Hospitalists 'perfectly poised' to drive health care reform

 

ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.

That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.

“Patient-centered, team-based coordinated care needs to be the norm,” said Dr. Goodrich, who also is still a practicing hospitalist and a member of SHM. “That is what we do. That is what hospitalists do. This is why I think hospitalists are so perfectly poised to help drive this change. Because all the things that we in the federal government – and commercial payers – are looking for, you’re already doing.”

Many of the measures involved in payment reform – with its Merit-Based Incentive Payment System (MIPS), Medicare Access and CHIP Reauthorization Act (MACRA), and Advanced Payment Models (APMs) – focus on outpatient and ambulatory care, Dr. Goodrich acknowledged. But it’s also about medical systems, she said.

“What do you focus on as hospitalists? Improving systems of care,” she said. “We focus on clinical care for our individual patient, but part of our job is also to think about it in terms of how do I improve the care across my hospital system?”

One aspect of reform that is most likely to directly affect hospitalists is the facility-based measurement part of the Quality Payment Program, slated to take effect in 2019. If participating in MIPS – the payment model in which clinicians can receive an increase or decrease in payments based on performance measured by data on quality, cost, and other factors – clinicians can choose to have their hospital’s quality measures count toward their MIPS quality score. The facility measurement was developed in part after conversations between CMS and SHM, Dr. Goodrich said.

“Many stakeholders are very excited about this possibility for a couple of reasons: No. 1, there would be absolutely no quality-reporting burden for you if you chose to do that,” she said. “No. 2, it really aligns the incentives between you and the hospital that you’re working in. Because, after all, we are all in this together. And some folks have felt like they aren’t always aligned with the incentives of the hospital that they are working with, or working for.”

 

Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”

But she said there are steps hospitalists can take to make quality change – and necessary change – happen.

“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.

Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.

 

“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”

Yet, she noted that she often senses trepidation.

“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”

 

ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.

That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.

“Patient-centered, team-based coordinated care needs to be the norm,” said Dr. Goodrich, who also is still a practicing hospitalist and a member of SHM. “That is what we do. That is what hospitalists do. This is why I think hospitalists are so perfectly poised to help drive this change. Because all the things that we in the federal government – and commercial payers – are looking for, you’re already doing.”

Many of the measures involved in payment reform – with its Merit-Based Incentive Payment System (MIPS), Medicare Access and CHIP Reauthorization Act (MACRA), and Advanced Payment Models (APMs) – focus on outpatient and ambulatory care, Dr. Goodrich acknowledged. But it’s also about medical systems, she said.

“What do you focus on as hospitalists? Improving systems of care,” she said. “We focus on clinical care for our individual patient, but part of our job is also to think about it in terms of how do I improve the care across my hospital system?”

One aspect of reform that is most likely to directly affect hospitalists is the facility-based measurement part of the Quality Payment Program, slated to take effect in 2019. If participating in MIPS – the payment model in which clinicians can receive an increase or decrease in payments based on performance measured by data on quality, cost, and other factors – clinicians can choose to have their hospital’s quality measures count toward their MIPS quality score. The facility measurement was developed in part after conversations between CMS and SHM, Dr. Goodrich said.

“Many stakeholders are very excited about this possibility for a couple of reasons: No. 1, there would be absolutely no quality-reporting burden for you if you chose to do that,” she said. “No. 2, it really aligns the incentives between you and the hospital that you’re working in. Because, after all, we are all in this together. And some folks have felt like they aren’t always aligned with the incentives of the hospital that they are working with, or working for.”

 

Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”

But she said there are steps hospitalists can take to make quality change – and necessary change – happen.

“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.

Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.

 

“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”

Yet, she noted that she often senses trepidation.

“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”

 

ORLANDO – As dizzying as the alphabet soup of payment reform might seem – with its swirl of new incentives, alignments, and models – hospitalists should already be familiar with many of its main ideas, said keynote speaker Kate Goodrich, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services.

That makes hospitalists poised to help reform a U.S. health care system with the dubious pairing of staggering costs and poor outcomes, Dr. Goodrich told a packed ballroom on Monday at the annual meeting of the Society of Hospital Medicine.

“Patient-centered, team-based coordinated care needs to be the norm,” said Dr. Goodrich, who also is still a practicing hospitalist and a member of SHM. “That is what we do. That is what hospitalists do. This is why I think hospitalists are so perfectly poised to help drive this change. Because all the things that we in the federal government – and commercial payers – are looking for, you’re already doing.”

Many of the measures involved in payment reform – with its Merit-Based Incentive Payment System (MIPS), Medicare Access and CHIP Reauthorization Act (MACRA), and Advanced Payment Models (APMs) – focus on outpatient and ambulatory care, Dr. Goodrich acknowledged. But it’s also about medical systems, she said.

“What do you focus on as hospitalists? Improving systems of care,” she said. “We focus on clinical care for our individual patient, but part of our job is also to think about it in terms of how do I improve the care across my hospital system?”

One aspect of reform that is most likely to directly affect hospitalists is the facility-based measurement part of the Quality Payment Program, slated to take effect in 2019. If participating in MIPS – the payment model in which clinicians can receive an increase or decrease in payments based on performance measured by data on quality, cost, and other factors – clinicians can choose to have their hospital’s quality measures count toward their MIPS quality score. The facility measurement was developed in part after conversations between CMS and SHM, Dr. Goodrich said.

“Many stakeholders are very excited about this possibility for a couple of reasons: No. 1, there would be absolutely no quality-reporting burden for you if you chose to do that,” she said. “No. 2, it really aligns the incentives between you and the hospital that you’re working in. Because, after all, we are all in this together. And some folks have felt like they aren’t always aligned with the incentives of the hospital that they are working with, or working for.”

 

Dr. Goodrich didn’t try to send a message that payment reform isn’t a challenge for hospitalists or anyone else – she called the new system “complicated” and said that “we are in a stage of fairly dramatic health system transformation.”

But she said there are steps hospitalists can take to make quality change – and necessary change – happen.

“First of all, of course, continue to provide high-quality patient care, focus on the patients in front of you, and lead the teams that you need in order to provide high-quality care,” she said.

Also, Dr. Goodrich said, hospitalists should learn to work more closely with their own hospital administrators and the post-acute facilities in their local communities.

 

“We have to figure out ways to collaborate with them and align the incentives across all of these systems of care,” she said. “Some of that comes top down from payers, but much of that can happen at the local level as well.”

Yet, she noted that she often senses trepidation.

“I always get the question: ‘Well, how do we do this? How do we make this change? It’s not something that we’re necessarily trained for,’ ” Dr. Goodrich said. “There are people out there who are doing this well. This is actually spreading across the country. So seek out those high-performers and learn from them. There’s a lot of learning networks out there that you can access to learn how to make some of these changes.”