovation testing/evaluation: 1 Solicit partners to implement/test

new payment and delivery system models.... #aafpfmcc
Relevant across diverse geographic areas and states #aafpfmcc

BizConnectGroup BizConnectGroup
CMS Innovation - wants to hear from YOU - submit ideas at

innovations.cms.gov "Open Door" forums and listening sessions
#aafpfmcc
Interdisciplinary - allow a continuum of care and coalescing of

community involved with care #aafpfmcc
Meet the needs of most vulnerable and address disparities in care;

Address priority areas in the National Quality Strategy #aafpfmcc
Focus on health conditions that offer greatest opportunity to improve

care and reduce costs #aafpfmcc
submit ideas for better care models at www.innovation.cms.gov

#aafpfmcc #pcmh #cms
CMS Innovation - Cost analysis looking mostly at Medicare, Medicaid

and CHIP - focus on these metrics when brainstorming #aafpfmcc
CMS Innovation - wants to hear from YOU - submit ideas at

innovations.cms.gov "Open Door" forums and listening sessions
#aafpfmcc

CMS Innovation Process: Solicit ideas for new models, select most
promising models, test/evaluate models, spread successful ones
#aafpfmcc
CMS Innovation: Looking at #pcmh, #ACO, Bundled Payments,

Readmission Reduction Programs #aafpfmcc
Payment reforms will motivate and reward innovation at a whole new

level #aafpfmcc
Better healthcare, better health - addressing underlying causes of

poor health, reduced costs #aafpfmcc

IOM 6 domains of quality: Safety, Effectiveness, Patient-Centerdness,
Timeliness, Efficiency and Equity #aafpfmcc
CMS Innovation - Mission: deliver better healthcare, better health, and

reduced costs through improvement for CMS beneficiaries #aafpfmcc
CMS Innovation Center - Opp to "scale up" - authority to expand

successful models to the national level #aafpfmcc
CMS Innovation Center - $10 billion funding FY2011 through 2019

#aafpfmcc

CMS Innovation Center - desire preference to models that improve
coordination, quality, efficiency of health care services #aafpfmcc
#aafpfmcc Cohen: dually eligible Medicare/Medicais pts are both high

need and high cost-CMS now has an office dedicated to them due to
ACA
Fed Coordinated Health Care Office: help w dually eligible

Medicare/Medicaid - majority of nursing home patients #aafpfmcc
New tools CMS toolbox - bonus payments for #primarycare, gen surg,
investing in primarycare training, Medicare Shared Saving Prog
#aafpfmcc

Meaningful Use: 2011-Data capture/sharing 2013-Advanced clinical
processes 2015-Improved outcomes #aafpfmcc
Cohen - the foundation for Delivery System Innovation: Meaningful

Use. #aafpfmcc
#aafpfmcc Mandy Cohen, MD, senior advisor in Innovation Center at

CMS- foundation of transformation: meaningful use
Cohen - dedicated nurse manager for high-risk patients embedded in

physicians office - improve outcomes, decreases cost #pcmh
#aafpfmcc

Cohen - Opportunity - innovation isn't about trying to find something
new - sometimes it is improved processes #aafpfmcc
Cohen - Transform: Affordable, accessible, seamless & coordinated,

high quality, person/family-centered, supportive of clinicians
#aafpfmcc
miller7 Ben Miller
MT @mdstudent31: 46 million Americans lack #healthcare coverage -

it is uncoordinated, unsupportive, and unsustainable #aafpfmcc
Cohen - one thing in this town we can agree on - it costs a lot and it is
unsustainable #aafpfmcc

46 million Americans lack coverage - of that coverage, it is
uncoordinated, unsupportive, and unsustainable #aafpfmcc
Goertz: Don't get caught up in everything at visits. Think about the

core message that family medicine provides to our patients
#aafpfmcc
Goertz: We have been here 3 times in the past several weeks

#aafpfmcc
Next speaker: Mandy Cohen, MD – Senior Advisor, CMS Innovation

Center at Centers for Medicare & Medicaid Services #aafpfmcc

While Rome is burning, we need to lobby them to do the right thing...
or just to do something #aafpfmcc
Congress and Health Care - 2 parties are in exam room arguing and
everybody is in the waiting room dying #aafpfmcc
Most people we talk to in visits will be much younger than we are (not
me I guess!) #aafpfmcc
..Medicaid expansions, Low income subsidies, aggressive oversight of

agency actions on implementation, tort ref, remove reg burden
#aafpfmcc

#hcr repeal targets: IPAB, employer responsibility, individual mandate,
insurance exchanges, IRS enforcement, CLASS Act... #aafpfmcc
#aafpfmcc Our current speaker Hobson has been a DC lobbyist for

40 years.
Hobson: Facebook, Twitter--I'm old. Screw that. #aafpfmcc I love this

guy!
The house oversight values twitter and social media #aafpfmcc


Institutional politics - Congressional oversight = house : agenda =
waste, fraud, abuse. #aafpfmcc
Biggest issue w/ freshmen congressmen - cutting spending

#aafpfmcc
#aafpfmcc While the big issue is the impending 25% medicare

reimbursement cut on Jan 1, 2012, this is not a big issue in the grand
scheme.
Washington discussion is all about cutting spending by both parties -

where do physician issues fit w/ all these issues? #aafpfmcc

There is no middle anymore - moderates eliminated. #aafpfmcc
Hobson - did not sign up for a party - both parties suck #aafpfmcc
Most did not sign up for retirement program - don't plan to be here for
long, and don't care #aafpfmcc
A majority did not sign up for the federal government's health care
insurance program. #aafpfmcc
More than half of the freshman congressmen have NO government

experience. #aafpfmcc
87 Republican Freshmen - more than half of the offices have no prior

government experience #aafpfmcc
There are 21 physicians in Congress #aafpfmcc

Now listening to "Congressional Political Landscape" - Julius Hobson,

Jr., Senior Policy Advisor , Polsinelli Shughart PC #aafpfmcc
The Bad News - "Everything in Washington is political" #aafpfmcc

#aafpfmcc Meet your state delegation!!

Now introducing - members of Council of Academic Family Medicine

#aafpfmcc
It's going to be a difficult year ahead to protect our gains for

#primarycare in #hcr #aafpfmcc
»
Now up, Dr Jerry Kruse, Chair of AFMAC #aafpfmcc

Getting ready to tweet up @AAFP Family Medicine Congressional

Conference! We will be using #aafpfmcc hashtag. #FMRevolution
#hcr #mdchat
9 hours ago

Day 1 - Family Medicine Congressional Conference

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Day 1 - Family Medicine Congressional Conference

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tweetyturt Heidi Meyer

tweetyturt Heidi Meyer

MAFPadvocacy MAFP Advocacy

MAFPadvocacy MAFP Advocacy

Give Deputy Administrator at CMS Johnathan Blum credit for coming

tweetyturt Heidi Meyer

mdstudent31 Kevin Bernstein, MMS

tweetyturt Heidi Meyer

@aafp #aafpfmcc comments for ACO rules: ensure patient memory

mdstudent31 Kevin Bernstein, MMS

tweetyturt Heidi Meyer

mdstudent31 Kevin Bernstein, MMS

tweetyturt Heidi Meyer

#aafpfmcc ACO proposed rules online

drkkyu Kim Yu, MD, FAAFP

mdstudent31 Kevin Bernstein, MMS

Now listening to Jonathan D. Blum, Deputy Administrator, Center for

Muhahaha...RT @maverickmd2012: @MAFPadvocacy DC is the

mdstudent31 Kevin Bernstein, MMS

mdstudent31 Kevin Bernstein, MMS

FamMedPAC - we don't give to D's, we don't give to R's, we give to I's:

MAFPadvocacy MAFP Advocacy

Proud to say Michigan's student member at #aafpfmcc Leanne

Most residents and students have given to FamMedPAC today at

mdstudent31 Kevin Bernstein, MMS

#aafpfmcc Pomeroy: tips to asks: 5 pick battles carefully 6 don't

mdstudent31 Kevin Bernstein, MMS

#aafpfmcc Pomeroy: tips to asks: 3 - perfection can be the enemy of

mdstudent31 Kevin Bernstein, MMS

#aafpfmcc Pomeroy: tips to asks: 2 - never underestimate

#aafpfmcc Pomeroy: tips to asks: 1 keep it simple, really simple,

mdstudent31 Kevin Bernstein, MMS

#aafpfmcc Pomeroy: Congress ready to listen to frontline

mdstudent31 Kevin Bernstein, MMS

#aafpfmcc Pomeroy: The republican party, excited about the

JudyYChoi Judy Choi

Love the FMCC updates, Kevin! RT @mdstudent31: Socioeconomic

RT @mdstudent31: Health outcomes and cost are optimized in

JudyYChoi Judy Choi

Agreed. RT @tweetyturt: MedPAC commission chair Glenn

mdstudent31 Kevin Bernstein, MMS

mdstudent31 Kevin Bernstein, MMS

Next topic: Meeting the Constituents by Former U.S. Representative

tweetyturt Heidi Meyer

MedPAC commission chair Glenn Hackbarth: "the training system is

mdstudent31 Kevin Bernstein, MMS

Isn't THC concept included in #HCR to modernize primary care

mdstudent31 Kevin Bernstein, MMS

These only adjust reg requirements in keeping w/ Congressional intent

mdstudent31 Kevin Bernstein, MMS

Pushback: Didn't #hcr take care of paying for training in community

mdstudent31 Kevin Bernstein, MMS

Primary care physicians are a critical piece of the physician workforce

mdstudent31 Kevin Bernstein, MMS

Strengthening primary care workforce promotes ambulatory and

mdstudent31 Kevin Bernstein, MMS

Why should Medicare pay for this kind of training? Response:

tweetyturt Heidi Meyer

mdstudent31 Kevin Bernstein, MMS

Pilot - budget neutral, 5 yrs, 4 organizational modes tested (2 each),

mdstudent31 Kevin Bernstein, MMS

mdstudent31 Kevin Bernstein, MMS

Currently, GME out of Medicare Part A Trust Fund goes to hospital,

mdstudent31 Kevin Bernstein, MMS