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

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.