Sources of Change

Some of us are very comfortable with change. For others, change is unwelcome and causes a great deal of anxiety. Organizations are very similar, I believe. I have read many postings and articles on healthcare sites about the stresses caused by the mandated changes in healthcare. Too, politicians love to rail against a wide variety of changes, especially if the politician is in the minority party at the time.

Change is a constant for organizations and for humans. Some changes are forced upon us, as the Physician Quality Reporting System (PQRS) is mandatory for those who provide Medicare Part B services and as buying healthcare insurance is for adults in the U.S. Other changes are voluntarily adopted by organizations to improve their services and products. An example for organizations is a group of healthcare providers becoming an accountable care organization (ACO). Many individuals want to lose weight. Not all are successful.

I believe that resisting change is unhealthy, for both businesses and individuals. Not responding to mandated changes can be costly. Individuals who do not buy health insurance face a tax penalty. Providers who do not strive to provide the best care, to excel at patient engagement, may lose patients to their competition.

Let us look at some organizational changes and their consequences.

This is a very critical year for providers involved in the PQRS program. Reporting in 2014 for eligible professionals is required by CMS or in 2016 reimbursements will be reduced by 2%. This can have a significant impact on providers who have a high proportion of Medicare or Medicaid clients. Those who are successful in reporting will receive a 0.5% bonus on their Part B Fee Schedule. The Medical Group Management Association (MGMA) provides an easy to use reference for its members that guides providers and staff through the steps of providing CMS with the necessary information to avoid the penalty in 2016. It lists four steps with links to resources necessary to finish each step:

1. Determine if you are an eligible professional (EP)

2. Determine if you will report on individual measures or a group of measures

3. Choose your registry from the approved list on the CMS site

4. Use the reporting wizard in your registry to report the data to CMS

Hopefully, you already are using a registry that is approved by CMS.

There are several other mandatory programs that require major changes and challenges for providers in the coming year. Two of these are reporting on meaningful use stage 2 for electronic health records (EHR’s) and preparing for the switch to ICD-10. Of these three, I believe that the most challenging and most important is the switch to ICD-10 coding as it can be very costly not to be ready on October 1, 2015.

As noted above, some organizations decide to make major changes in order to improve their services or their products. Healthcare groups are reorganizing as they look forward to changing reimbursement patterns. Two of these reorganizations styles are patient-centered medical homes (PCMH) and accountable care organizations (ACO). Both organizational styles focus on improving the quality of outcomes while cutting costs to payers and becoming more patient-centered. Both organizational styles can reap significant rewards from payers if they are effective.

In the November 2013 edition of HealthLeaders various executives of provider groups reviewed their moves to adopt population level health analytics to improve the outcomes of their ACO’s and, thus, improve the likelihood of sharing in any savings to the payer. Aric Sharpe, vice president of UnityPoint Health, an ACO in West Des Moines, Iowa, stated that, “We felt it necessary to build a platform where we can mesh together both claims data and data out of our electronic health records, because there’s a lot more that’s able to be learned in that type of environment.”

Reorganizing to become an ACO or a PCMH is usually a decision made by executives along with their governing boards. The implementation of the reorganization is based upon documents detailing structures and goals agreed upon by payer or national organization and provider. The changes are driven from the top levels of the organization. A few very effective organizations also drive continuous change from the bottom up. That is, they take suggestions from front-line staff to improve services by making changes that are usually small and incremental. If an organization seriously undertakes to implement most of the suggestions that can be seen to improve quality (I know one organization that implemented 95% of the suggestions from front-line staff) the cumulative outcome can greatly improve patient or client satisfaction and care and improve the bottom line.

In the May/June 2014 issue of MGMA Connection in the article “As Payers and Government Push for Quality Care, Staff Motivation and Goals Must Change” Jennifer Gasperini, a senior representative of the MGMA Government Affairs body stated that CMS has expanded PQRS reporting and the Value Based Payment Modifier (VBPM) over the past two years. Further, she states that, “We can expect that trend to continue in the near-term future, particularly with regard to VBPM, which will affect all physicians beginning in 2017.”

Intermountain Healthcare in Salt Lake City takes this statement seriously. It is using clinical groups to identify disease areas for clinical focus. It then uses a Lean Six Sigma approach to drive improvements. It has trained over 900 of its over 3000 employees in this continuous quality improvement approach. Quality efforts are team based. Data is regularly collected on identified metrics. The measurement results are regularly reported back to the staff in order to improve outcomes even more by making adjustments to improvement strategies as needed.

I am presently involved in creating an implementation plan for the coming fiscal year at a nearby health department. The drive to improve the quality of the programs used to prevent the use of tobacco and drugs by individuals in the county is being led by members of a workgroup committee that is comprised of staff of the health department and by community members. One focus of the new implementation plan is to improve the monitoring of the outcomes by using an expanded set of quality indicators.

Bob Dylan was right when he sang The Times They Are A-Chanin’. The next few years will see significant changes in healthcare. Some of these changes will be demanded by bodies external to the providers. The best providers will adapt to these demands as well as creatively foster change from within. These organizations will reap the benefits of improved patient satisfaction, improved patient outcomes and a much better bottom line.