If we in healthcare had one wish, we’d probably ask for a glimpse of the future. What impact will the coming wave of regulations have on the care we deliver? Is the Accountable Care Act a boon, or a bust?
Dr. Paul McGann, Chief Medical Director for Quality Improvement at the Centers
for Medicare and Medicaid Services (CMS) also serves as the co-director of CMS Partnership for Patients and the co-director of the Transforming Clinical Practices Initiative. While he can’t foretell the future, he does have a unique insider’s view on what we can expect to see in our industry over the next few years.
Recently, I was facilitating a Board of Directors strategic planning retreat for a client and had the opportunity to hear Dr. McGann speak to our small group. When someone asked him to describe what the regulatory landscape looks like from his perspective, he had a one-word answer; “Chaotic.” Not particularly positive! But he did have some fascinating insights into how we in healthcare can stay nimble and ahead of the curve as changes continue.
- Be a continuous learner; read and keep up to date with the new regulations as they come down from on high. “There are no magic answers from CMS any more; fee for service payment is effectively finished, and quality/value will replace volume payments” he said. For insight on this issue, see the New England Journal of Medicine article, Setting Value Based Payment Goals: Efforts to improve the US Health” by HHS.
- Get ready to innovate! We are in the midst of a healthcare revolution with the goal of making 50% of all Medicare/Medicaid payments go from fee-for-service to some alternative method based on quality measures by 2018. Being open to doing things in new ways is necessary for survival. CMS hasn’t quite figured out how to get to 50% Quality payments, but those answers will be forthcoming in the near future, so it’s critical that we stay up to date on what is released by CMS, and that we add our voices to the ongoing discussions.
- Work to strengthen relationships with others, especially with those groups already using/applying alternative payment methods (ACO’s, Medical Homes, etc.)
- Invest in learning about new models of care: you should be asking your leadership team: “What one aspect of the healthcare future do we find most exciting and relevant to our core mission?” and then invest in learning more
- Strategize on how you and your organization can raise yourselves to the top percentile of quality performers in your field.
- Choose your path now; commit to shaping your own future, rather than allowing someone else to choose it for you. Imagine a new paradigm for patients at the end of life; be ready to do more than you are doing now and in entirely new ways
- This healthcare revolution is much bigger than just Medicare and Medicaid. Big private insurance companies will be the laboratories for the future. Regardless of the outcome of the 2016 presidential election, the healthcare revolution is underway,” said Dr. McCann
Don Schumacher, PhD, President and CEO of the National Hospice and Palliative Care Organization also spoke at this event. His key points for hospices included:
- Hospices should not stay addicted to the Medicare Hospice Benefit. Innovate and diversify.
- Things are changing fast, and successful hospices will be at the table with their local accountable care organizations and other healthcare providers who work in their sphere.
- Be prepared for a higher level of scrutiny from regulatory agencies: CMS has identified significant “leakage” in the Medicare Part A, B and D programs when beneficiaries are enrolled in hospice ($694 million was paid for drugs, GIP and DME under Medicare parts A, B and D while patients were enrolled in hospice), and they’ll be looking to block those leaks.
- Focus will be on patients with Alzheimer’s disease and dementia with long lengths of stay in hospice and low utilization of other healthcare expenditures (few hospitalizations/tests/etc.) prior to hospice admission.
- A February 2016 studyregarding hospice visits in the Journal of American Medical Association demonstrated that in the last day of life, 24% of patients did not receive a visit from hospice staff; in the last two days of life, 12% of hospice patients did not receive a staff visit. Hospice visits in the last 2 days of life by professional staff were less likely when the Medicare beneficiary was black, dying on a Sunday, and receiving care in a nursing home. Make sure you are offering the right services to the right patients at the right time.
- In order to compete, focus on being the highest quality provider in your service area.
- Recruit and encourage hospital CEOs and key physicians to be on your board.
Hospice was born out of the need for a more humane alternative to what was then the standard for end of life care. Just as we did at its inception, we must think like entrepreneurs and innovators about the smartest and most impactful ways to use our resources to provide that care. If there’s one message to take from the experts, it’s that resting on our laurels isn’t an option. We need to refresh our perspectives, rethink our operations, and forge new working partnerships, both community and professional, to stay ahead of the curve.
Dr. Paul McGann, Chief Medical Director for Quality Improvement at the Centers for Medicare and Medicaid Services (CMS)