Feature: Value-based purchasing and the transformation of healthcare
Physician engagement is a lot like football, or so says Richard E. Wild, MD, JD, MBA, FACEP, Chief Medical Officer for the Atlanta Region Centers for Medicare and Medicaid (CMS). “You can be a great quarterback, but if you have no team backing you up and supporting you, you’re going to get tackled.”
Wild presented to nearly 2,000 attendees during the general session at the 9th Annual ACDIS Conference. During his presentation, he discussed CMS’s plans to improve patient care and quality. At the center of these efforts, he says, will be motivating and engaging providers—a challenge that is anything but easy. “Herding cats is easy,” says Wild. “Managing a department of physicians is nearly impossible.”
Some of the largest issues in the US healthcare system include its extremely high cost. Wild showed a bar graph which illustrated the relationship between life expectancy and spending per capita across 31 well-developed countries. Cuba had the lowest cost per capita—less than $500. The United States, an outlier, had the highest cost per capita—over $4,500. The life expectancies were almost identical—in between 76 and 77 years.
Following the graphs, Wild displayed a series of color-coded maps of the United States, indicating performance on Medicare Quality Indicators. The maps revealed that regions which spend more money also have poor quality rankings. This connection, Wild says, can be linked back to physician engagement and motivation. “The healthcare system rewards physicians for doing, not what they are providing,” he said. “We are wasting money, and we need to focus on making the process more efficient.”
Incentive programs are currently shifting, rewarding quality care through tools and programs such as pay-for-performance and bundled payments. As the healthcare system works to become more transparent, another thing physicians face is public reporting on websites such as Hospital Compare and Physician Compare. “Physicians aren’t aware that they’re getting ranked and scored,” says Wild.
CDI can play a crucial role in educating and notifying physicians of these quality and incentive programs, which, in turn, may help motivate them to engage and provide better documentation. But they need support.
Train clinicians to work in teams, says Wild. A trend the industry is starting to see is team-based education—all members working together and learning to coordinate, says Wild. This will be critical, especially as physicians begin to experience consistent ranking.
“[Providers] will need to understand that this is reality, this is life,” says Wild. Being graded, and paid, based on the quality of care rather than the amount of care provided represents a change for physicians and facilities but “patient care needs to be a quality product that is efficient.”