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Richard Young, MD

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NCBI: db=pubmed; Term=(Young R[Author]) AND (John Peter Smith[Affiliation] OR JPS Health Network[Affiliation] OR JPS [Affiliation] NOT Japan Pancreas Society[Affiliation])
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Would Medicare for All Be the Most Beneficial Health Care System for Family Physicians and Patients? No: Medicare for All Would Cause Chaos and Fail to Control Health Care Costs.

Wed, 10/07/2020 - 01:05

Would Medicare for All Be the Most Beneficial Health Care System for Family Physicians and Patients? No: Medicare for All Would Cause Chaos and Fail to Control Health Care Costs.

Am Fam Physician. 2020 Oct 01;102(7):392-393

Authors: Young RA

PMID: 32996754 [PubMed - in process]

Improving quality in a complex primary care system-An example of refugee care and literature review.

Tue, 07/07/2020 - 00:18
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Improving quality in a complex primary care system-An example of refugee care and literature review.

J Eval Clin Pract. 2020 Jun 29;:e13430

Authors: Young RA, Nelson MJ, Castellon RE, Martin CM

Abstract
RATIONALE, AIMS AND OBJECTIVES: Applying traditional industrial quality improvement (QI) methodologies to primary care is often inappropriate because primary care and its relationship to the healthcare macrosystem has many features of a complex adaptive system (CAS) that is particularly responsive to bottom-up rather than top-down management approaches. We report on a demonstration case study of improvements made in the Family Health Center (FHC) of the JPS Health Network in a refugee patient population that illustrate features of QI in a CAS framework as opposed to a traditional QI approach.
METHODS: We report on changes in health system utilization by new refugee patients of the FHC from 2016 to 2017. We review the literature and summarize relevant theoretical understandings of quality management in complex adaptive systems as it applies to this case example.
RESULTS: Applying CAS principles in the FHC, utilization of the Emergency Department and Urgent Care Center by newly arrived refugee patients before their first clinic visit was reduced by more than half (total visits decreased from 31%-14% of the refugee patients). Our review of the literature demonstrates that traditional algorithmic top-down QI processes are most often unsuccessful in improving even a few single-disease metrics, and increases clinician burnout and penalizes clinicians who care for vulnerable patients. Improvement in a CAS occurs when front-line clinicians identify care gaps and are given the flexibility to learn and self-organize to enable new care processes to emerge, which are created from bottom-up leadership that utilize existing interdependencies and interact with the top levels of the organization through intelligent top-down causation. We give examples of early adapters who are better applying the principles of CAS change to their QI efforts.
CONCLUSIONS: Meaningful improvement in primary care is more likely achieved when the impetus to implement change shifts from top-down to bottom-up.

PMID: 32596835 [PubMed - as supplied by publisher]

Increasing Spending on Primary Care to Reduce Health Care Costs.

Sun, 02/16/2020 - 15:24
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Increasing Spending on Primary Care to Reduce Health Care Costs.

JAMA. 2020 Feb 11;323(6):571

Authors: Young RA

PMID: 32044937 [PubMed - in process]

Family Medicine and Obstetrics: Let's Stop Pretending.

Fri, 09/27/2019 - 14:44
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Family Medicine and Obstetrics: Let's Stop Pretending.

J Am Board Fam Med. 2018 May-Jun;31(3):328-331

Authors: Young RA, Sundermeyer RL

PMID: 29743215 [PubMed - indexed for MEDLINE]

Coding Family Medicine Residency Clinic Visits, 99213 or 99214? A Residency Research Network of Texas Study.

Thu, 04/25/2019 - 04:56
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Coding Family Medicine Residency Clinic Visits, 99213 or 99214? A Residency Research Network of Texas Study.

Fam Med. 2019 Apr 23;:

Authors: Young RA, Holder S, Kale N, Burge SK, Kumar KA

Abstract
BACKGROUND AND OBJECTIVES: The purpose of this study was to characterize Current Procedural Terminology (CPT) coding patterns for professional services in family physician (FP) residency clinics.
METHODS: Trained assistants directly observed during every other FP-patient encounter in 10 clinics affiliated with eight residencies of the Residency Research Network of Texas. Three investigators later independently coded each visit for the highest code level reasonably allowed. The primary outcome was the number of clinic visits that were actually coded as a CPT 99203/213 that could have been coded at a higher level.
RESULTS: In 850 physician-patient encounters where the CPT code billed was identified, the investigators completely agreed on the allowable code 93% of the time. Overall, a 99203/13 or lower or preventive services code was billed in 651 visits (76.6%), more commonly in resident visits (515/570 [90.4%] vs 136/280 for faculty [48.6%], P<.001). There were 476/660 (72.1%) visits coded at a 99213 or less that could have been coded as a 99204/214 or higher. This was more common in resident visits 385/434 (88.7%), but there was undercoding in faculty patients as well 91/226 (40.3%). We found very few cases of overcoding-16 total.
CONCLUSIONS AND RELEVANCE: FPs coding patient encounters in residency clinics undercode for their work, which leads to decreased clinic revenue. This may be because the primary care exception is felt to be too onerous to bill for higher-paid codes, or a lack of knowledge of CMS coding rules among residents and faculty, or other reasons.

PMID: 31013346 [PubMed - as supplied by publisher]

Primary Care Physician Characteristics Associated with Low Value Care Spending.

Wed, 03/13/2019 - 19:11
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Primary Care Physician Characteristics Associated with Low Value Care Spending.

J Am Board Fam Med. 2019 Mar-Apr;32(2):218-225

Authors: Barreto TW, Chung Y, Wingrove P, Young RA, Petterson S, Bazemore A, Liaw W

Abstract
BACKGROUND: Previous work has shown that $210 billion may be spent annually on unnecessary medical services and has identified patient and hospital characteristics associated with low value care (LVC). However, little is known about the association between primary care physician (PCP) characteristics and LVC spending. The objective of this study was to assess this association.
METHODS: We performed a retrospective analysis by using Medicare claims data to identify LVC and American Medical Association Masterfile data for PCP characteristics. We included PCPs of adults aged 65 years and older who were enrolled in Medicare in 2011. We measured Medicare spending per attributed patient on 8 low value services.
RESULTS: Our final sample contained 6,873 PCPs with 1,078,840 attributed patients. Lower per-patient LVC Medicare spending was associated with the following PCP characteristics: allopathic training, smaller Medicare patient panel, practiced family medicine, practiced in the Midwest region, were a recent graduate, or practiced in rural areas. The largest associations were seen in Medicare patient panel size and geographic region. The average per-patient LVC spending was $14.67. LVC spending among PCPs with small patient panels was $3.98 less per patient relative to those with larger panels. PCPs in the Midwest had $2.80 less per patient LVC spending than those in the Northeast.
CONCLUSION: Our analysis suggests that LVC services are associated with specific PCP characteristics. Further research should assess the strength of these associations, and future policy efforts should focus on systemic interventions to reduce LVC spending.

PMID: 30850458 [PubMed - in process]

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era.

Wed, 01/30/2019 - 08:32
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A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era.

Fam Med. 2018 02;50(2):91-99

Authors: Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF

Abstract
BACKGROUND AND OBJECTIVES: Electronic health records (EHRs) have had mixed effects on the workflow of ambulatory primary care. In this study, we update previous research on the time required to care for patients in primary care clinics with EHRs.
METHODS: We directly observed family physician (FP) attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas. The FPs were purposely chosen to reflect a diversity of patient care styles. We measured total visit time, previsit chart time, face-to-face time, non-face time, out-of-hours EHR work time, and total EHR work time.
RESULTS: The mean (SD) visit length was 35.8 (16.6) minutes, not counting resident precepting time. The mean time components included 2.9 (3.8) minutes working in the EHR prior to entering the room, 16.5 (9.2) minutes of face-to-face time not working in the EHR, 2.0 (2.1) minutes working in the EHR in the room (which occurred in 73.4% of the visits), 7.5 (7.5) minutes of non-face time (mostly EHR time), and 6.9 (7.6) minutes of EHR work outside of normal clinic operational hours (which occurred in 64.6% of the visits). The total time and total EHR time varied only slightly between faculty physicians, third-year and second-year residents. Multivariable linear regression analysis revealed many factors associated with total visit time including patient, physician, and clinic infrastructure factors.
CONCLUSIONS: Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits.

PMID: 29432623 [PubMed - indexed for MEDLINE]