‘Qual­ity is like love. There are lots of dif­fer­ent forms of it’

Modern Healthcare - - Q & A -

Dr. Halee Fischer-Wright, a pe­di­a­tri­cian by spe­cialty, has been pres­i­dent and CEO of the Med­i­cal Group Man­age­ment As­so­ci­a­tion since Fe­bru­ary.

The Englewood, Colo.-based MGMA rep­re­sents more than 33,000 med­i­cal group ad­min­is­tra­tors and ex­ec­u­tives at about 18,000 health­care or­ga­ni­za­tions na­tion­wide. She pre­vi­ously served as chief med­i­cal of­fi­cer at Cen­tura Health’s St. An­thony North Hos­pi­tal in West­min­ster, Colo. She also led the 680-physi­cian Rose Med­i­cal Group in Den­ver for 12 years, served as a man­age­ment con­sul­tant and au­thored the best-seller Tribal Lead­er­ship. Mod­ern Health­care re­porter Andis Robeznieks re­cently spoke with her about leg­is­la­tion re­peal­ing the sus­tain­able growth-rate for­mula for physi­cian pay­ment, physi­cian group readi­ness for ICD-10, and the ef­fect of merg­ers and ac­qui­si­tions among med­i­cal prac­tices. This is an edited tran­script.

Mod­ern Health­care: Ad­dress­ing the SGR has al­ways been a pri­or­ity for the MGMA. Are the mem­bers happy with the re­peal law? Are there some con­cerns?

Dr. Halee Fischer-Wright: They are over­joyed, by and large. Now that af­ter 17 years we have taken away that loom­ing specter of 20% fee cuts in Medi­care, the ques­tion is, now what? We are sup­posed to get to value-based pay­ment mod­els by 2018; mean­while, we have not seen that suc­cess­fully done by Medi­care. So where are we with that? We have traded un­cer­tainty for am­bi­gu­ity.

MH: How are prac­tices bet­ter off, or how are physi­cians bet­ter off, now that they don’t have those pay cuts hang­ing over them?

Fischer-Wright: It’s a mixed bag. The good news is, for a lot of peo­ple who have been hold­ing off on tech­no­log­i­cal in­vest­ment, they feel com­fort­able enough to move for­ward. How­ever, there is still that ques­tion of where our value-based pay­ment is go­ing in the fu­ture. Prac­tices are still a lit­tle leery of adding peo­ple, both staff and physi­cians, un­til th­ese value-based pay­ment mod­els are more so­phis­ti­cated and bet­ter ex­plained. Prac­tices are con­cerned about all the reg­u­la­tion that does not add qual­ity to clin­i­cal out­comes.

MH: What is the membership’s readi­ness level for ICD-10?

Fischer-Wright: They are as ready as they can be. The MGMA has ad­vised prac­tices to im­ple­ment cost-ef­fec­tive, small steps to ease our way into ICD-10. I feel pretty con­fi­dent that our prac­tices, par­tic­u­larly our more so­phis­ti­cated prac­tices and some of our mid­sized prac­tices, are pre­pared. But there’s a lot of angst about third par­ties that in­te­grate with those prac­tices in ar­eas such as billing and cod­ing—the in­sur­ers and elec­tronic med­i­cal-record providers. Are they up to speed and ready to go for ICD-10?

MH: What other reg­u­la­tory is­sues are out there?

Fischer-Wright: Ev­ery­one is hold­ing their breath with the Supreme Court case in­volv­ing in­sur­ance sub­si­dies. It’s all con­jec­ture, but if the court does knock out that part of the Af­ford­able Care Act, all of a sud­den we have a large group of the pop­u­la­tion that may not have health in­sur­ance. The risk to our prac­tices is a cash-flow is­sue. For a lot of the health plans that fall un­der that um­brella, they are high-de­ductible plans, sort of cat­a­strophic cov­er­age. Prac­tices with those pa­tients will have to be very so­phis­ti­cated and very com­pe­tent at col­lec­tions up­front.

MH: The Physi­cian Qual­ity Re­port­ing Sys­tem has al­ways been one of MGMA’s sore points. Has it im­proved?

Fischer-Wright: Un­der the SGR re­peal, a lot of those qual­ity-based pro­grams are go­ing to phase out by 2018, re­placed by value-based per­for­mance pay­ment plans. What we have dis­cussed within our or­ga­ni­za­tion is that qual­ity is like love. There are lots of dif­fer­ent forms of it; peo­ple have dif­fer­ent in­ter­pre­ta­tions of it.

There are sev­eral qual­ity-per­for­mance projects un­der­way. PQRS is the one that sur­prised peo­ple with the 1% or 2% cuts in re­im­burse­ments; they didn’t know they had to at­test to it or sub­mit. Peo­ple don’t know how this is ac­tu­ally af­fect­ing per­for­mance—83% of sur­vey re­spon­dents said they don’t be­lieve th­ese pro­grams are en­hanc­ing qual­ity; they’re just adding lay­ers of in­fra­struc­ture and bu­reau­cracy that do not en­hance their abil­ity to per­form good health­care or im­prove the pa­tient’s ex­pe­ri­ence.

“Prac­tices are still a lit­tle leery of adding peo­ple ... un­til th­ese val­ue­based pay­ment mod­els are more so­phis­ti­cated and bet­ter ex­plained.”

MH: What’s your view of all the prac­tice merger-and-ac­qui­si­tion ac­tiv­ity in re­cent years?

Fischer-Wright: It’s much like the wave of merg­ers and ac­qui­si­tions in the 1990s. Then the pen­du­lum swung to, “No, we are not buy­ing prac­tices.” And now, in the past cou­ple of years, we have swung back to buy­ing, buy­ing, buy­ing. What we have seen as an or­ga­ni­za­tion is that M&A has ac­tu­ally dropped quite a bit. In our polling, only 5% of peo­ple an­tic­i­pate a deal in 2015, which is sig­nif­i­cantly less than it has been in the past three years, when it was maybe 25% to 35%.

MH: How has it af­fected prac­tices within your or­ga­ni­za­tion?

Fischer-Wright: Much like we found in the M&A wave in the 1990s, merg­ers and ac­qui­si­tions don’t solve a lot of the prob­lems that prac­tices were look­ing to solve when they sold them­selves. You think you are go­ing to sell your­self and be­come more fi­nan­cially se­cure or that you are go­ing to de­crease your level of com­plex­ity. In fact, most of the time, you ac­tu­ally in­crease com­plex­ity.

An­other is­sue is that physi­cians have a strong core of au­ton­omy. I think it’s the No. 1 cul­tural dis­tin­guisher of physi­cians. That means cul­tural align­ment should be a key con­cern in con­sid­er­ing a merger. For some rea­son, health­care doesn’t do that; there is al­ways this sense of ur­gency to get the deal done. So what we see are cul­tural mis­matches that even­tu­ally erode and de­te­ri­o­rate the re­la­tion­ship.

MH: How has the M&A ac­tiv­ity af­fected your membership?

Fischer-Wright: Our membership has been rel­a­tively sta­ble, but who our mem­bers are has changed. We are see­ing a lot more large or­ga­ni­za­tional group mem­ber­ships. It used to be that the MGMA was the domain of the small prac­tice ad­min­is­tra­tor. What we are see­ing now is a strat­i­fi­ca­tion of membership that goes any­where from CEO down to small prac­tice ad­min­is­tra­tor. And we see a cou­ple big buck­ets within that. We see sys­tem and hos­pi­tal ex­ec­u­tives. We see large-group ad­min­is­tra­tors.

MH: You pre­vi­ously wrote a book ti­tled Tribal-Lead­er­ship. Are you notic­ing any “tribal lead­ers” within the MGMA?

Fischer-Wright: Tribal Lead­er­ship is 8 years old, and the sto­ries in it are 8 years old. Some of them are still great. I see the book as a tool in a leader’s chest to help ad­dress the most fun­da­men­tal el­e­ment in a busi­ness that will lead to your suc­cess or your pro­found fail­ure—cul­ture. So cul­ture, be­ing some­thing soft and squishy, is hard to get your arms around. The book is just a method­ol­ogy to do that.

In the MGMA, the most valu­able thing that we have is our peo­ple. We may not di­rectly take care of pa­tients, but we take care of peo­ple. My busi­ness man­age­ment back­ground is to al­ways use your as­sets. Our best as­set is our peo­ple. Do I think there are tribal lead­ers in the MGMA? Yes, there are big, loud tribal lead­ers in the MGMA. I don’t mean just in­ter­nal to the or­ga­ni­za­tion. Our past lead­ers are a loud and proud voice, and our mem­bers are very vo­cal as well; they are very ac­tive and en­gaged.

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