CEO Looks Back at Healthcare
Ten years ago, our large medical specialty group practice had its hands full. We were instituting our first electronic health record, moving five out of six clinics and spearheading the construction of a new hospital/MOB/ASC campus. At the time the challenges seemed insurmountable. But somehow we managed to sail through the chaos and survive. Even with all the upset, things seemed so much simpler then. Why? Well…here is a list of items that weren’t even on our radar back then.
PQRS, Meaningful Use, Value-based performance, Obama Care, and ICD-10.
PQRS
To us, measuring quality meant the occasional patient satisfaction survey. We committed ourselves to customer service but it wasn’t a matter of government mandate, it was a matter of taking pride in everything we did in a way that spoke to our commitment to quality care. The days of “report cards” for doctors were unthinkable. Now, the decree either obliges us to report or suffer less payment from Medicare.
Meaningful Use
To be honest, when we implemented our first EHR, we did it because we wanted to expand and in our market, real estate was pricey. It doesn’t seem that long ago we had aisles and aisles of patient charts and 9 (yes, 9!) storage units chocked full of years old charts, X-rays, and hundreds of boxes of assorted flotsam. We had no room to add more revenue-producers. If the by-product of going paperless to find more room for doctors was smoother flow, all the better but that wasn’t the primary reason for such a massive undertaking. The scanning alone took over 6 months to complete. To be sure, a properly deployed electronic record SHOULD increase productivity. But the initial hit, especially amongst our, let’s call them “more seasoned” doctors was substantial. The meaningful use of an EHR was our idea to adopt, not the government sanctions we see now.
Value-based Performance
Cost effective quality care is nothing new. Ten years ago, we strived to provide the highest standards with the least amount of waste. Secretary Burwell’s announcement two weeks ago heralds a whole new ball game in reimbursement. By the end of 2016, 30% of Medicare payment will be tied to a value-based model. Ten years ago, it was easy. We got paid for the services and procedures we rendered according to a set schedule. With the advent and ramp up of performance-based models driving Accountable Care Organization, Patient Centered Medical Home, and now Medicare (with Commercial payers already committing to follow suit) have we seen the death of traditional fee for service reimbursement. Ten years ago that was unthinkable, especially with the long past demise of the old “capitated” payments.
Obama Care
Ten years ago, the challenge was to ensure we captured the blend of insured lives to financially sustain. We wrangled with managed care organizations over fee schedules and carve-outs and carefully watched our payer mix. With the Accountable Care Act comes a government program that feeds many into the system. We see patient premiums continue to climb to the extent the employers (ala Roberto Duran) say, “No mas.” Many employees, formerly immune to health costs, now see only catastrophic care coverage paired with extremely high deductibles. In order to care for the many we turn to assembly line medicine that means less face time with the patients. It is no wonder the forecast for numbers of doctors in front line specialties is dim.
ICD-10
Ten years ago, ICD-10 was a distant specter we would have to deal with “someday.” Not that day is here in concert with RAC audits, meaningful use, PQRS, ACA patients, and trying to figure out how to predict survivability under this “value-based thing” that’s coming. I agree with the recent thought that ICD-10 doom and gloom is overstated. It’s not that bad if organizations embark on the clinical documentation improvement and training required to meet the new specificity. But it’s still a project that needs to be resourced. While everyone is trying to do their “real” job, time has to be taken away in order to learn the new coding constructs. Doctors have to learn the new elements, technology has to be addressed across the enterprise, and we all wait with baited breath about just how badly the payers are going to game the new system.
I never thought I’d say this but with all the bedlam, I find myself longing for “the good old days.” The disarray caused by SO MANY changes to the way we do business is overwhelming. The old hassles didn’t go away. We still have to deal with the paper chase involved in credentialing, benefit and professional liability haggling, and seemingly endless payer payment policy changes. But we had well-defined targets with clear objectives that took basic organizational skills to navigate. Unlike ten years ago, there are so many unknowns. Where are they going with quality measurements and meaningful use mandates? How far down the road is ICD-11 and/or SNOMED? Is Obama Care merely the first step down the path of completely socialized medicine that will put the entire industry in turmoil? Are they going to tell us exactly how we’re going to be paid under value-based performance by the end of 2016? As a CEO, it is critical we know the answers to at least some of these questions so we can take care of those who depend upon us to make the right decisions.
With the increased complexity of our jobs, it’s now a lot harder to find time to smile. So, for all you past, present, and future CEOs and Administrators out there, I hope this brightens your day.
The CEO and the Frog
A guy was walking through the forest one day when a frog called out to him from the side of the path…
It said “If you kiss me, I’ll turn into an enchanting, beautiful princess”. He bent over, picked up the frog, put it in his pocket and continued with his walk.
The frog chimed up again and said, “If you kiss me and turn me back into an enchanting and beautiful princess, I will stay with you for one week.” The guy stopped, took the frog out of his pocket, smiled fondly at it, returned it to his pocket and resumed his walk.
The frog then cried out, “If you kiss me and turn me back into an enchanting, beautiful princess, I will stay with you and bring you happiness to the end of your days.” Again the guy took the frog out, smiled at it and put it back into his pocket.
Finally, the frog asks in exasperation, “What the heck is wrong with you? I’ve told you I’m an enchanting, beautiful princess; that I’ll stay with you and make you happy the rest of your days. Why won’t you kiss me?“
The guy said, “Look, I’m the CEO of large health care organization. With all the new challenges I have to deal with I don’t have time for a girlfriend. But a talking frog – How Cool is THAT!! “
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