A year for change

Con­fer­ence in­cludes new leader, rules, tech­nol­ogy

Modern Healthcare - - THE WEEK IN HEALTHCARE - An­dis Robeznieks

Last week, the Med­i­cal Group Man­age­ment As­so­ci­a­tion’s mem­bers wel­comed a new leader and tack­led the just-re­leased rules on the Medi­care ac­count­able care pro­gram, the scram­ble for mean­ing­ful-use money, and the ever-present threat of slashes to the Medi­care pay­ment rate.

All of that against the sur­real back­drop of Las Ve­gas lights and moun­tains made for a lively an­nual con­fer­ence, held Oct. 23-26.

To­tal at­ten­dance—in­clud­ing ex­hibitors, me­dia and guests— num­bered 5,700 this year, up al­most 24% from last year’s fig­ure of 4,600 at last year’s con­fer­ence in New Or­leans.

The meet­ing was the first for new Pres­i­dent and CEO Dr. Su­san Tur­ney, former CEO and ex­ec­u­tive vice pres­i­dent of the Wis­con­sin Med­i­cal So­ci­ety. As she opened the con­fer­ence less than two weeks af­ter start­ing the job, she told at­ten­dees “ad­vo­cat­ing for physi­cian prac­tices is our bread and but­ter.”

“I’m so glad to be here; be­ing your CEO seems like com­ing home,” said Tur­ney, who was the 2005-06 chair­woman of the MGMA board. “Please tell me what’s on your mind. I mean that, re­ally.”

Dave Gans, MGMA vice pres­i­dent of in­no­va­tion and re­search, said the two main ques­tions at­ten­dees had on their minds were: How do all these new reg­u­la­tions ap­ply to me? And what can I do to get ready for other changes com­ing down the road?

The an­swer to the sec­ond ques­tion can be ex­pen­sive.

“We have to use tech­nol­ogy,” Gans said. “Not just elec­tronic health records, but also tech­nol­ogy in the pa­tient home—glu­cose me­ters, scales, blood pres­sure cuffs—that au­to­mat­i­cally trans­fer data back to a doc­tor’s of­fice that al­lows doc­tors and nurses to mon­i­tor pa­tients. If the scale reg­is­ters a weight gain two days in a row, the pa­tient is hav­ing a water gain—that puts pres­sure on the heart and lungs—and you can call them in for a di­uretic be­cause, other­wise, they might have a heart at­tack.”

Key­note speaker Eric Dish­man, di­rec­tor of health in­no­va­tion and pol­icy and a fel­low at In­tel Corp., echoed Gans’ state­ments on us­ing tech­nol­ogy to fa­cil­i­tate home care, and he also raised a few eye­brows when he sug­gested to­day’s health­care sys­tem re­lies too much on hos­pi­tals and clin­ics.

Dr. Farzad Mostashari, the national co­or­di­na­tor for health IT, told at­ten­dees that im­ple­ment­ing tech­nol­ogy will pre­pare prac- tices for what­ever changes are com­ing ahead—even if it’s just re­tir­ing and try­ing to sell a prac­tice.

He also de­fended the de­ci­sion to move ahead with adopt­ing the more com­plex ICD-10 di­ag­nos­tic codes, say­ing to de­lay im­ple­men­ta­tion for an­other three years would only post­pone re­al­iz­ing the sys­tem’s ben­e­fits.

Mostashari also said his of­fice is work­ing to get qual­ity mea­sures of var­i­ous govern­ment health pro­grams to match and align.

“Ev­ery new reg­u­la­tion is an op­por­tu­nity to har­mo­nize a bit more,” he said, adding that fail­ure to do so is a lost op­por­tu­nity “to fo­cus the mes­sage.”

If there are 12 dif­fer­ent mea­sures used for 12 dif­fer­ent pro­grams, Mostashari said, “it be­comes white noise.”

The big “how does this ap­ply to me?” ques­tion in­volved the re­cently re­leased fi­nal rule on the Medi­care shared-sav­ings plan for ac­count­able care or­ga­ni­za­tions. A ma­jor change be­tween the fi­nal rule, re­leased ear­lier this month, and the pro­posed rule, re­leased March 31, was the re­duc­tion in qual­ity mea­sures from 65 to 33.

An­ders Gil­berg, the MGMA’S se­nior vice pres­i­dent for govern­ment af­fairs, said what should be “some­what lib­er­at­ing” for mem­bers was that all of the hos­pi­tal-spe­cific qual­ity mea­sures were elim­i­nated, which means prac­tices can form stand-alone ac­count­able care or­ga­ni­za­tions (if they wanted to) with­out be­ing teth­ered to a hos­pi­tal.

Gil­berg warned that there are still sub­stan­tial startup costs—pos­si­bly be­tween $1 mil­lion and $2 mil­lion. But, he said, while the con­cept may not work in ev­ery com­mu­nity, it was now more wor­thy of con­sid­er­a­tion. “Think about it,” Gil­berg con­cluded. “It may be a good pro­gram for your sys­tem.”

An­other hot topic (as usual) was what to do about dis­rup­tive doc­tors.

An over­flow crowd of about 300 peo­ple lis­tened to Dr. Alan Rosen­stein, med­i­cal di­rec­tor of Physi­cian Well­ness Ser­vices in San Fran­cisco, and Dr. Michelle Mudge-ri­ley, who owns a con­sult­ing busi­ness, Physi­cians Help­ing Physi­cians, based in Glen Allen, Va., ex­plain dis­rup­tive be­hav­ior by physi­cians, and they drew a di­rect line be­tween this dis­rup­tion and poor out­comes for pa­tients.

“Doc­tors are not happy,” said Mudge-ri­ley, a self-de­scribed “burned out” doc­tor who left clin­i­cal prac­tice to con­sult. Fac­tors caus­ing un­hap­pi­ness and dis­rup­tive be­hav­ior in­clude the ex­ter­nal chal­lenges from health­care re­form, as well as in­ter­nal con­cerns about ef­fi­ciency, pro­duc­tiv­ity, re­cruit­ment and re­ten­tion, rev­enue cy­cle and pa­tient sat­is­fac­tion, she said.

Dur­ing the meet­ing, the MGMA an­nounced that it will merge with its aligned or­ga­ni­za­tion, the 6,700-mem­ber Amer­i­can Col­lege of Med­i­cal Prac­tice Ex­ec­u­tives, to form one le­gal en­tity, the MGMA-ACMPE, on Jan. 1, 2012. The MGMA’S 22,500 mem­bers lead 13,500 groups in which about 280,000 physi­cians prac­tice.

Gans said he could tell his or­ga­ni­za­tion’s mem­bers were fo­cused on the meet­ing. “I ob­served, as a group, some­thing I thought was very in­ter­est­ing,” Gans said. “Very few peo­ple in the casi­nos.”

—with Paul Barr and David Burda


To­tal at­ten­dance at the MGMA an­nual con­fer­ence was up by al­most 24% from last year.

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