If the Department of Health and Human Services has its way, hundreds of physician practices will follow the money and take up a coordinated model of health care. The Comprehensive Primary Care Initiative, announced Wednesday, will increase Medicare  payments to primary care providers who adopt a coordinated care model. A four-year demonstration, overseen by the Centers for Medicare and Medicaid Services, begins next year in several health care markets. Providers in HHS-supported accountable care organizations, which also promote coordinated care, will not be able to participate. Coordinated care is based on teamwork among primary care doctors, specialists and other providers, with a particular focus on prevention and better managing chronic disease. HHS officials said that coordination yields both quality improvements and significant savings — primary goals of the 2010 health law this initiative stems from. Richard Baron, director of the Seamless Care Models Group at the Center for Medicare and Medicaid Innovation, said the HHS initiative “recognizes the need to see changes in the primary care practice model, but that we first need to see changes in the payment model for primary care.” CMS will select five to seven health care markets for its demonstration. According to Baron, CMS is looking for areas with multiple interested insurers, both public and private. These insurers will then help target and select about 75 practices in each market. Providers will be paid an extra $20 per month, on average, per Medicare beneficiary in the first two years; the funds will cover a little over 330,000 Medicare patients total. The money can be used at providers’ discretion to build up infrastructure for coordinated care, likely with increased staff, longer hours of access and electronic health records. The $20 per month represents a “very significant contribution” toward coordinated care efforts, said Bob Dougherty, a senior vice president with the American College of Physicians. Combined with the support of their insurers, practices will have certainly have enough resources to implement coordinated care, he added. Practices will also financially benefit from cost savings for Medicare. After a year, CMS will begin evaluating providers based on yet-to-be-decided criteria for quality of care. This information will determine how much of the expected savings to Medicare that individual practices can share in. In the end, CMS expects that with decreased costs and coordinated methods in place, providers will expand the care model to all patients. Insurers must submit a letter of intent by Nov. 15, while full applications are due Jan. 17. Once markets are selected, individual practices will apply for funds, likely in the spring, and funds will begin to be distributed in the summer. Source: Kaiser Health News, September 28, 2011

By Stephen Follansbee, MD and Steve Heilig, MPH The California Medical Association can be a formidable force in Sacramento health policy. The CMA House of Delegations meeting, scheduled for October this year, is the opportunity for physicians to guide the CMA on important issues and set the priority for these efforts. Your elected SFMS delegates have introduced a roster of policy resolutions to be debated at the meeting. As your representatives, we thought you might like to see what we will be addressing – along with the many other resolutions introduced from other delegations throughout the state. The SFMS is a relatively small but relatively “loud” presence each year, with a good track record of successful policies; here is our list. In November we will publish a scorecard on what we were able to get adopted; and then the real work begins in the halls of politics, translating these words into something that benefits patients, the public, and physicians all over our state – and beyond as some of these would then be referred on to the AMA.

SFMS Proposed Policies for 2011 (authors in italics):

Reduction of Subsidies of Tobacco in Films (Fung): Did you know that the movie industry gets big tax credits for filming, including when they portray tobacco use? UCSF researchers have shown this is true – that taxpayers subsidize tobacco marketing, in effect – and we hope to stop that. Unethical Rebates from Pharmaceutical Companies (Susens): Some drug makers still offer money to doctors who prescribe their products. Some doctors take that money. This is against ethical codes and we hope to stop that. Deceptive Pregnancy ‘Crisis/Counseling’ Centers (Lopato): As reported in the Chronicle, certain “clinics” are in fact “pro-life" centers which seek to divert women from considering abortion with misinformation and fear. We would require full disclosure of what is and is not offered at such places. Regulation of Electronic Cigarettes (Fouras, Aragon): These nicotine delivery devices may have their place as harm reduction, but they need more regulation for both users and the public, and this resolution would require that. Supporting The California Cancer Research Act (Margolin): The CRCA will be on the ballot, increasing tobacco taxes for cancer research, and we ask the CMA to join the full-court press to help it pass in this "no new taxes” era. Clinical Research - Banning "Seeding" and Similar Marketing Trials (Susens): Pharmaceutical companies do marketing in the guise of “research” even after the medication is approved, with unwarranted cost and safety implications; we hope to stop that. Healthy Food Marketing for Children (Desai, Schickedanz, Udovic-Constant): The obesity epidemic too often starts in childhood, and better “selling” of healthy food is indicated; this would encourage that on various fronts. Opposing Legal Prohibition of Circumcision (Tabas): This intrusion was blocked from the state ballot, but will likely be back, and we want CMA and AMA on record in opposition for next time. Firearms and Censorship (Follansbee): Another intrusion, courtesy of the gun lobby, prohibits Florida physicians from even talking with patients about the risk of guns in the home. We hope to stop this there and before it spreads. Contraception as a Fully-Covered Health Insurance Benefit (Silverman, Desai, Myers): This has now been adopted as national policy, but attempts to overturn it are already promised. We want CMA and AMA on record in support of full coverage. Increasing Organ Donation via Presumed Consent (Follansbee, Margolin): The waiting lines for organs get longer, and more people die while waiting. It is time for some changes in organ policy and we are asking CMA to weigh in, based upon evidence, ethics, and what some other nations are doing. Clinical Sense and Costs at the FDA; Generic vs. Brand Medications  (Susens): When a generic medication mysteriously goes back to “brand," and the price skyrockets, that seems wrong, and we think the FDA should take a closer look. Vision Screening for School-Aged Children (Leung): Too much pediatric poor vision is missed, and schools may be a good place to screen for that and refer to early intervention. Emergency Department Overcrowding (Maa, Curran): When emergency departments get too crowded, some hospitals have “triaged” based on financial considerations.  That’s not good; there must be better ways, and we'll ask CMA to try to find them. As you can see, it's a full and diverse roster. As already mentioned, there will be much more from other delegates around the state; any CMA member can propose a resolution, and perhaps we can help you bring good ideas forward next year.  As for this year, stay tuned. Stephen Follansbee is an SFMS past-president, chairs the SFMS delegation to the CMA, and is an infectious disease specialist at Kaiser San Francisco and a clinical professor at UCSF. Steve Heilig is on the SFMS staff.

The Calfornia Medical Association's annual House of Delegates (HOD) will convene in Anaheim October 15-17. The HOD is CMA's legislative body, which establishes the policies that govern the association. SFMS will be sending a delegation to represent San Francisco physicians at this event. At this year's meeting, physicians from across the state will debate and set policy on important health care issues including vaccinations, disaster preparedness, health information technology, and peer review. During the three-day meeting, the 500 delegates will address more than 100 resolutions on these and other key issues that affect the practice of medicine. CMA invites all members to visit its online forum to discuss or comment on the resolutions and reports that will be considered by the delegates. To participate in the online discussion, log into your web account and click on "My Account" at the top of the page. Once there, you will see a button on the left side called "House of Delegates." To provide online testimony on resolutions and reports, click on the "Resolutions and Reports" tab, and then click on the "Post Comment" button below any of the resolutions on which you wish to provide testimony. You can also download the reports and resolutions in both Word (.doc) and Acrobat (.pdf) formats by clicking on the "Documents" tab. Written testimony will be accepted until October 7, 2011.