CALTCM President

Wow! What a conference! Thanks to the education committee and to all of  you who attended this year's CALTCM conference focused on person-centered care and palliative care. Based on early feedback and my own observations, it was a great conference with a focus absolutely on the right topic.

It is exciting that finally the larger health care system is beginning to recognize that something has gone terribly wrong with the US health care system. The entire reimbursement system has rewarded volume over quality. Everyone gets paid on the basis of numbers of procedures done and the proceduralists and specialists get paid much more than the primary care physicians. It is no surprise that this payment system drives incredible volumes of care delivered without quality outcome improvement.

Even the approach of the government to evaluation and management services payment, with increasing documentation requirements, mostly drives volume of paperwork, and undermines quality conversations.

In our CALTCM annual meeting’s keynote address, nationally renowned geriatrician Dr. Kenneth Brummel-Smith described well the need for a more thoughtful approach in his superb talk with reference to "slow medicine." While I don't necessarily agree that "slow" is the best term, I certainly appreciate that our geriatrician Congressional fellow has hit the nail on the head with the need for  more thoughtful  approach to care, with much more time to be sure care reflects the goals of our patients and not the financial needs of  providers.

Other talks in the conference provided critical information and ideas to implement the transformation we need in health care, especially for the most frail patients in long term care. I reviewed the likely tsunami of patients with dementia and the opportunity to improve care.   Deb Bakerjian and others worked with attendees to implement quality improvement action plans. Jim McGregor dazzled with a inspired talk about the opportunities for palliative care, several talks covered essential elements of advance care planning including cross-cultural humility with Silvia Austerlic, and Glenn Panzer reviewed decisional capacity assessment. Eric Widera presented clearly an overview of tools for us to understand prognostication, another essential ingredient for advance care planning.

After practical review of physician communication and conflict resolution by Kim House and Ron Cohn,  we learned of the scale and scope of huge opportunities to improve care for the dually-eligible patients from Tim Schwab and June Simmons and discussed medication reconciliation and readmission reduction opportunities with national and state leading experts including our own leader experts Jay Luxenberg, Flora Brahmbhatt and Nancy Beecham. Our poster session was notable for record submissions and quality.  We capped off the last with hot topics in SNF care by Rebecca Ferrini and the threats and opportunities "when hospitalist meets SNFologist" with Jim Lett, Nasim Afsarmanesh, and Joe Bestic.

Finally at this conference we started a new tradition-- the Leadership in Long Term Care award, and it was an honor to present it to Cheryl Phillips, our own California physician leader who has gone on to be President of both AMDA and AGS, and who continues to drive national policy improvements in her policy leadership role at Leading Age.

The opportunity for transformation is here, and we are doing what we can to provide ideas, tools and cutting-edge information for all of you. Now,if  we are to fulfill our destiny, we need you to act. Please share the value of this organization with every colleague- every member of your interdisciplinary team. Please send us an email and let us know you want to be a part of our ongoing work on our Policy and Professional Services Committee or Education Committee. We are in  the right  place with the right ideas. We need to all take action to get to the transformation of medicine we need.