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AMDA Update October 2007. Charles Crecelius MD PhD FACP CMD. Trends in LTC. Younger physicians in LTC Worsening shortage of geriatricians Increase in Medicare beneficiaries Increasingly ill residents in NH Bowel & bladder incontinence Mechanically altered diet Assistance with > 5 ADLs

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amda update october 2007

AMDA UpdateOctober 2007

Charles Crecelius MD PhD FACP CMD

trends in ltc
Trends in LTC
  • Younger physicians in LTC
  • Worsening shortage of geriatricians
  • Increase in Medicare beneficiaries
  • Increasingly ill residents in NH
    • Bowel & bladder incontinence
    • Mechanically altered diet
    • Assistance with > 5 ADLs
    • Mental/Cognitive & Physical Impairments
    • Recent admits > 1 major dx
  • ALOS declining, less beds per 1000 > 65

2006 AMDA Survey Data 2007 Kaiser Foundation Report www.kff.org/medicaid/upload/7663.pdf. 2007 Managed Care Digest Series, Senior Care Digest, www.managedcaredigest.com

AAMC Recent Studies and Reports on Physician Shortages in the US April 2006 www.MedPac.gov/documents/Jun07_Entirereport.pdf

trends in ltc1
Trends in LTC
  • Increase in persons with multiple chronic diseases, but decline in disabled person
  • Increased education / sophistication beneficiaries
  • Healthcare costs outpace personal income, with increase in income disparity
  • Increase in AL beds
  • Nursing shortage
  • Increased use of physician expenders
  • Quality measure / performance evaluation
  • Increase interest in care coordination and comparative effectiveness analysis
amda strategic planning four areas of concentration
AMDA Strategic PlanningFour Areas of Concentration
  • Organizational strength & stability
  • AMDA’s Roles
  • Membership & State Chapters
  • Improving Practice & Performance
organizational strength stability
Organizational Strength & Stability
  • Leadership Development
  • Accountability & Oversight
  • Continuity
  • Board & Staff relations
  • Financial Viability
organizational strength stability examples
Organizational Strength & StabilityExamples
  • Board of Directors & staff responsibilities clearly written & delineated in writing, with yearly evaluations
  • President, president-elect & vice-president work together to ensure year to year continuity and project development
  • Reserves being set aside for emergencies, appropriately invested
  • Five year Executive director contract
amda s roles
AMDA’s Roles
  • Functioning in the Current Environment
  • AMDA’s current constituency
  • Other Settings in the Continuum
  • Improving LTC Quality and Practice
  • Other organizations and associations
amda s roles examples
AMDA’s Roles - Examples
  • NPP Role in LTC continuum
    • Recent legislation (AHCA)
    • Regulatory re-evaluation
    • Ideal practices (NP
  • Medical Home Model (ACP)
  • Physician Quality Reporting Initiative (AGS)
  • Physician Consortium for Performance Improvement (AMA)
  • Home care LCD (AAHCP)
  • F tags -Pain, EOL, Abuse & Neglect (CMS)
membership state chapters
Membership & State Chapters
  • Core membership
  • State Chapters
  • Liability & Risk Issues
  • Reimbursement
membership state chapters examples
Membership & State ChaptersExamples
  • Interactive State Network News
  • State Chapter Open Mike Call
  • Mentoring Program
  • Toolkit, other members only website benefits
  • Weekly emails, Health Policy Advisor
  • Professional Liability Insurance
  • LTC Direct
  • Improved Reimbursement
reimbursement the ruc
Reimbursement & the RUC
  • Relative Value Update Committee (RUC)
    • Determines how 78 billion dollars of physician payment are distributed to physicians and paraprofessionals via RVS process
    • 26 RUC voting members, 114 advisory committee members (Dennis Stone MD MBA CMD AMDA Advisor; Dr Crecelius alternate representative)
  • Resource Based Relative Value System (RVS)
    • Determines the relative value of one CPT code to another based on survey data of resources used
    • 3 components of RVS – Work, Practice expense, malpractice
  • Nursing Home Codes re-evaluated for 2008
improving practice performance
Improving Practice & Performance
  • Medical Director and Attending Physician Education
  • Other disciplines
improving practice performance examples
Improving Practice & PerformanceExamples
  • Improved website links to best practices, toolkit, & other educational sources
  • Exploring collaborative educational efforts with other organizations
  • Considering certification in LTC medicine
  • Promoting educational material / offerings of AMA
  • Healthcare information technology
amda needs you
AMDA Needs You !!
  • We are a grass roots organization
  • Comments and concerns always welcome
  • Look at our website regularly for updates
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