1. 5/15/2012
FMCC Updates from the
The Robert Graham Center
Bob Phillips, MD MSPH
Director
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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2. 5/15/2012
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
Geographic distribution of health care professionals, 2011
All specialties Primary care
U.S.
Geography General General Pop
NP PA Docs NP PA FP/ GP
IM 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%
http://www.ahrq.gov/research/pcworkforce.htm
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3. 5/15/2012
Sources:
Census, AAMC 2011 State Physician
Workforce Data Book, AACOM
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4. 5/15/2012
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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5. 5/15/2012
Primary Care Incentive Payments
$560 Million in 2011
But it is still
broken
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6. 5/15/2012
What if we used the Definition of
Primary Care for Incentives?
Primary Care
How to measure and use for payment
Definitional Elements
Family medicine, general internal
first contact care medicine, general pediatrics and geriatrics
(claims-based or NPI)
Patients who see this physician/clinic get
continuity of care the plurality of their care there (claims-
based)
Breadth and depth of ICD-9 codes used by
comprehensive care
physicians in Medicare claims
Patients who see more than 3 physicians
coordinated care are seen by a PCP or PC practice at least
every 6 months
Bridges personal,
family, and Undetermined
community
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7. 5/15/2012
Better Way of assigning Primary Care
Incentive Payments?
Percent of Physicians Meeting Threshold
Comprehensive All
ness Continuity Coordination 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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8. 5/15/2012
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. and
“Positive assumption of responsibility Failure
to do so will damageand standing of the profession
positive action – the this alone – can keep
and educational institutions and will invite - even
the initiative in the hands of those best
make necessary - less desirable approaches to
meeting the to plan theneeds of a growing
prepared health care destiny of medical
America. If those responsible for medical education
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
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9. 5/15/2012
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 % IM # %
Name State # Res % PC 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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10. 5/15/2012
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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11. 5/15/2012
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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12. 5/15/2012
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 2010
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http://www.graham-center.org/online/graham/home/tools-
resources/npi.html
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13. 5/15/2012
The Graham Center
will keep working for you
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