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I am planning on really making it this time - but only if Bert shows up for this convention.

Only if it's in D.C.

Hey Suggestion for some of us more Radical AC Users.... Another group I stay half in touch with, IMP, Ideal Medical Practices had it annual Camp in the DC area. On the Monday following when Camp Broke, those who wanted to, stuck around an extra day to do a "Lobbying Day".... We couldn't make and now I wonder how it all worked out because if memory serves me correctly it was on one of the most insane days in recent DC history...

What was it that actually set back the "Offical" opening, ribbon cutting of the Dr. King Memorial? Was it some weather thing or a super bad news day, I can't remember now.... But it was a big enough thing to actual impact and change plans for some place as large as DC.... Now that I think about it, I believe it was the moderate Earthquake that cracked a few important buildings and historic sites inlcuding the Washington Monument Needle was closed down and sectioned off from the public... That was what it was...

I believe that Monday was the same day as what canceled it, or perhaps was the day that it eventually got re-scheduled for, so DC was a flippin' Mad House I'm sure as that was a huge happening. And being a small conference with members around the country much like ours (and we have a good amount of cross over between the two groups too I might add. Lots of IMP AC Users out there for Sure) it was not like they could follow the Dr King people's lead and reschedule everything as the hotel and meeting room were booked as were many hotels res there and in other surrounding places, plane and train tickets too I'm sure... So they had to just go with it the way it played out....

But I digress here. The idea of us similar in mind and purpose AC users who probably all come from fairly small practices who have that small, Anti-ACO (newest HMO on Steriods and in Lipstick, right?) and other HUGE, still divided care, double payments to the Big Boys for Facility Fees putting the small guys at a disadvantage for sure... Why not pay us for our Facililties at the same kind of rates and watch us finally have enough money to add nice furniture, more and better equipment, better digs and locations, more staff with better retention because we might actually be able to afford to pay them better and give them some sort of bennies that most of us can not longer afford no matter how much we might feel the good deed need to do if we only could afford it.... To me the WORST Part of ACO's is the concept of Our side suddenly being forced, by hook or by Crook to start sharing and absorbing "Risk" and cost sharing.... Since when does a Laywer absorb any risk except on a civil suit against a manufacturer kind suit? You divorce is your own risk, I simply advise and guide here... Too many variables to control and that are outside of my and your control....

Insurance Carriers charge prices to absorb and offset risk. That is the Business that they created for themselves and only they really have the law on their side and the means to properly assess and then start to charge, and are pretty much assured a profit then, even in the face of absorbing and backstopping health care risks.

IMHO, If we are not allowed to sell insurance straight up (the main state based barrier to docs creating even small or modest cost membership practices and patient panels, the states say we are in effect "Selling" helath insurance) then why are we allowed to be, almost being forced to start absorbing the "risk" without being really allowed a NO Fee Schedule, charge whatever we see fit, let us ALL Collude amoung ourselves and with the Carriers to, to finally have a proper handle on any and all of the potential variables and data that would then influence our pricing structure based upon the very real risks that we are now going to be exposed to????

We all LOVE AC and support the best of a Real Free Market that has now been badly tilted against the likes of AC and other smaller, leaner, more efficent and Reasonably Priced Products... All this excessive money really was corporate Welfare for the NextGen's of the world, at the expense of products, vendors like Jon and AC who were kicking their butts by providing a decent product, that was super user friendly and at a price that was just about impossible to beat.... I bet most of us really don't want to have to cough up Medical Records and Open Up our data to "Prove" how meaningful we all are or that we actually "Improved" our outcomes based upon one or two semi-randomly chosen, or chosen with some intent but not very much or great science, not yet really proven to be completely valid Metrics like A1c's for DM... With disregard for the rest of the patient and the balancing games most of you have to play especially with very sick and or older patients. Many of these measures need to be balanced out against others...

Heck Bert could even bring along his $12 and change Maine Caid or Care, (State of Maine based Medicaid) check for his wasting an entire half a day or full day (what was it again???) for his "Expert" witness testimony in one of his patients cases... Now that is a deep sign of respect and appreciation for the full force and wide reach of a professional's knowledge and expertise if I have to say so myself... Take a bow Bert. The state of Maine really values you and your expert opinion, the time spent preparing, predeum for traveling, time spent away from your "Viable" practice and your patients....

What I'm saying is that between the lot of us, we sure as heck have more great stories and real live in the trenches facts about what kind of insane and unacceptable garbage we all put up with than any AAP, AAFP, AMA lead group of overfed and overpaid, disconnect lobbyists every could and would put forward. This should include ending the strangle hold on Office Visit and other forms of Cognitive Medicine E&M fees created by the AMA and their answers to nobody RUC.... If I walk like a RUC, and Looks like a RUC and Smells like a RUC, and talks like a RUC, then I would have to assume it must be a pretty pucked up RUC.

What say all of You???? Night ya'll.
Paul

Paul,

I think you should have your own health blog or editorialize in a fairly large newspaper. I think you would be very good.

You too Bert once I get you rolling with me.... :-)

Thanks for the kind words buddy... Want to help me get one started? It's monitizing it for one so I could actually get paid decently for it, and 2) really I get my best ideas from other sources like this, Kevin, IMP, Fierce (which drive me nut with the crap that goes on, on the other side... pass me my Benicar before I bust a brain Leak or something... gotta stay at goal, gotta stay at goal) and so it is from others that I get my best data and sources and ideas to then get rolling from... But I guess as long as I properly give credit where credit is due then that would be OK... Read Kevin in the Morning or AC here or what have you and then go write my own thing there on my own pages I guess....

But you are a great friend and supporter Bert, and so are so many of you others out there, and you know who you are too.... Thanks so much and I'll try to stick around some more now that I'm trying to return from the Living Dead....

Paul

I think D.C. sounds good - it gives me an expensable reason to go there (have always wanted to)....

Super Brain Idea... (or should I save it for my Blog????) Well you all read it here first as my copyright witnesses and as the Admin Bert will allow me to quote myself, right Bert??? Just properl reference or link back to the ACUB?

Now that docs are being forced to join, or strangled out, priced out, bought out and the like to join ACO's, I believe that all of those docs really are allowed to Collude Openly with any other ACO doc, not just in their practice but in ANY practice across the entire country or at least their own state or market region to say the very least... WHY???? You might ask? I'm glad you asked?

Because it was back in 1948 that the law passed, Mcclaren Fergerson act to first allowed the insurance carriers to collude and share data and info and the like because they needed to be allowed to share supposedly to be able to properly set the "Community Rates".... Sure sounds like some suggested industry created legistlation to me, but hey what do I know, I'm just some dumb youth hockey coach and official right? Too many hits and pucks to the head... (really too).

Well, sooooo, if now docs and their ACO's are supposed to be absorbing risk and defusing that risk, what was until now only the provence of the insurance industry and carriers, then now they too will need the freedom and ability to gain the needed insight and data that can only be gleemed from being allowed to very openly share and talk about rates and costs, risks and the like amoung themselves too, just as any other risk manager, insurance carrier has to do and has the right and the law at their side to do..... Heck now that I think about, we should all create one single, super huge, national ACO of only doctors and no outsiders or hospital wonks (except us Nationalized Citizen Married family members of physicians, right???? :-) and demand that we be allowed to not only work as a group (one tax ID number) and contract as a group but that we need to be allowed to talk and gather data and set prices with any and all other ACO's so that we can properly access and price out the risk just like the insurance carriers....

Heck if we're the ones making the choices now and absorbing and dispersing, and taking the risk upon ourselves, at what point do we no longer need an insurance carrier what so ever???? If they don't access risk and create rates based upon risk, then what function other than taking in money to pass it back to their investors do they have left to perform at all??? And at that point, they have allowed, written themselves out of a job and market, rendering themselves completely Obsolete, and at their own design and lobbying, while attempting to make themselves richer and more powerful... The Screwed themselves with one single new little extra "Gottcha" idea of theirs that has now officially backfired on themselves....

I LOVE It! Thoughts, ideas, feedback???? Night.
Paul

I think it is time to start thinking about another smaller conference as we did in Taho.
Let's start throwing around some dates and location, maybe next spring.
I will get things started.

Cruise leaving out of New Orleans
Alaskan Cruise
Seattle
Portland Oregon
Tetons/Yellowstone
Canyonlands in Utah
Dude Ranch in Wyoming or Montana
RV caravan
Let's socialize while we collaborate!!

Since I only have to drive 2-3 hours I vote for Portland, Or or Seattle, WA. Another option would be to fly to either and then travel to my neck of the woods - condos, or such at the beach would be nice (weather is unpredictable), but some great things to see and do.

Tetons/Yellowstone/Bryce/Zion

I know not all in the same vicinity.

Now, you have to promise me my input counts.

Be cool if a train connected them all. Travel, tour, travel...

Paul, you just need a website and an editor and a time line. I have also always wondered why since doctors can't collude with one another, why not doctors' friends.

ANYWAY, I THINK THIS IS OFFICIALLY A HIJACK SO HAVE TO TAKE IT TO EMAIL.

Once again, I am disappointed by the ethnocentric view that any practices west of the Appalachians are not really worth the effort to support fully. It is no easier or cheaper to hold a conference in DC (and probably more expensive) than in, say, Denver or Salt Lake, and no one can rationally claim that the staff will be able to "nip back to the office over lunch to get things done". I really do find this annoying.

David, have patience. The ACUC venue has moved west ever so slightly since last year. By my calculations, the 2024 ACUC should be held in Fairbanks. By that time, the practice management module should be in beta.

Couldn't make the Tahoe meeting, time line was much to compressed.
So if there is a west of the Appalachians UG, will try to make it given some planning time.

But for the AC folks, PLEASE consider webcasting the conference!!! realtime or recorded!!

I have been lurking on this conversation, and your thoughts provoke some questions.

When we got together last year in Tahoe, we had a great time! It was too loosely organized in a few respects, but that came from trying to facilitate a user-centric get-together. The consensus afterwards is that we wanted to do it again this year, and Lori and I committed to hosting another one, where-ever we settled on a mountain-y resort (e.g. Tahoe, Tetons)

Since we have already had some questions about timing this year, we are looking to nail down a weekend mid-September/October that works for the most folks. Based on our free-wheeling past, this will be mostly advanced folks who get together for the collegial atmosphere and the raconteurs who hold forth a plethora of subjects. We may even have the return of the dutch ovens and cookout on the grill - with the kosher section no less.

There were some new users who happened in as well, and they were graciously received, and by the after-action reports helped greatly.

So, the questions:
<1> To CME or not CME?
<2> Setting - is a larger cabin/hunting lodge sufficient or do we need formal meeting space this time?
<3> Driving distance from an airport - Yellowstone & Grand Tetons are a drive from any airport - what is the comfortable driving distance? Or do we need to look at hiring a shuttle bus for in/out? Some people like the drive to decompress/see nature.

So we will eventually kick up a separate discussion so as to not distract from ACUC, but my guess is that we can start with those questions.

Indy, I did not really consider the Tahoe conference, since it seemed like a "mini-conference", not the full meal deal. Much as I would have liked to have visited with the folks there, it seemed more like the regional chapter meeting than the annual meeting. It is nice if it is a short trip, but not for a long one.

It really depends on your definition of what constitutes a "conference."
I think Tahoe was very much a conference. I learned a lot and had a lot of fun. Very low key. It was very much like how the original AC users conference was planned, but that then blossomed to 100 folks.
We did not have a hard formal agenda, although there were topics we all wanted to cover and did.
I suspect that what you get out of a conference is what want.
Indy, CME may be nice but there is a long process to get it. While it makes it easier to make it deductible, it should still be deductible as a training expense for EMR.
I think the large cabin worked out fine.
Driving, I would say 2 hours semi max. While I like to drive and see the landscape, I also would rather get to my destination and explore there. Hiring a bus might be an option. Depends on how much time we allot and how many people show.

David - the get together in Tahoe drew two types of people; there were new(er) users from the surrounding area, and several of the great long-time contributors from the board. I'm not aware of anyone thinking of it as a replacement for the AC-hosted conference, rather a smaller, more informal meeting of the raconteurs.

For some folks, they rolled into Reno earlier in the week and choose 'Independent Study' in the Open Classroom of Yosemite, but everyone arranged their comings and goings as befit their constraints.

David,
I understand your concern (and your frustration about the locale of the upcoming meeting). Those points aside for the moment, I think you are hearing that Tahoe was something a bit different from the ACUC, but was no less of a conference. It was much smaller, much less formal, and much more user directed. The attendees were mostly (but not entirely) experienced AC users so the topics tended to be more tailored to the group. The fact that Jon B was there for a day added a dimension to those discussions.
It was in no way a "regional" meeting, and was by no means a short trip for us. We found the 2010 ACUC to be one of the most worthwhile CME conferences we had ended; we felt equally positively about Tahoe.
The timing and the location of this year's ACUC along with family and work issues will make it a challenge for us to attend both conferences, but that is not because either is of any lesser value, from an academic or social standpoint.

I agree with David completely. When I first heard of the locale (having some earlier knowledge), I wrote, "I can't wait until this is officially released). Honestly, I thought there would be much more of an outcry than there has been so far. I do think it is a complete slap in the face against those on the west coast. What drives AC is its users, a group of people that no other EMR has. It's unbelievable. I have read at least 300 of David's posts, many backing me up and not just a few taking me to task but all intelligent and helpful.

I, for one, am tired of the location being decided on the AC staff. I know that the cost always rises, but if you figure the cost and then divide it into the overall cost so that the users pay for them, it can't be that much more.

With the caveat that I have made three out of four of the ACUCs (even planning to go -- but not due to severe depression) and not having made Tahoe, I don't think anyone can convince David that Tahoe would be the same as the actual national user's conference. Yes, it is a conference based on what a conference is, but it is not the ACUC (for good or for bad).

That would be like saying that going to a football game in your region should count as the Super Bowl, simply because it is a football game, albeit an incredibly good football game.

That is the funniest post ever written on the board, not surprisingly by one of two of our best. The scariest thing is, it would be funnier if it weren't true.

OK, maybe I was too harsh in my criticism. I can see that Tahoe could have even been better, given that it was a more committed core. Mea Culpa. So, what do we do about it this year?

The great thing about Tahoe was that it was small enough that everybody got to interact with everybody else. No microphones, no real rules, no one telling us to avoid talking about work-arounds. And, the social interaction was fantastic (just glad we decided not to do the hike down to the castle or we might be JBS-less now). Leave Providence for the the new users. The rest of us can do our own thing and likely do it better than under the purview of AC.

Indy, no on the CME. Although I enjoy getting the credits, I think it changes the whole feeling of the conference. As for where? Jackson, Wy. is a neat place, has an airport with car rentals, plenty of meeting facilities (Snow King Resort if you want something traditional) and you are within easy access of 2 fantastic National Parks. September is beautiful.

Or maybe Jimmie knows of something in Montana. Or Pete in Utah. The possibilities are endless. The Olympic Peninsula is beautiful. Can't get too much further West than that.

Lincoln, Mt--unabomber
Jordan, Mt--the freemen

Glacier I think is one of the best parks around, but November would be late in the season, and depending on weather the going to the sun road sometimes opens late and closes early--but has to be one of the most scenic drives. Big mountain is close by which is one of the best ski mountains in the northwest. Flying in and out would be out of Kalispell.

Big Sky if later in the season would be great for skiing or snowmobiling into Yellowstone, or hot tubbing at Chico Hot Springs,and flying in and out of Bozeman.

OK, I nominate Jimmie to be first assistant to Indy in making all the arrangements, booking all the lodging, booking all the flights and rental cars, arranging all the meals and giving the first 6 hours of lectures! But, you do not want to see this fat lady in any Hot Springs!

Every software conference I've ever attended has been held in the city where the company is located, which is the ONLY reason I've been to Kalamazoo in the dead of winter. I do not understand why AC has decided to hold it in DC, unless there's something else going on there they need to attend, so this allows them to kill two travel birds with one stone (or one plane, if David's piloting).

Think they should just stick with having the official conference in Providence, and let us plan smaller conferences elsewhere. For next Spring, I'd vote for Seattle, Portland, Bryce/Zion, Denver, St. Louis or San Diego on the West Coast; NC Outer Banks, Charleston, or Savannah on the East Coast.

jimmie,

I think we were talking about spring?

The problem with Providence is that it's boring. At least D.C. has attractions.

We now have two votes for Bryce/Zion.

Wait. The conference is going to be in WASHINGTON DC. Oooh, I may get to meet some of you guys (and gals).

Just suggesting Montana for future dates is all-- But Bozeman would be my pick for a place in MT. Looking forward to the conference.

OK, I nominate Jimmie to be first assistant to Indy in making all the arrangements, booking all the lodging, booking all the flights and rental cars, arranging all the meals and giving the first 6 hours of lectures! grin

lESLIE--lodging--Jordan at the Freeman compound
"flights"--by wagon train
"rental cars"--mules or horses
"meals"--antelope, moose, white or mule deer, rattlesnake, rough stock Montana wheat whiskey, wheat, rye or barley bread only
"lectures" --How AC users in MT have discovered the advantages of the telegraph, electricity, and those lucky enough below Fr Benton riverboat access for quicker internet speeds.....

Jimmie, you have know idea what you are getting into. You probably picked the one person who will go with the "mule" idea.

Jimmie,

I am in!! But rather than rough stock Montana whiskey, I will haul in some good old Kentucky Bourbon. You get to do the rattlesnake hunting.

http://www.lonemountainranch.com/
This gets my vote

I am ready to get "duded out" on lone mountain !!!

I also forgot to put mule/horse meat on the list of items for meals.

If it was good enough for our military it is good enough for me (although I would cry all the time I was eating it.)

Leslie,

Not familiar with the lone mountain ranch but it does look intriguing--and I am afraid of horses--had one rheum here in the area whose dad was in the horsing business and gave him 3 rules--
1. Horses are dumb
2. Horses are big
3. Horses will hurt you

But I can still get duded up--

I could do that for sure. My spouse/partner might tell me it was her turn, however. Better not plan for too early in the spring. It is probably less fun with six feet of snow on the ground.

I thought your motto was EVERYTHING is more fun with six feet of snow on the ground.

It is pricey, no doubt about it. But, all meals are included. You can do as much or as little as you want. There would be lots for spouses and kids to do and if you have never been to Yellowstone, it is something every one should do at least once in their life. Bozeman is a great western city (right, Jimmie?) Kick it around.