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Confessions of a Pediatric Practice Consultant


With the announcement that the AAP has updated its RBRVS guide for 2012, I guess I have to get off my duff and work on the 2012 RVUs.

Part 1: My annual  GPCI comparison.  AFAIK, this is still the only place where anyone actually breaks down the GPCI changes from year to year.  While some people jump up and down about a 1% change in a particular code or the annual conversion factor, we all need to pay attention to the GPCI scores.  For some parts of the country, the impact has been significant.  

What do we see this year?  Some big hits this year.  The average locality should expect a 1.76% decrease in their payments in 2012 before any changes to the CF or individual codes are taken into account.  OUCH.

Locality 2011 → 2012 2009 → 2012
AL -3.7% -0.2%
AK -0.8% -0.8%
AZ -1.3% 0.0%
AR -4.5% -1.0%
CA – Anaheim/Santa Ana -1.9% -1.7%
CA – Los Angeles -2.9% -3.3%
CA – Marin/Napa/Solano -0.5% 0.2%
CA – Oakland/Berkley -1.0% -0.9%
CA – San Francisco -1.9% -2.3%
CA – San Mateo -2.2% -2.7%
CA – Santa Clara 1.0% 1.6%
CA – Ventura -2.2% -2.8%
CA – Rest of CA 0.7% 2.1%
CO 0.3% 0.7%
CT -2.5% -3.3%
DC + MD/VA Suburbs -0.6% -0.5%
DE 0.1% 0.0%
FL – Ft. Lauderdale -0.1% 0.7%
FL – Miami -1.3% -1.5%
FL – Rest of FL -1.5% 0.0%
GA – Atlanta 0.3% -0.1%
GA – Rest of GA -3.2% -0.4%
HI/Guam -1.8% -0.2%
ID -3.3% -0.5%
IL – Chicago -0.2% -0.7%
IL – East St. Louis -1.7% 0.3%
IL – Suburban Chicago 1.0% 0.7%
IL – Rest of IL -2.7% 0.2%
IN -3.2% -1.5%
IA -4.5% -1.6%
KS -3.8% -0.8%
KY -4.3% -0.9%
LA – New Orleans -2.8% -3.9%
LA – Rest of LA -4.7% -2.2%
ME – Southern ME -0.9% -0.6%
ME – Rest of ME -3.8% -1.2%
MD – Baltimore/Surr 1.1% 2.7%
MD – Rest of Maryland 1.6% 3.2%
MA – Metropolitan Boston -3.9% -6.2%
MA – Rest of MA -1.4% -1.5%
MI – Detroid -0.5% -1.6%
ME – Rest of MI -2.2% -0.5%
MN 0.7% 1.2%
MS -5.0% -1.7%
MO – Kansas City -1.9% -0.6%
MO – Metropolitan St. Louis -0.8% 0.9%
MO – Rest of MO -5.3% -1.0%
MT -2.6% 5.0%
NE -3.6% -1.1%
NV 0.7% 1.4%
NH -0.2% 0.4%
NJ – Northern NJ -1.2% -2.4%
NJ – Rest of NJ -0.5% -1.2%
NM -2.2% 0.4%
NY – Manhattan -3.7% -4.9%
NY – NYC Suburbs/Long Island -2.4% -2.8%
NY – Poughkeepsie, N NYC -0.2% -0.2%
NY – Queens -0.6% 0.1%
NY – Rest of NY -1.7% 0.4%
NC -3.0% -1.4%
ND -1.7% 5.9%
OH -1.6% -0.1%
OK -5.7% -2.2%
OR – Portland 1.5% 1.7%
OR – Rest of OR -1.2% 0.8%
PA – Metro Phil. -1.1% -1.7%
PA – Rest of PA -2.7% -1.2%
PR -13.5% -6.6%
RI -0.5% -1.0%
SC -3.2% -1.1%
SD -2.7% 3.6%
TN -3.8% -1.3%
TX – Austin -0.4% -0.1%
TX – Beaumont -3.8% -1.4%
TX – Brazoria 0.4% 1.9%
TX – Dallas 0.5% 0.2%
TX – Forth Worth -0.4% 0.6%
TX – Galveston 0.8% 1.7%
TX – Houson -0.1% -0.4%
TX – Rest of TX -2.8% -0.1%
UT -3.2% -1.1%
VT -0.9% 0.0%
VA -0.4% 1.4%
VI 0.3% 1.0%
WA – Seattle 2.4% 3.4%
WA – Rest of WA 0.8% 1.6%
WV -6.0% -2.3%
WI -0.8% 1.4%
WY -1.2% 6.7%


Spread the word!


The AAP Immunization Program is conducting a survey on when you received your influenza vaccine- private and VFC. There have been variable delivery times with large lags in VFC vs private stock in recent years, and this survey helps pinpoint the problem areas. The AAP was the only one to collect this information last year, and consequently made some significant strides toward identifying where the problems are. 


The Immunization Program is conducting our survey again to see if changes have been made for the better this year. You will need information on hand of what types and quantity of vaccine was rdered, as well as dates and quantity of vaccine received. Thank you for your


The IAC has published an updated Vaccine Refusal Form which is stronger than the AAP's.  Worth sharing, worth using.

On behalf of our newest client, I'm posting this request for questions relating to FASDs.  For those of you in NJ especially, please send in your questions.


AAP NJ has received an FASDs visiting professorship grant and is planning two webinars that will be transmitted live in January and then will be available as a recording for everybody.

When our visiting professors asked what questions pediatricians would like to be discussed, I decided to take the request literally and to ask pediatricians themselves. Thus, I posted the survey link

I need to know what exactly you think about the FASDs - do we have a problem here? Or may be it is somewhat overblown? What question(s) do you have about the condition? Or, if you don't have any questions - just write "none" in lieu of the first question. You can provide your contact info if you want more communication about the project, or you can be absolutely anonymous. 

And please, ask your colleagues to participate too, as the more responses, the merrier :)

Thank you in advance,

Alla Gordina, MD, FAAP

Clinical Assistant Professor of Pediatrics

Drexel University College of Medicine and


- Robert Wood Johnson Medical School

Global Pediatrics
International Adoptions Medical Support Services
7 Auer Court, East Brunswick, NJ 08816, USA
732-432-7777 (voice)
732-432-9030 (fax)


Sometimes, other people ask me questions and sometimes they then even publish what I say.  Here is a piece about the unique demands of pediatricians have with EHRs over on the EMR and EHR blog.  They ran my email exchange with them verbatim - I always wish I'd said something else in retrospect, but please share your experience as a pediatrician so we can spread the word about your unique challenges.


During the NCE, Dr. Couchman suggested that I whip together a spreadsheet to show how to quickly calculate the divot made when you drop a poorly paying insurance company.  Here it is.

The concept is fairly sound and simple: if you have an insurance company that pays you less than the rest of your payers, dropping them does not require a 1:1 visit replacement ratio for you to do well. If you average $100 visit from most of your payers, but only average $50 from the company in question, you really only need to replace 1/2 of their visits to be revenue neutral, right?

And, given that some percentage of your patients will stay with you at your typical revenue rate(somewhere between 30-60%, usually), you will need to replace even fewer than you think.

I have written about this phenomenon before and have done some spreadsheet/sketches for my own use, but I've attached a working copy (M$ Version here, OpenOffice version here).  

For it to work, you only need fill in five cells.  The first four you can get from your PMS (right?!): the number of visits and revenue per visit of the company you want to examine and the rest of your payers.   You then need to estimate the percentage of patients from the plan you expect to keep.  In essence, just update the fields in light blue.

The spreadsheet then calculates the impact on your revenue and the number of visits you'll need to replace in order to be revenue neutral.  For example, I've tossed some numbers into the form - the insco represents 1000 visits @ $85 visit while the rest of the practice is 5000 visits @ $100 visit.  If 50% of the patients stay with you and generate "average" revenue, you lose only 6% of your revenue and you only have to replace 350 visits to get back to "break-even" (vs. the 500 most people expect).  

Play with the numbers for a little bit and you can see how it works.  Once you realize that your practice probably has 100s or 1000s of kids overdue for their well visits, ready to fill in the divots, it might not be so bad.



simple_insco_calc.ods16.33 KB
simple_insco_calc.xls8.5 KB

I usually don't talk much about PCC's actual "business" here, but I can't help myself today.

Although we've known for a little while, it's official now: PCC has passed ARRA certification!  Woohoo! I wanted to throw an image of the certified seal up here, but I didn't want the Gods of ONC to come down on me.

If you see a PCC developer, designer, or training, pat him or her on the back.


I had planned to write about the 5010 software upgrade scam today, but this topic takes precedence!

10/17/11, 8:30-11:30pm, Kinsale Irish Pub, Boston

The official invite.


I'll be speaking on Nov 4, 2011, from 3:15-4:30 (it'll be more like 5pm if I do it right), for the GA AAP chapter at their annual Pediatrics On The Parkway event.

I know the titleof my talks says "Practice Performance Improvement: Simple Steps that Improve Patient Care & Your Bottom Line" but it's really going to focus on the pediatric recall process.  How.  Why. How again.  It's a good one - if you're in Atlanta, come say hello and have dinner with me.

I was recently introduced to Diane Lipton Dennis, the CEO at Lipton HealthSomeone thought that I might appreciate her approach to pediatric medical care, which has been to put together a concierge program not for herself, but as a replicable model to be delivered anywhere in the country.

In other words, if you're thinking about 'going concierge' (whatever that even means), it might be worth a phone call to Diane.  Check out their brochure.

When I started to look into the concierge model a few years ago, I have to admit being surprised how well the commercial programs out there (like MDVIP) actually understood how different pediatrics is.   I am used to most organizations giving little thought to how medicine for kids is different, but they got it. From what I can tell, Diane really gets it.

I started taking notes during our conversation and captured some of the better moment.  These may not be exact, but they sure capture the spirit of the conversation:

"We give them a choice in the way they practice medicine by offering their patients an opportunity to participate in a memberhip program.  The program gives them access to service available to them beyond insurance, like 24/7 access to the doctor.  Skype, for example - good for rashes, a good way to see if they should bring the kid in.  Next day well visits.  Extended visits, no more 'door knob medicine.'  The doctors get a chance to really observe, to sit and talk, make recommendations.  Better hand offs to specialists, better communication.  Better interpretation about what the hospital says, better help during most stressful times."

What made my internal beeper go off was that she finds the "fees" necessary for this kind of work are in the neighborhood of "$15-20-25 a month" which is right in line with some of the data I have presented here in the past.

As I understand it, the practices pay Lipton health a portion of their revenue - which is normal among the concierge business consultants, and in return, "We provide all of the marketing, which is perhaps the most important factor to the success of the practices.  Stark laws limit the amount of marketing they can do for themselves.  We want them to stick with what they are good at: practicing medicine.  We do a lot of patient surveying and don't stop with the signup period. We do customer-service followup, in-office marketing, social networking.  We do a lot of hand holding throughout the entire process.  One of the biggest pieces we deliver is the legal work...this type of medicine differs from state to state, and we do that work."

So, what happens if a practice just uses Lipton Health to get started?  Diane says that she has no problem with someone using their services for a year and, if they are not satisfied, going on their own. "If we're not delivering the value, we can't ask them to pay us."  

Right now, Lipton Health is focused on the DC metro area but are moving into Connecticut, Philadelphia, Richmond, Charlotte...the entire north-east corridor.

Diane spends a lot of her time in the practices, so she encourages anyone interested in even a brief chat to reach her on her cell phone: 202-441-0444.

Good luck to all!