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151103HealthcareReform1Health care reform has pushed primary care offices like Eugene Pediatrics to rapidly adapt to a multitude of new requirements aimed at improving patients’ health.

Under the new law, a portion of Medicare and Medicaid payments are withheld across the state of Oregon each year. That money is then awarded to individual Coordinated Care Organizations and clinics within those regions, based on “quality metrics” performance, which is determined by the Oregon Health Authority. The same process is happening in every other state in the U.S.  

Eugene Pediatrics has remained a top performing pediatric clinic in our region. What’s our secret? We spent a great deal of time, money and effort to hire new staff, update our computer systems and develop work flows to support the new requirements.  

But the process of improving health care, according to these quality measures, is hitting an interesting roadblock. Under the new law, doctors and hospitals are now judged on their ability to get patients to comply with the medical advice they are given. If they don’t, the payments clinics receive for their services are docked.

Let me give you an example: We know from well-designed research studies that if a parent is hesitant about vaccinating their child, a physician’s advice often fails to change that. So, it is no surprise that nearly one third of the families who come to Eugene Pediatrics do not follow our advice on immunizing their kids. Because of that, our “quality” profile and associated payments will suffer.

If doctors cannot meet the requirements, they are deemed a lower quality clinic and receive fewer reimbursements from insurance. Ultimately, that means they struggle financially to keep their doors open. Or, in an attempt to minimize their losses, some physicians could ask non-compliant patients to leave the practice. In both scenarios, patients may soon find fewer places that will offer them care. If clinics close or patients are “fired,” nobody wins—and a system meant to improve health care will have failed.  

I will be the first to say that I do not have all the answers, but I will ask the tough questions: How can we grapple with the ethical dilemmas created by health care reform? What happens when the rights of an individual to choose how to manage his or her health runs contrary to the health of the larger community? How can we support all patients without being penalized for trying to help those who might not always want to do (or have the capacity to do) what’s best for their health?  

This is an interesting time to be a doctor, certainly unlike any era of health care I have seen in my decades as a pediatrician. But there’s one thing I can guarantee—your physicians at Eugene Pediatrics are working hard, within the framework of health care reform, to demonstrate our quality to the State Health Authority, to private insurers, and most of all to you, our patients and families.

We are dedicated to helping every child be well. We want to partner with families and provide individualized care in a way that puts kids on a path to good health. Without you, we have no purpose.

Posted by on in News

EPA location2 sm1Eugene Pediatric Associates has achieved another critical milestone — we were the top pediatric clinic (by far) in performance of Coordinated Care Organization (CCO) Quality Metrics for our region.

What is a CCO? It’s an innovative idea in Oregon where health care providers (physical health care, mental health care and sometimes dental care providers) have agreed to work together to serve people who receive health care coverage under the Oregon Health Plan (Medicaid). EPA is part of a CCO.

This new concept in paying clinics based on specific quality measures is called “pay for performance.” The idea is to give better care to more people for less money. Seventeen broad quality measures in Oregon touched both pediatric and adult medical care. The measures specific to Eugene Pediatric Associates’ performance were:

  • Follow up office visits at least every 12 weeks with children who have ADHD.
  • Mental and physical health assessment of children placed in foster care within 60 days of placement.
  • Emergency Room utilization decreases.
  • Adolescent well checks at least once per year.
  • Developmental screening at well checks before age three.
  • Patient-Centered Primary Care Home enrollment.
  • Patient satisfaction/access to care questionnaires.
  • Electronic Health Record adoption.
  • Screening for depression.

Those clinics that had an outstanding rating for quality and number of patients served received more money. Those clinics serving fewer patients or underachieving on the metrics received less. That we did an outstanding job on these metrics speaks to several factors.

First, our clinic was rewarded for being on the leading edge of technology and change. When the drumbeat of health care reform made it clear to me that a conversion from paper charts to electronic was needed, and when the PCPCH program was announced, we did not wait, we led our field. The complicated and expensive transition to electronics, which included adding staff to attend to the million new details, paid off. The results have all benefitted the kids we serve.

Second, Eugene Pediatrics is the perfect size to make rapid transformation. Change is hard, especially when hundreds or thousands of doctors and nurses are forced to change work habits they have had for decades. Larger, more corporate clinics are struggling in this new paradigm. When it’s a smaller clinic like ours, we can meet as a team, talk about new regulations and implement them quickly.

Third, and perhaps most importantly, our patients are engaged. Look again at the list of requirements and notice that several of them depend upon patients doing what is in the best interests of their kids:  

  • Come for well checks.
  • Answer detailed developmental questionnaires.
  • Utilize expensive emergency room care only in a true emergency.

We at Eugene Pediatrics work hard to reach out to you and give our best care at every opportunity, and you respond. For that, we are truly grateful. Working together, we can make the greatest positive impact for your kids’ health.

Health care reform is moving quickly in a very new direction. Instead of paying for services given, doctors in the future will be paid if their clinics meet increasingly complex quality metrics. For now, it’s mostly the government-insured system leading us in this direction, but private insurance companies also are starting their own quality metric programs.

Eugene Pediatric Associates is ready for all of that because, ultimately, we must meet these challenges and be a leader if we are to do what we love the most: earn your trust and take care of your precious children. Every step of the way.

140611EPAadultdocs FINALSaturday, I volunteered to sit in a boardroom on a sunny day with 30 other people from various professions talking about the crisis we face in our community: inadequate access to good-quality primary care for adults in our area.

At this point, we have a huge victory: 15,000 adults have been assigned a primary care provider (PCP) since last November. Many of these individuals have had no access to healthcare for decades. The stories are compelling:

  • A woman in her fifties who has never had a mammogram.
  • A gentleman who has smoked for many years, has a chronic, worsening cough, but was never seen by a doctor.
  • A diabetic woman without a blood sugar meter.

Now, they have hope for better care.

But there are 10,000 more adults in our area who have signed up for primary care and are yet unassigned to a PCP due to an inadequate numbers of medical providers.

Our provider workforce is aging quickly — the average age of adult primary care providers in Lane County is 55 years. And if we don’t soon address the need to inject new, young blood in our medical community, there will be only a few providers left here in a few years to take care of all of us.

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140515EPA poverty1I was sitting in my car at a red light recently, when a driver moving through the intersection rolled his window down and screamed an obscenity at a rumpled man holding a cardboard sign: “Get a job, you — !”

That man and the people who, forced by life’s circumstances, stand by the side of the road begging for food and spare change are frequent reminders of something we confront every day at Eugene Pediatrics — poverty.

It’s not only seeing children living and coping with poverty that upsets me. It’s a feeling that they will grow up without a key component for success — a vision of another possibility for themselves. I have a growing rage that I can do so little to help change the fate of these children and families.

This week, a little boy came to see me, and it had been too long. I saw him the day he was born, just like his siblings. Three darling kids. Their mother has struggled for all the years I’ve known her. I have seen her beaten, filthy, exhausted, frightened and assaulted by her boyfriend (but afraid to report him). I have also seen her happy, in love with her babies and hoping for a positive change in life.

We have laughed together, talked about her kids and discussed options for her. I know she struggles with drugs, alcohol and depression — they are her demons.

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140303EPA vaccinationblogA front page article Friday in The Register-Guard highlighted a new law that went into effect March 1 requiring all children who attend school either be vaccinated or have a parent produce evidence that they have been educated about vaccines and still chose not to vaccinate.

Proof of exemption can include a form signed by your child’s physician and a certificate obtained by watching an online education module produced by the State of Oregon about vaccines.

Here is some information I want to share on the new vaccine exemption process:

  • Your pediatricians at Eugene Pediatric Associates believe strongly that vaccinating kids saves lives. We have all seen firsthand the impact of vaccine-preventable diseases on kids. Dr. B vaccinated her own precious children based on many years of experience and confidence in the safety and efficacy of childhood shots.
  • We welcome your questions about shots during your visits at Eugene Pediatrics. You can also read information on vaccines on our website under both the Vaccines and the Resources sections.