Contorta 的 啟示 當代醫學 39:195, 2012.3

1. 別以為我院子裏的草 特別油綠 我總得到我想要的 當生活艱難低調的時候 我總盯著Contorta 非常扭曲的曲線 安慰自己 “這就是生活　它扭曲盤轉” 最終還是向上 我一直不敢去肯定 它的真實性 很多次 相信這是真的 至少讓我能堅持下去 黑暗隧道的盡頭 總是亮的 塞翁失馬　焉知非福 Contorta的 啟示 當代醫學 39:195, 2012.3

2. Gross domestic product (GDP)

4. Medicare Expenditures in 2009Per Enrollee ($) • National NYS • Total: 10,365 11,604 • Hospital Care: 4,847 5,650 • Physician Services: 2,407 2,794 • Home Heath Care: 656 395 • Nursing Home Care: 616 646 • Other Professional Services: 301 405 • Durable Medical Products: 164 130 • Other Personal Care: 101 87 • Dental Services: 6 12

8. 救醜 不救命？ 五大科（內、外、婦、兒、急） 全台醫師荒！ 讓鴻海董事長郭台 銘投資醫美的同時 也憂心法令、體制與人才跟不上進度 強調醫療法規需鬆綁 讓醫院出的起高薪，去延攬優秀人才 首富花了百億仍救不回至 親，白袍的辛酸血淚史！

9. 棄外科走醫美 大家都擔心以後會沒有醫師看。 而由新光醫院急診科主治醫師張志華等人發起的 「搶救急診室」臉書，則公佈數據說明，在台灣救人一命(插氣管內管加上CPR半小時)，健保只給付不到3000元， 連車門烤漆的一半都不到！ 醫勞盟說， 「心臟按摩，居然比腳底按摩還便宜？」

10. 善意救人、不能拒絕急重症病人的醫師 在台灣成 為「犯罪率」、「有罪率」最高的國家， 讓台灣醫師成為 「世界第一大黑幫」

11. http://en.wikipedia.org/wiki/Health_care_in_the_United_Stateshttp://en.wikipedia.org/wiki/Health_care_in_the_United_States

12. *PPP: Purchasing Power Parities

13. Centers for Medicare & Medicaid Services(CMS) health maintenance organization (HMO) accountable care organization (ACO) Independent Practice Association(IPA) Patient-Centered Medical Home(PCMH)

15. CAIPA Vision • To provide quality, affordable, accessible and sustainable healthcare to our community • Expand managed care contracts to bring more values to members • Represent membership interest in dealing with managed care companies in all aspects • Endorse and collaborate with AAACO to succeed in healthcare reform

17. CAIPA Membership

18. CAIPA’sMedical Loss Ratio • Medicare • 65-67% of CMS Funding • Medicaid Plus • 65-70% of DOH Funding • Commercial • 73% of Plans’ Premium • Inpatient • 40% less than NYC average • ER Visit • 60% less than NYC average

19. CAIPA Covered LivesEst. 360,000 • MANAGED MEDICARE • 25,000+ • MANAGED MEDICAID • 200,000+ • COMMERCIAL • 50,000 • TRADITIONAL MEDICARE • Est. 26,000; 13,000 in AAACO’s MSSP program Multipurpose Senior Services Program (MSSP) • TRADITIONAL MEDICAID • Est. 60,000

20. Centers for Medicare & Medicaid Services(CMS) health maintenance organization (HMO) accountable care organization (ACO) Independent Practice Association(IPA) Patient-Centered Medical Home(PCMH)

21. AAACO Mission • Medically and financially accountable for quality, cost, and patient satisfaction for the population of patients under contract • Create shared-savings with all payers through clinical innovation and care coordination • Maintain financial independence of practicing physicians through development of a clinically integrated network

22. Presume CAIPA’s Medicare AdvantageAverage Fund vs. Cost • Ave. Funding PMPM • Ave. Cost PMPM • Ave. Saving PMPM • Ave. % Saving • $720 • $612 • $108 • 15%

23. AAACO Priority Programs:(focused on reducing preventable ER visit/hospitalization) • Case Management and Care Coordination • Off-Hour Medical Advice Telephone Service/Urgent Care Initiatives • Palliative and End-of-Life Care Program

24. AAACO First Year Clinical Goals • Identify high-risk / high cost patients • Introduction of priority programs • Coordinate area hospitals to reduce re-admission rate

25. Case Management Program • In-language RN Care Managers & Care Coordinators • Support, coordinate with physicians and patients for quality and cost effective services in high-risk/high cost cases • Communicate, educate, monitor, evaluate, feedback in high-risk/high cost case management among providers

26. After-Hour Triage/Urgent Care Telephone Service • Bilingual RN triage & medical advice • Patient caller’s physician • On-call Emergency physicians • Next day follow up at physician office or hospital • Ensure accurate and updated records to all parties

27. Chronic Disease Management • CHF Management • Hypertension Control & Stroke Prevention • Diabetes Control • COPD / Asthma Control • Multiple Chronic Diseases

28.  Evaluation and Management Coding ( E/M Coding or E&M Coding)  

30. 美國一個普通胃痛急診醫藥費--李詠嫻 希望你可以耐心看完這篇，因為那是我活生生，血淋淋的例子。 照片中是張醫院給我的帳單，上排左邊數字$21,459(台幣643,770)是總金額，最右邊$3,526.15(台幣105,784.5)是我必須付的金額。其它則是保險支付，這還不包括抽血檢查$150(台幣4500)和吃的藥$32(台幣960)。也許你們會以為我生了場大病或動了什麼大手術，完全沒有；只是4/23那天胃痛到掛急診而已。那天到急診室大約傍晚6點，但等到醫生開始為我治療時已經凌晨12點多，這6小時中有幾次痛的幾乎不能呼吸(還很想打人)。而他們只是給我量量血壓、心跳、包括抽血...等等檢查都是午夜過後才開始。那晚折騰到凌晨三點多才回家，最後的結果只是胃酸過多，打了三劑止痛藥。其實他們做的就跟在台灣的急診室做的差不多，你可以看到照片底下整排的日期只有4/23和4/24，確定沒住院。 我想在台灣急診室等一小時應該就開駡了吧，有誰可以等6小時，又有誰可以想像在美國一個普通胃痛急診醫藥 費高達60多萬台幣。想要跟大家分享這個是希望所有台灣人都能珍惜健保資源，我們的健保真的很好，不要浪費了，也不要讓它倒 了，如果你的身邊有職業病人，或是拿了藥就丟一邊的人，請勸勸他們，真的有需要再看醫生，真的....真 的....請大家告訴大家。謝謝你的耐心看完我的感言！

33. AAACO MSSP Contract as of July 1, 2012 • CAIPA, KAP IPA, and CBWCHC • 220+ providers • 13,000 + traditional Medicare lives • Upcoming open enrollment for additional providers

34. Data Collection & Analyses • Internal quality & cost monitoring, evaluation, improvements • External quality metrics and other MSSP reporting • EHR and HIE

36. 百大良醫也心寒 遠見雜誌 2012年7月號 第313期 http://www.gvm.com.tw/Boardcontent_20323.html 台大婦產部主治醫 師  施景中： 台灣的未 來 不是健保垮 就是 醫生跑

37. Where Did It Go?Major components of the $3.5 trillion spent in fiscal 2010 • Social Security20.4%National Defense20.1%Medicare13.1%Medicaid/CHIP8.1%Interest5.7%Low-Income Assistance5.3%Unemployment Compensation4.6%Education & Training3.7%Federal Employee Retirement3.5%Veterans3.1%Transportation2.7%Other health care 2.6%Parks & natural resources1.3%Space/Science0.9%Foreign aid0.9%Agriculture0.6%Everything else3.5%

43. United States national debt passes 20% of the entire world's combined GDP (Gross Domestic Product). In 2011 the National Debt will exceed 100% of GDP, and venture into the 100%+ debt-to-GDP ratio that the European PIIGS have (bankrupting nations).

49. CAIPA

50. What We Do… • We represent our healthcare professionals to contract and negotiate with various plans in New York City. • We develop and manage multi-specialties network to provide residents in our community a comprehensive medical delivery system. • We fund and support various community related medical and disease management researches that are relevant to Asian-Americans. • We collaborate with community-based health organizations by providing funding and support in provide free flu vaccination, health screenings, and offer funding to support various programs in senior centers that serve Asian-American elderly. • We publish CAIPA DOCTOR semi-annual magazine to offer evidence-based health educational information to Asian-American residents in New York. http://caipa.net/test/http://caipa.net/test/http://caipa.net/test/