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 這張Contorta 的照片，沒有右邊的啟示說明，誰會想到，它代表“ 生活的扭曲盤轉”“最終還是向上“ ；不敢去肯定 它的真實性，“相信這是真的”堅持下去 “ Contorta 的 啟示 當代醫學 39:195, 2012.3

Gross domestic product (GDP)

Medicare Expenditures in 2009 Per 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

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！

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？」

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」

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

Net Monthly Income constant 2005 US$ [a] [d] Gross Monthly Job Income General Physician Job Average Salary Country Net Monthly Income constant 2005 US$ [a] [d] Notes, Source Gross Monthly Job Income Compulsory Deductions Weekly Hours U.S. average salary PPP $ 8,189 $ 8,189 Family and general practitioners, standardized hours (2,080 hours/year), 2005. U.S. Department of Labor, [t]. 11,698 dollars 30% Taiwan average income PPP $ 5,388 $ 2,885 Full-time and part-time employees, 2004. National Statistics Republic of China, [9]. 112,658 17% 40.5 Physician income *PPP: Purchasing Power Parities

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

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

CAIPA Membership

CAIPA’s Medical 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

CAIPA Covered Lives Est. 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

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

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

Presume CAIPA’s Medicare Advantage Average Fund vs. Cost Ave. Funding PMPM Ave. Cost PMPM Ave. Saving PMPM Ave. % Saving $720 $612 $108 15%

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

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

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

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

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

Evaluation and Management Coding ( E/M Coding or E&M Coding) MIN E/M code MEDICAR AETNA BC CIGNA OXFORD OX LIBE OX MEDI UNITED 1199 HIP OUTPATIENT   99245 317.2 198.22 178.2 consultation 99244 262.97 253.8 256.61 153.04 137.58 222.89 189 99243 112.73 New patient 99204 221.98 163.32 179.27 40 99215 155.89 98 25 99214 116.29 130.95 121.4 129.88 69 62.1 107.34 107.36 92 139.55 15 99213 78.83 87.24 58 47.81 54.6 94.6

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 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！

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

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

百大良醫也心寒 台灣的未 來 不是健保垮 就是 醫生跑 遠見雜誌 2012年7月號 第313期   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

Where Did It Go. Major components of the $3 Where Did It Go? Major components of the $3.5 trillion spent in fiscal 2010 Social Security20.4%National Defense20.1%Medicare 13.1%Medicaid/CHIP8.1 %Interest5.7%Low- Income Assistance5.3%Unempl oyment Compensation4.6%Edu cation & Training3.7%Federal Employee Retirement3.5%Veteran s3.1%Transportation2.7 %Other health care 2.6%Parks & natural resources1.3%Space/Sci ence0.9%Foreign aid0.9%Agriculture0.6 %Everything else3.5% Major components of the $3.5 trillion spent in fiscal 2010

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).

CAIPA

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/