Business Meeting Agenda
June 4, 2014
Meeting Location:
Unitarian Universalist Church
1685 W 13th AveEugene, OR 97405
2013-2014 Executive Committee:
President: M. Sophia Aguirre, Ph.D.
President-Elect: Peter Powers, Ph.D.
Secretary: Bill McConochie, Ph.D.
Treasurer: Amy Athey, Psy.D.
Attending: Peter Powers, Galyn Forster, Ruth Braun, Robert Rogers, Craig Steinberg, John Davies, Rachel Sheppard, Joy Lum, Rachel Chester, Ellie Dominguez, Carol Carver, Teri Strong, Ruth Bitchel (sp?), Matt Fleischman, Amy Athey.
Presentation:
Teri Strong, Ph.D. and Carol Carver, Ph.D. presented on “Health Care Reform for the Affordable Care Act”. Dr. Strong made first part of presentation: Portions of the presentation were taken from the Oregon Psychological Association’s Healthcare Task Force- Identified 3 factors for psychologists: Relevance, Sustainability, and Coherence-subcommittee for each.
Coherence: Congressional decisions applied to clinical work. One reason for HCR is increasing costs for healthcare over the last several decades, constituting unsustainable portions of our national gross domestic product. Patient Protection and Affordable Care Act emphasis on teams, sharing patients, collaboration. Oregon Health Plan has 16 regional CCO’s (Coordinated Care Organizations)
Trillium is Lane County’s CCO 935K total members this year; 321K new; startling statistic: 50% of all babies born in Oregon are on OHP; Cover Oregon statistics also reviewed-e.g. 80% received financial assistance; most signed up for silver plans and of total most overall signed up for silver and bronze plans which are lowest outpatient benefit/highest copay (e.g. est. $100 copay for bronze, $65 for silver), essentially out pricing services for lower income individuals. In Lane County strong emphasis on integrating care (Behavioral Health in Primary Care or “reverse integration” of PC in BH). Loss of physicians on panels discussed, including “meaningful use” documentation via electronic health records (EHR) taking more time away from direct care and disliked by physicians/others, at same time more enrollees. 11K members in Lane County have no PCP!
Proposed practice distinctions: Coordinated-most common-what most of us are doing already-coordinate care as needed, records shared via fax, etc.; Co-located-at same location
Integrated-side by side practice, new model in 15 minute service intervals. Levels of integration vary depending on numerous factors (clientele, locale, etc.)
Relevance : Guided by principles of psychology-systems, theory, research, statistics, ethics, industry, assessment, and behavior. As psychologists we understand clinical complexity; we must articulate our values; we are flexible in our approach to mental health; we have breadth and depth of training and can apply our skills to a wide range of practice settings; we provide positive communication, information flow, can partner with other disciplines, measure outcomes and provide assessments, conceptualize cases with other providers. Co-located relevance factors-flexible funding, financial needs and requirements (may not get paid due to no codes for services we provide in such short intervals, must have some comfort with risk. Integrated care relevance-flexibility in service delivery while maintaining best practice models can be down-e.g. Strosahl; FACT; develop/train others in assessment methods
Alternative funding models (for those not wanting to accept HCR requirements). As psychologists we have many ways to make a living-custody, forensic, 2nd language evaluations, bill client directly, psychological assessments privately paid for, specialty clinics, consultation, training, supervision, sliding fee practice. Some people believe private practice model is dead or dying (E.g. book “The End of Private Practice” about that happening in parts of Texas) but Dr. Strong does not believe this will actually occur given our ability to adapt.
Sustainability-all about how to remain diverse and productive like in ecological version; “every connection we engage in is a form of integration”; change cascade likely as payer and care delivery models change; how will that affect your practice model? How will your practice be sustainable? What is your clinical model? What is your business payment model? Lots of options-e.g. solo, shared, IPA practice, shared administrative group practice, contracting with other organizations, shared business contract, fully employed. AMHA had worked to charter IPA’s and one IPA operating (out of 2 we know of) is available for informal consultation in develop others. AMHA provides access to Care Path an integrated electronic health care record, for only $25 per month for members
Dr. Carver provided update on alternate payment methods subcommittee:
LCPA JUNE 4, 2014
HealthCare Reform
Payment Methodologies Models
EPISODES OF CARE
Provider receives a set amount for all care related to a given “episode”. (ex: Joint replacement, coronary artery bypass grafting). Can also be used for certain diagnoses over a defined period of time (Ex: COPD, ADHD)
This model is designed to encourage efficiency & emphasize quality care to avoid acute interventions or complications.
BUNDLED PAYMENTS
Includes multiple providers in an episode of care. Best example is one set amount to cover ALL hospital, physician & auxiliary services for a given procedure or diagnosis. (Ex; knee replacement, hip replacement).
This model is intended to encourage coordination & shared accountability for efficiency & quality of care.
SHARED SAVINGS
The payer sets a cost target for “care”. If providers meet or exceed those targets while caring for patients, they share in the savings. The targets are usually tied to quality and outcomes measures. Savings are paid as bonuses to providers.
This model is designed to reward value of care over volume.
SHARED SAVINGS PLUS SHARED RISK
This model builds on the previous model. If a provider exceeds the cost savings “target”, they share the “risk”, usually receiving a reduced payment for costs exceeding the target. This is similar to the model used by OMHA and Reliant Behavioral Health with “risk withhold” amounts that were only paid to providers if cost savings targets were met or exceeded.
This model is designed to reward efficiency and enhance provider accountability.
PAY-FOR-PERFORMANCE
Providers are paid for meeting certain goals. Payment methods include bonuses, fee schedule adjustments, per-member-per-month. Common goals include Quality of Care standards and Patient outcome measurements.
This model is designed to reward quality of care over quantity.
PAYMENT PENALTIES
Payment may be reduced or withheld for: 1) Failing to meet quality or outcomes goals; 2) Certain healthcare acquired conditions; 3) Deviation from evidence-based practice standards; 4) Services that are inefficient
This model is designed to increase quality of care and provider accountability
Most of the above material is from the OHSU Center for Evidence-based Policy Allison Leof,
Reviewed some OHP benchmarks, how to “incentivize” prenatal visits to decrease costs associated with premature births and NICU intervention. Each CCO tracked on benchmarks. Discussion followed about ethics and use of incentives, prior research about what this does, barriers to access, etc.
Respectfully submitted,
Peter A. Powers, Ph.D.
Business Meeting
I. Call To Order
II. Approval of Minutes
III. Reports
a. Treasurer Report (Amy Athey, Ph.D.)
b. OPA Liaison Report (Shannon Young, Ph.D.)
IV. Announcements
V. Unfinished Business
a. Vote for 2014-2015 Officers:
i. C0-Presidents-Elect: Rachel Shepard & Ruth Bichsel
ii. Secretary: ??
b. If no secretary is elected, problem solving solutions?
VI. New Business
a. Allowing professionals from other disciplines to attend CE portion of meeting at a cost?
VII. Upcoming Presentation
9/4/14: Awards Presentation 7:00-7:15 PM
"Outstanding Community Program Award" - Jeff Todahl, Ph.D. (for 90x30 program: http://90by30.uoregon.edu/home)
"Community Service Award" - Coalition to End Sexual Violence (http://uocoalition.wordpress.com/), headed by Jennifer Freyd, Ph.D. at the UO
7:15-8:45 Presentation by Scott Pengelly, Ph.D.: “Innovations in the behavioral management of pain”
The meeting is adjourned.
OFFICER DUTIES: CURRENT
President: Lead monthly and executive committee meetings, bring snacks, arrange speaker for Town Hall and coordinate with OPA presence, prepare agendas, signer on bank account
President-Elect: Arrange speakers for October, December, January, February, March, April, May, June, and next September monthly meetings , bring equipment (projector, etc.) as needed for speakers, arrange for materials to be copied for presentations as requested, move into President role next year and coordinate movement of new officers via informal summer orientation meeting/lunch , member of executive committee
Treasurer: Maintain active membership list, accept dues payments and deposit in account, help with sign-in at Town Hall, write checks (signer on bank account), report on account balances at meetings, pay bills, get mail from PO Box, member of executive committee
Secretary: Take minutes at meetings (both summaries of CE presentations and business meetings), post minutes and meeting reminders via email , along with upcoming meeting noices, coordinate with President-Elect to create and then pre-sign CE certificates, coordinate with “Web Master” (sp?) for what gets posted on web page, member of executive committee
Web Master: Coordinate with Secretary for website postings; coordinate with web administrator for changes/updates to member listings
OFFICER DUTIES: DEFAULT PROPOSAL IF NO SECRETARY
President: Same as above and add-provide backup for President-Elect handwritten business meeting note taking-see below
President-Elect: Same as above and add-take handwritten business meeting notes on type written agenda page and provide to Web Master at end of each meeting for posting; create and distribute CE certificates at meetings
Treasurer: Same as above and add-distribute membership list/attendance sign -in (see below) with typed names of officers (who have dues waived) and those who have paid dues preprinted on form at each meeting, then provide to Web Master at end of each meeting for posting.
Web Master: Same as above and add-receive business meeting agenda with handwritten notes, key point summary from presenters (see below), and membership list/attendance sign in (see below) and post on Web each month before next meeting.
NEW PROCESS DETAILS
Key Point Summary from presenters: either on form we provide or free form request presenters provide name of presentation, their credentials, and key points summary (1 page or less)
Business Meeting Agenda: notes handwritten on form and submitted at end of each meeting
Membership List/Attendance Sign In: Each September Treasurer starts with blank form except for the names of Officers whose dues are waived (officers names are typed in and officers sign in next to typed name). All other attendees print and then sign their names for CE recording purposes. Names are typed in and added to list as Treasurer receives checks. At future meetings typed in names signify dues are paid and sign in next to them signifies attendance at a particular meeting. Web Master’s most recent posting of Membership List/Attendance Sign In is always up to date automatically that way each month. No emails.
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