#MDchat

Healthcare Hashtag Twitter Transcript

From: Tue Feb 15 18:08:00 PST 2011
To: Tue Feb 15 19:04:00 PST 2011

Learn more about #MDchat at The Healthcare Hashtag Project

mdstudent31 Will we need #watson to answer as well? #mdchat

Tue Feb 15 18:08:23 PST 2011

MD_chat T1 ACOs: Saviors, Devils or Unicorns? http://bit.ly/i0JcEO Discuss thoughts on ACOs -

promises/pitfalls. #MDchat
Tue Feb 15 18:08:54 PST 2011

MD_chat Note: No need to read the article linked - just for reference. #MDchat :)
Tue Feb 15 18:10:07 PST 2011

quality1 @MD_Chat T1: Like the promise of better coord of care w ACOs, but concerned small MD
practices will disappear #MDChat
Tue Feb 15 18:10:26 PST 2011

doctorpreneur T1 #mdchat The core principles of improving integration through clarifying accountability with
ACOs are hard to argue against..
Tue Feb 15 18:10:31 PST 2011

mdstudent31 T1: Potential Saviors, Devils if not utilizing primary care correctly w/ #pcmh, unicorns w/o
appropriate workforce #mdchat
Tue Feb 15 18:11:00 PST 2011

RichmondDoc @quality1 T1 Small practices are already disappearing as more docs choose to be employed, but
practices could join to become ACOs. #mdchat
Tue Feb 15 18:12:17 PST 2011

mdstudent31 Private practices need to look ahead to join together now. Cannot be reactive if private/small
practices are to survive #mdchat
Tue Feb 15 18:13:07 PST 2011

RichmondDoc T1 The first question for me is: "Accountable" to who, for what, and to what extent? If payment is
based on outcomes, which ones? #mdchat
Tue Feb 15 18:13:08 PST 2011
RichmondDoc T1 I think ACOs in theory stand to make changes in reducing costs, but must avoid capitation
models that failed in the 90s. #mdchat
Tue Feb 15 18:13:52 PST 2011

RichmondDoc @mdstudent31 Agree that ACOs need to include #PCHM models: pt management must be part of
the equation, more team-based care. #mdchat
Tue Feb 15 18:14:44 PST 2011

mdstudent31 @RichmondDoc Both providers AND patients need to be held accountable... What are the patient
incentives? #mdchat
Tue Feb 15 18:15:26 PST 2011

doctorpreneur T1: Are ACOs something everyone is talking about but no one knows quite what they are nor how
to be one in practice? #mdchat
Tue Feb 15 18:15:48 PST 2011

pjmachado Likely RT @quality1: @MD_Chat T1: Like the promise of better coord of care w ACOs, but
concerned small MD practices will disappear #MDChat
Tue Feb 15 18:15:52 PST 2011

EllenRichter LOL trying to go back to the start & catch up to everyone! :) #MDchat
Tue Feb 15 18:16:26 PST 2011

mdstudent31 T1: If we continue specialist/proceduralist-driven care, all models of delivery will fail. #mdchat
Tue Feb 15 18:16:50 PST 2011

MD_chat @doctorpreneur Short answer: Yes. But @KentBottles is a good source of ideas on ACOs.
#MDchat
Tue Feb 15 18:17:08 PST 2011

pjmachado Health & $$$ RT @mdstudent31: @RichmondDoc Both providers & patients need to be held
accountable... What are the patient incentives? #mdchat
Tue Feb 15 18:18:04 PST 2011

EllenRichter @mdstudent31 T1 We are so far down the path of specialist/proceduralist, how do we go back to
start? #MDchat
Tue Feb 15 18:18:25 PST 2011

RichmondDoc @EllenRichter @mdstudent31 Burn it all down? #mdchat

Tue Feb 15 18:19:26 PST 2011

pjmachado Yes RT @doctorpreneur T1 ACOs something everyone is talking about but no one knows quite
what they are nor how to be 1 in practice? #mdchat
Tue Feb 15 18:19:46 PST 2011

RichmondDoc @EllenRichter @mdstudent31 Fundamentally, ACOs need to have a foundation of primary care:
shown to reduce costs, improve outcomes. #mdchat
Tue Feb 15 18:19:54 PST 2011
mdstudent31 @EllenRichter Reform payment delivery to place more emphasis on cognitive/coordinated care.
@RichmondDoc - burning it down also good #mdchat
Tue Feb 15 18:19:58 PST 2011

mdstudent31 @EllenRichter @pjmachado Physicians will change delivery of care when they know how their
time will be compensated for #mdchat
Tue Feb 15 18:20:30 PST 2011

RLMitchell T1: i like that the focus on incentives for efficient, well coordinated, quality care, but wary of new
bureaucracy #MDchat
Tue Feb 15 18:20:56 PST 2011

RichmondDoc T1 I think "ACO" is a great talking point, but: accountable to who? For what types of care? What
are the rewards/penalties? #mdchat
Tue Feb 15 18:21:09 PST 2011

doctorpreneur @EllenRichter T1 #mdchat we are seeing return to holistic whole person care approach but there
is an existing tension with subspecialisation
Tue Feb 15 18:21:24 PST 2011

BonnieRN @mdstudent31 Agree, compensation is a strong motivator #MDChat

Tue Feb 15 18:21:59 PST 2011

EllenRichter @pjmachado T1 Yes but I think health is becoming more "in fashion"....the scale is tipping in the
right direction #MDchat
Tue Feb 15 18:22:05 PST 2011

RichmondDoc T1 To be successful, the ACO model will need to focus on primary care, integrated care, primary
care/specialist communication... #mdchat
Tue Feb 15 18:22:36 PST 2011

pjmachado FFS is root cause... RT @mdstudent31: T1: If we continue specialist/proceduralist-driven care, all
models of delivery will fail. #mdchat
Tue Feb 15 18:23:11 PST 2011

mdstudent31 #pcpcc #pcmh pilots already showing this-all old news. When will we actually change? Super-
duper-specialists agree? Nope #mdchat
Tue Feb 15 18:23:16 PST 2011

RichmondDoc T1 ...providing right care at the right time for right person, reimbursement for providers, team-
based care to enhance pt care... #mdchat
Tue Feb 15 18:23:56 PST 2011

nickdawson T1: ACOs - important to understand model: $s based on % of savings. Investment to build is high.
Is % of savings worth it? #mdchat
Tue Feb 15 18:23:58 PST 2011

RichmondDoc T1 ...value face-to-face care in a way that could reduce reliance on expensive tests/studies--all
while keeping pt confidence/trust. #mdchat
Tue Feb 15 18:24:49 PST 2011
nickdawson @RichmondDoc ACO model is well defined, your comment hints at a missing party: the patient
#mdchat
Tue Feb 15 18:24:55 PST 2011

EllenRichter @nickdawson Thanks for that info. I didnt realize that. #MDchat
Tue Feb 15 18:25:11 PST 2011

mdstudent31 @nickdawson Budget cuts for primary care in FY2012 fed budget + provisional spending cuts for
primary care=no change soon #mdchat
Tue Feb 15 18:25:53 PST 2011

RLMitchell T1 no it just needs to reward good health/cost outcomes. health staff+ hosps need incentives and
space to be entrepreneurial again #mdchat
Tue Feb 15 18:26:11 PST 2011

nickdawson @EllenRichter its interesting to do the math. CMS estimates <5% savings for small % of total
covered lives. #mdchat
Tue Feb 15 18:26:51 PST 2011

RichmondDoc @MD_Chat #PCMH would provide the centering point for pts--in ACOs, or without them. #mdchat
Tue Feb 15 18:27:27 PST 2011

mdstudent31 How do we cut $141.925 million for National Health Service Corps and expect to have primary
care where we need it? #mdchat
Tue Feb 15 18:27:59 PST 2011

quality1 @RichmondDoc @mdstudent31 @nickdawson Agree. Since primary care at the heart of ACO
care coord, a big issue to overlook #MDChat
Tue Feb 15 18:28:21 PST 2011

pjmachado Patients/payers-all care/prevention-enough 2keep HCPS in the game RT @RichmondDoc:

T1accountable 2 who?what care?rewards/penalties? #mdchat
Tue Feb 15 18:28:26 PST 2011

EllenRichter @nickdawson Thats kind of distressing to hear. So what is the incentive to change existing
practice, other than to involve patients? #MDchat
Tue Feb 15 18:29:20 PST 2011

nickdawson @mdstudent31 exactly. Actions differ from talk. ACOs mean emphasis on PCPs & reducing DX
svcs like imagining. Is that a trend today? #mdchat
Tue Feb 15 18:29:28 PST 2011

RichmondDoc @pjmachado So: accountable to everyone for all needed care, for poorly-defined benefits and
possible penalites? Not real appealing. #mdchat
Tue Feb 15 18:29:37 PST 2011

mdstudent31 How do we cut $1 billion from Community Health Centers and expect any system to help? #mdchat
Tue Feb 15 18:29:40 PST 2011
pjmachado Will be over time RT @RichmondDoc: @nickdawson We speak of ACOs as accountable
2outcomes; not clear accountable to patients enrolled #mdchat
Tue Feb 15 18:30:20 PST 2011

doctorpreneur @quality1 the "personality" of smaller practice health care has in no small way led to irrational
exuberance of healthcare costs #mdchat T1
Tue Feb 15 18:30:37 PST 2011

RichmondDoc @nickdawson @mdstudent31 T1 All our current trends in medicine away from primary care and
toward high $ services. #BassAckwards #mdchat
Tue Feb 15 18:30:56 PST 2011

nickdawson @RichmondDoc re: accountable to whom - you answered it in your next tweets (smart guy!),
#PCHM model is heading in that direction #mdchat
Tue Feb 15 18:31:16 PST 2011

EllenRichter T1 Yes the healthcare $$ cuts are practically unfathomable. How can we expect more & better for
less when we cant do it for more? #MDchat
Tue Feb 15 18:31:20 PST 2011

quality1 @doctorpreneur Would love to learn more. Thought chronic conditions were large driver of
healthcare costs. Thx #MDChat
Tue Feb 15 18:31:51 PST 2011

RLMitchell @doctorpreneur @quality1 I think its the loss of that "personality" that is part of the exodus of
medical students from primary care #mdchat
Tue Feb 15 18:32:07 PST 2011

EllenRichter @RichmondDoc LOL @ #BassAckwards :) #MDchat

Tue Feb 15 18:32:08 PST 2011

RichmondDoc T1 ACOs can work: Geisinger seems pretty tight, Kaiser is doing well, etc. But tightly integrated
systems built from ground up. #mdchat
Tue Feb 15 18:33:01 PST 2011

mdstudent31 @rlmitchell @doctorpreneur @quality1 Family Medicine was #1 specialty choice for DO match and
among top in military this year #mdchat
Tue Feb 15 18:33:07 PST 2011

nickdawson @EllenRichter distressing indeed.Incentives dont exist. Providers have to cannibalize existing
profitable "products" to make it work #mdchat
Tue Feb 15 18:33:17 PST 2011

RichmondDoc @ritika61 Also: need better communication from specialists back to us! :) #mdchat
Tue Feb 15 18:33:21 PST 2011

quality1 @ritika61 Do we need ACOs to achieve better communications? #MDChat

Tue Feb 15 18:33:34 PST 2011
mdstudent31 @RichmondDoc Tightly integrated systems built ON A foundation of primary care and #pcmh
coordinated care model #mdchat
Tue Feb 15 18:34:03 PST 2011

nickdawson Agree! Also in rural area and owns a payor, thus assuming own risk. RT @RichmondDoc: T1
ACOs can work: Geisinger seems pretty tight #mdchat
Tue Feb 15 18:34:09 PST 2011

RichmondDoc @ritika61 Huzzah! #mdchat

Tue Feb 15 18:34:43 PST 2011

RLMitchell @mdstudent31 but what was #1 DO choice last yr? (did it change), and what # was it for all MDs?
not even close to enough #mdchat
Tue Feb 15 18:34:56 PST 2011

MD_chat Shoulder tap!: 2nd topic batting up in 2 seconds. #MDchat

Tue Feb 15 18:35:17 PST 2011

RichmondDoc @nickdawson so, for ACOs to work, will it be necessary/advantageous to own a payor, too?
#mdchat
Tue Feb 15 18:35:22 PST 2011

MD_chat T2 Suicidal Ideation: http://bit.ly/gt6hOO We talk of caring for patients, but who cares for docs?
What programs/measures work? #MDchat
Tue Feb 15 18:35:43 PST 2011

quality1 .@RichmondDoc True. One of my concerns about ACOs - models are ground up, now trying to
patchwork other systems into existence #MDChat
Tue Feb 15 18:35:45 PST 2011

nickdawson @EllenRichter Im not an ACO naysayer at all, just think many missing the economic realities. % of
savings model is not sustainable #mdchat
Tue Feb 15 18:36:06 PST 2011

DrJonathan Over 60% of DOs go into primary care specialties- that is in the single digits for MDs, although it
has been on the rise recently. #mdchat
Tue Feb 15 18:36:13 PST 2011

mdstudent31 Family med was up 15%, MD results March 17th. FamMed big MD increase in % last yr #mdchat
Tue Feb 15 18:36:31 PST 2011

nickdawson @RichmondDoc or partner with a payor or large employer - thats the model to date. Payor (CMS is
de facto) shares % of savings. #mdchat
Tue Feb 15 18:37:02 PST 2011

mdstudent31 Match Results: 2010 Fill Rate for Family Medicine Highest Ever #mdchat
Tue Feb 15 18:37:17 PST 2011
quality1 @RichmondDoc @nickdawson Geisinger & Kaiser do, but does Mayo Clinic (own a payor), the
other strong model? #MDChat
Tue Feb 15 18:37:21 PST 2011

DrJonathan @RLMitchell The DO Match was yesterday. Family Medicine was still #1 this year. Here are match
results: http://tinyurl.com/6crk2nu #mdchat
Tue Feb 15 18:37:47 PST 2011

RLMitchell @mdstudent31 awesome to hear #mdchat

Tue Feb 15 18:38:01 PST 2011

EllenRichter @nickdawson I just assumed that since ACOs were considered a new & "better" system, they
would at least be monetarily efficient too! #MDchat
Tue Feb 15 18:38:06 PST 2011

pjmachado Need 2 start over & redesign model RT @EllenRichter: t1 How can we expect more & better for
less when we cant do it for more? #MDchat
Tue Feb 15 18:38:35 PST 2011

quality1 Gr8 RT @DrJonathan Over 60% of DOs go into primary care spec-in the single digits for MDs,
although it has been on the rise recently #MDChat
Tue Feb 15 18:38:38 PST 2011

RichmondDoc T2 Medicine is built on a foundation of self-reliance, bravado, and the character-building of

toughening up. Needs to change. #mdchat
Tue Feb 15 18:38:48 PST 2011

ritika61 T2: Medicine has a culture of invincibility bred into us from day 1, plus huge stigma around mental
health. This needs to change! #MDchat
Tue Feb 15 18:39:08 PST 2011

mdstudent31 @DrJonathan Overall Primary Care (at 90% IM specialization rate and 66% peds specialization
rate) is at about 20% for MD #mdchat
Tue Feb 15 18:39:34 PST 2011

pjmachado Own risk/benefit & analyze RT @RichmondDoc: @nickdawson so, for ACOs to work, will it be
necessary/advantageous to own a payor, too? #mdchat
Tue Feb 15 18:39:38 PST 2011

ritika61 @RichmondDoc Good answer haha. #MDchat

Tue Feb 15 18:39:40 PST 2011

RichmondDoc @MD_Chat T2 The measures listed in the link are positive developments--but we need to remove
the stigma involved in seeking help. #mdchat
Tue Feb 15 18:39:43 PST 2011

EllenRichter T2 One of the most wonderful neurosurgeons I knew committed suicide. There has to be some
way to recognize symptoms in colleagues #MDchat
Tue Feb 15 18:39:49 PST 2011
RichmondDoc @ritika61 Ditto! #GreatMinds #mdchat
Tue Feb 15 18:40:08 PST 2011

quality1 @nickdawson I thought Mayo was one of the original models for this concept. #MDChat
Tue Feb 15 18:40:19 PST 2011

DrJenGunter What is T2 on #MDCHAT ?

Tue Feb 15 18:40:46 PST 2011

EllenRichter @RichmondDoc T2 Why is it doctors cant seek help yet can give it so freely? Its truly odd how
common that is. #MDchat
Tue Feb 15 18:40:49 PST 2011

RichmondDoc @DrJenGunter Suicidal Ideation: http://bit.ly/gt6hOO Talk of caring for patients, who cares for
docs? What programs/measures work? #mdchat
Tue Feb 15 18:41:34 PST 2011

RichmondDoc @EllenRichter I think we perceive it as a sign of weakness, that we should be tougher than that.
Pretty much all guilty of that. #mdchat
Tue Feb 15 18:42:07 PST 2011

ritika61 @EllenRichter - Not odd at all. We see our role as the helped. Also has to do with power dynamics
and not wanting to seem weak. #MDchat
Tue Feb 15 18:42:09 PST 2011

nickdawson T1: Look to Berwick: reduce cost, reduce hospital dependency, get innovative, share clinical data -
is that PCMH or ACO, or both? #mdchat
Tue Feb 15 18:42:23 PST 2011

ritika61 @RichmondDoc - get out of my brain! #MDchat

Tue Feb 15 18:42:40 PST 2011

RichmondDoc T2 Seeking help when needed should become the standard course of action, and needs to be
taught in medical school. #mdchat
Tue Feb 15 18:42:53 PST 2011

nickdawson @MD_Chat and on T2 this non clinician politely bows out :) - back into listening and learning
mode #mdchat
Tue Feb 15 18:43:08 PST 2011

EllenRichter @ritika61 @RichmondDoc Yes that was scary similar! I took a double-take! :) #MDchat
Tue Feb 15 18:43:34 PST 2011

RichmondDoc @ritika61 Mwah, hah, hah! #mdchat

Tue Feb 15 18:43:35 PST 2011

ritika61 @RichmondDoc @EllenRichter That must mean there is truth to it. Strength in numbers! I learned
that in a book. :P #MDchat
Tue Feb 15 18:44:19 PST 2011
RichmondDoc @DrJenGunter I think we feel we should be able to handle it, and we can get through. Others may
think the same thing on our behalf. #mdchat
Tue Feb 15 18:44:55 PST 2011

EllenRichter @nickdawson Glad you joined in! I learned from your tweets! :) #MDchat
Tue Feb 15 18:45:09 PST 2011

ritika61 T2: Breaking down doctor-patient divide will help. We need to see ourselves as equal. #MDchat
Tue Feb 15 18:45:15 PST 2011

healthblawg T1 FYI see my post this wk on Atrius and BCBSMA AQC which is pretty much an #ACO + #pcmh
http://bit.ly/gHNjvo #mdchat
Tue Feb 15 18:46:10 PST 2011

mdstudent31 @RichmondDoc @EllenRichter Would love to see how many docs take their own advice,
including diet/exercise (too much and too little) #mdchat
Tue Feb 15 18:46:16 PST 2011

pjmachado Current model is activity driven & HCP centered-need patient centered w/efficient health
outcomes. New roles needed & some dropped #mdchat
Tue Feb 15 18:46:28 PST 2011

RichmondDoc T2 We need to teach students--from the beginning--that we are all human, and all vulnerable.
Need to care for ourselves/others. #mdchat
Tue Feb 15 18:46:39 PST 2011

DrJenGunter @RichmondDoc the MD health insurance at my University had PATHETIC mental health
coverage. No one really wanted to help #MDChat
Tue Feb 15 18:46:41 PST 2011

EllenRichter @ritika61 T2 Yes! I think as we break down that doc-patient wall, maybe docs will become more
sensitive to their own health needs :) #MDchat
Tue Feb 15 18:46:44 PST 2011

EllenRichter T2 Doctors are patients too~ Arent they? ;) #MDchat

Tue Feb 15 18:47:12 PST 2011

DrJonathan Self-care is a paradox in medical education.We are taught its importance on health yet our
schedule/life does not support it for us. #mdchat
Tue Feb 15 18:47:20 PST 2011

RichmondDoc @DrJenGunter After something bad happened to me a couple yrs ago, I deferred counseling, etc;
no-one really pushed it on me ... #mdchat
Tue Feb 15 18:47:50 PST 2011

DrJenGunter @cynicalbstrd @RichmondDoc yes, lost 3 colleagues to suicide #mdchat

Tue Feb 15 18:48:04 PST 2011
mdstudent31 @DrJonathan Aint that the truth re: finding time for our own biopsychosocial health. #mdchat
Tue Feb 15 18:48:18 PST 2011

DrJonathan @DrJenGunter As a Counselor myself, I can attest to the fact that mental health coverage is
universally pretty lousy. #mdchat
Tue Feb 15 18:48:35 PST 2011

EllenRichter @DrJenGunter Thats so sad to hear how much trouble you had when you needed somewhere to
turn #MDchat
Tue Feb 15 18:48:40 PST 2011

EndoGoddess Wow. So so sad. RT @DrJenGunter: @cynicalbstrd @RichmondDoc yes, lost 3 colleagues to

suicide #mdchat
Tue Feb 15 18:49:03 PST 2011

DrJenGunter @EllenRichter sadly, I think my experience reflects the mental health experience in general
#mdchat
Tue Feb 15 18:49:54 PST 2011

EllenRichter @DrJenGunter I dont think I could work in a delivery room either if I was in your shoes. Totally
rational decision #MDchat
Tue Feb 15 18:50:28 PST 2011

EllenRichter T2 So if its recognized that doctors have high rates of suicide, &if mental health is so poor, how do
we remedy this serious issue? #MDchat
Tue Feb 15 18:52:00 PST 2011

RichmondDoc @EllenRichter T2 Start teaching med students differently. Instead of "tough it out" mentality, need
to teach self care. #mdchat
Tue Feb 15 18:53:01 PST 2011

DrJonathan @EllenRichter I think we start to remedy it by realizing that Drs, like everyone, are pts too and
entire system needs an overhaul. #mdchat
Tue Feb 15 18:53:14 PST 2011

RichmondDoc @EllenRichter T2 Also necessary for med school, residency, and medical practices to give docs
work/life balance. #mdchat
Tue Feb 15 18:53:42 PST 2011

DrJonathan Having gone through med and counseling grad school, med. has lots to learn from counseling
schools re: teaching/supporting self care #mdchat
Tue Feb 15 18:55:05 PST 2011

RichmondDoc T2 Docs are trained to internalize loss, take on long hours and difficult tasks, and rely on oneself
alone. Not a healthy approach. #mdchat
Tue Feb 15 18:55:12 PST 2011

EllenRichter T2 There could be continuing education classes offering CME that work on self-soul searching
process to recognize your own symptoms #MDchat
Tue Feb 15 18:55:49 PST 2011
pjmachado Yes RT @nickdawson T1: Look to Berwick: reduce cost, reduce hospital dependency, get
innovative, share clinical data-PCMH/ACO, both? #mdchat
Tue Feb 15 18:56:28 PST 2011

DrJonathan I do think DO schools do a slightly better job of supporting/teaching self-care but even they have
far to go #mdchat
Tue Feb 15 18:56:33 PST 2011

RichmondDoc @EllenRichter T2 I completed a faculty development workshop that focused on mutual support
and self-awareness. Greatly helpful. #mdchat
Tue Feb 15 18:56:36 PST 2011

DrJonathan @ritika61 That and give them time to sleep and exercise would be my basic advice. #mdchat
Tue Feb 15 18:57:45 PST 2011

EllenRichter Wonderful! Should be mandatory? RT @RichmondDoc I completed a faculty development

workshop focused on mutual support/self-awareness #MDchat
Tue Feb 15 18:58:33 PST 2011

RichmondDoc @EllenRichter T2 Should become inherent in the culture of medicine. #mdchat

Tue Feb 15 18:59:27 PST 2011

EllenRichter @ritika61 LOL thats so true about the mixed messages! Thats almost funny how dichotomous
those examples are! :) #MDchat
Tue Feb 15 18:59:56 PST 2011

mdstudent31 @ritika61 Water bottle and power bars in the white coat at all times. Never starved, never
dehydrated during clinical years #mdchat
Tue Feb 15 19:00:07 PST 2011

RichmondDoc Final: Communication and connections are necessary for health care: be it in an ACO or in caring
for oneself. People need caring. #mdchat
Tue Feb 15 19:01:05 PST 2011

pjmachado Great discussion & group at #mdchat wish you were all calling the shots on #HCR
Tue Feb 15 19:01:37 PST 2011

mdstudent31 @ritika61 Being allowed vs not speaking up to ask to go eat was always the issue. Slacker vs
being engaged. I asked regardless #mdchat
Tue Feb 15 19:01:58 PST 2011

EllenRichter @MD_chat As usual, great topics, AND great folks to respond & make the conversation
interesting! Thanks for putting it together Phil #MDchat
Tue Feb 15 19:03:47 PST 2011