PCPCC Stakeholders Working Meeting – Misc Notes

(presentations online here)

Paul Grundy, MD – “Think huge”

Purchaser guide – there have been many of these, but the first time one prepared with consumers and providers

Health Information Technology – help educate, advocate, demonstrate around PCMH the technology that will be necessary to help physicians make the transformation

Panel – What Does it Cost to Become a Patient Centered Medical Home?

Bob Berenson, MD, Senior Fellow, The Urban Institute

“A good medical home”- patient with superficial phlebitis treated via one office visit, 6 phone calls, 6 e-mails, including hematologic consultation, one reimbursement for in-office care

Julia Pillsbury, DO, Alternate RUC Representative, American Academy of Pediatrics

New G codes for Medical Home-type work. Crosswalked to currently existing codes, some subsume current G codes, some do not. Tier 1, 2, and 3, between 6.5 to 9.2 minutes per patient per month, may be around $50/member/month.

Patient Partnership

Sabrina Corlette, Director of Health Policy, The National Partnership for Women and Families

Grant from the Wellpoint Foundation to introduce consumer advocates to PCMH and involve them and shaping it. Environmental scan, Focus Groups, Develop consumer/patient principles

Debbie Peikes, Ph.D., Mathematica Policy Research

We should involve patients and providers in primary care assignment, using claims retrospectively is expedient perhaps but has difficulties


Oh boy, Ted's back, we have informationally dense posts to digest, dozens a day. 🙂

What are G codes and was is "crosswalked"?

Wellpoint Foundation sounds like people worth knowing.

Hey Dave,

Glad to be back. A G code is a numerical code that is submitted to a payer for reimbursement, like a CPT code. I believe that G codes are exclusive to Medicare, but I could be very very wrong about all of this. In this case, new codes have been developed that will allow a physician to bill for medical home-type services, like coordinating care, as opposed to doing a procedure, for example.

Crosswalked means that the new codes are compared to existing codes so that they are have a frame of reference.

If someone actively engaged in the science of medical billing would like to chime in, please do,


So, in that world crosswalking is analogous to mapping, or a lookup table?

Do you have an opinion about the project chaired by John Halamka at HITSP? Any thoughts about Medsphere's open source medical records initiative, which Halamka seems to like?


You got it – I think it's the healthcare system's awkward way of translating a piecemeal reimbursement system to a service that's meant to be holistic – sigh.

I always enjoy reading John Halamka's work and am happy he's in the blogosphere as transparently as he is. I hope other CIO/CMIO's follow. VISTA does not seem to have taken off in the private sector as well as it has within the VA system. The one critical thing that is missing from VISTA right now, in my opinion, is patient interaction. The VA's patient portal doesn't integrate with the provider front-end of VISTA (as far as I know, if there's new information about this, please feel free to clarify), even though both systems are very advanced. This is in contrast to systems in use at places like Kaiser Permanente, where the EHR is tightly integrated with patient access, and the patient's interaction with the record is woven throughout the care experience – you never "forget" that the patient is there with you.

There's no comment on the patient centered-ness of the new product and whether it will close this gap, so that any care provider interacting within the environment of the EHR can also interact with the patient's PHR. If they did address this, it would be great news.

I see there's a comment on John's post referring to HealthVault and Google, which I think gets at the same question, which confirms that I am not the only person thinking about this – that's reassuring,


It's time for me to end my cloudiness about EHR vs PHR vs EMR and all that. Where do I get tutorialed on it?

And what's the bottom line on the Kaiser Permanente method? Does "tightly integrated" mean it's an interwoven forum or transcript, where patient actions are logged in the same stream as provider actions?

What does HITSP have to do with VISTA? Is it derived from VISTA? HITSP talks about its 500 members – are they not adopting?


I'd suggest starting with the official definitions developed by NAHIT, courtesy of our tax dollars.

I am glad you and I took on defining Health 2.0 (which has helped me numerous times already); EHR and PHR is a place where a lot of work has already been done for us!

Re: HITSP and VISTA, they are unrelated acronyms – HITSP is the Health Information Technology Standards Panel and is a group of people working to harmonize the way HIT systems share data, so that present and future EHR's, including VISTA, will use the same protocols to communicate with patients, other systems, and health information exchanges. It's very complicated and intensive work. As I listened in on one of the calls, I kept telling myself, "The financial services industry was able to do this," as a way to keep my optimism at it's stratospherically high levels,


Ted Eytan, MD