Texas Quality Summit Will Give Physicians Tools to Thrive in a Value-Based Care Environment
Quality Feature — October 2016
By Kate Harrington
Tex Med. 2016;112(10:53-57.
The end of the federal Sustainable Growth Rate formula was largely met with cheers among physicians, but switching to the new Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) means physicians across all practices will need to be ready for some big changes. Among the biggest of those changes will be the transition to a pay-for-performance system.
"Quality is becoming such an important topic as we move away from the fee-for-service payment model to a value-based model," said Keller family physician Gregory Fuller, MD, chair of the Texas Medical Association Council on Health Care Quality. "Quality is a piece of that equation. We've got to educate physicians about quality from the standpoint of how do you measure it, what tools do you need to measure it, how do you transmit your data, mine it, and interpret it."
With that in mind, TMA and the American College of Medical Quality (ACMQ) are partnering to host the Texas Quality Summit on Nov. 18–19 in Austin at the TMA building (401 W. 15th St.). The two-day event will include group exercises and expert presentations and will give physicians the tools they will need to learn and implement the fundamentals of quality improvement and patient safety.
"You won't have a better opportunity to help set the system up," said Javier Margo, MD, a member of TMA's Council on Health Care Quality who plans to attend the summit. "This is your chance to come through that alternative payment model all-star league and learn to shoot hoops with the greatest. These are experts on the quality metric change. This may be a once-in-a-lifetime opportunity. When you see the people who are at my table who are themselves experts, and they're excited about some of these other speakers coming in, that's something you don't want to miss."
The summit isn't just for physicians. TMA and ACMQ encourage all members of the health care team, from residents and physician assistants to administrators, to come to the summit. To register, visit the TMA website.
The Quality Know-How You Need
Prathibha Varkey, MD, ACMQ president and chief executive officer (CEO) of the Yale Northeast Medical Group and senior vice president of Yale New Haven Health, will lead the pre-conference workshop on Nov. 18. Dr. Varkey, former CEO of Seton Clinical Enterprise in Austin, approached TMA's Council on Health Care Quality about cohosting the event.
"Our [ACMQ's] mission is to educate physicians and health care executives about quality, safety, and the leadership that it takes to enhance care for patients," Dr. Varkey said. "TMA is very well involved in preparing physicians for future challenges, and this seemed like a perfect match. The idea was to bring in some local leaders and experts and national experts to have this dialogue and invite physicians from various specialties to have a common dialogue and an understanding of what is going on."
It's significant that TMA and ACMQ are coming together to cohost an event for the first time now, Dr. Fuller says, because the shift to a pay-for-performance model and the role quality plays will have a big effect on physicians in every field. Together, he says, the two organizations can give physicians the tools they will need to adjust and thrive.
"Reimbursement models are changing rapidly, and physicians will need to learn to proactively make the changes necessary in a thoughtful and methodical way in order to be successful in their individual practices, and most importantly, be successful in caring for patients," Dr. Varkey said.
While some of the changes around the new payment system won't go into effect until 2019 – and there's some speculation that the timeline could get pushed out further – Dr. Varkey says the baseline measurements around quality will start in 2017, and those measurements from next year will be used to determine physician payment.
"I think there's not enough understanding about what it means to physicians," Dr. Varkey said of misconceptions around the move toward pay-for-performance models. "People see a flurry of acronyms and don't fully understand a lot of the nuances. Some physicians also think it won't affect them, but it is a huge change, and it will require a lot of infrastructure to get the data and manage things."
When you ask physicians, "What is quality?" everyone has an answer, Dr. Fuller says. But when you ask, "How do you measure it, and what can you tell us about yourself?" most people don't have as clear of an answer.
Learning how to measure quality accurately is so important to physicians, Dr. Fuller says, in part, because under MACRA, 50 percent of a physician's comprehensive score will be based on quality.
"Not only do you have to collect and show your quality measures," Dr. Fuller said, "you also have to do some other things to improve your practice and patient health outside of just managing their condition. It becomes a matter of what you are doing for your whole population of patients."
Beyond that, implementing quality strategies will benefit patients, Dr. Varkey says. Medical errors, the third leading cause of death in the United States, are not talked about as much as traditional diseases, she says.
"Americans get only half the care they deserve," Dr. Varkey says. "There's a gap between what we know as providers versus what actually occurs at the clinic side. It's not malicious; the problem is that there are so many issues to address, and people forget, or maybe electronic systems are not efficiently providing tools we need to provide recommendations. The other piece is, generally, medicine has been one-on-one care and occurs between patients and a physician. There's been no data available on how you're doing. It's been a huge change in the health care environment, understanding that we're not doing as well as we thought we were doing."
While many practitioners haven't yet put the new quality measurements in place, a few have, Dr. Margo says. Those physicians are seeing phenomenal results, he adds.
"Some of the changes will include having someone in the office call and follow up with patients to see how they're doing," Dr. Margo says. "Especially with high-risk patients, that's significant. I tend to see a lot of patients come to the ER because they weren't able to get their meds refilled. It's just that simple. And sometimes they can have a heart attack as a result. It's hard not to be excited about some of these changes when you see the potential for what they can do."
What the Summit Offers — Day 1
The summit, which includes the pre-conference workshop on Nov. 18, will give physicians and health care teams an intensive look at the science, tools, and methodology around quality. Experts will present information about the fundamentals of quality improvement and patient safety, as well as effective strategies for daily practice.
The hands-on pre-conference workshop features interactive sessions led by Dr. Varkey and expert ACMQ faculty. Participants in the workshop will leave with the resources and knowledge to implement the concepts of quality improvement, including basic methods, tools, and leadership strategies.
"The workshop is a deep dive into the science, tools, and methodology to create change. We will be going over how you measure quality, how to figure out what the solutions are to complex problems, and different quality techniques," Dr. Varkey said.
Following a quality improvement overview by Dr. Varkey, workshop participants will launch into quality improvement group exercises. The morning group exercise will give physicians a chance to identify types of quality problems, organize a team to improve the process around a hypothetical problem, and use a flow chart to identify and remove redundant or unnecessary activities.
A second set of exercises allows physicians to work hands-on with quality measures, such as structure, process, and outcomes; visual data communication; process capability and process stability; and root causes.
An afternoon workshop will focus on strategies for implementing quality as a core value, specifically relating to patient safety. Three workshop segments, with an opportunity to participate in exercises, will go into patient safety, implementing quality improvement changes, and leadership.
What the Summit Offers — Day 2
On Nov. 19, the summit kicks off with expert panelists speaking about putting quality strategies in place for a prosperous practice.
Lecture and panel topics will include population health in Texas; transitioning to value-based care; perspectives on quality, value, and reimbursement; MACRA and its implications for practices; alternative payment models; how to prepare your practice for quality- and value-based payments; and a spotlight on leading-edge transformations in physician practice.
"We'll drill down more into the specifics of some of these pieces, especially around practice and improvement," said Dr. Fuller, who will be moderating and facilitating presentations on the day of the summit. "We're going to talk to several groups about their specific practices and what they're doing."
The summit will conclude with the TMA Accountable Care Leadership Program class of 2016 graduation ceremony to acknowledge physician participants' achievements. The ceremony will take place Saturday, Nov. 19, at 3:30 pm in the May Owen conference room at the TMA building in Austin (401 W 15th St.). (See "Take Leadership to the Next Level.")
Why You Should Attend
Dr. Margo says the summit couldn't come at a better time.
"We're up against a sharp timeline," he said. "Physicians are eager to learn more about quality because we have to."
The proposed MACRA implementation rule is nearly 1,000 pages, a document Dr. Margo says many physicians likely won't read. That's why having experts speak directly to physicians is so important, he says.
Dr. Varkey says she hopes the summit, along with other conferences, workshops, and publications, will galvanize the medical community to make the changes necessary to improve patient health. She says many physicians haven't been trained on the science behind making practices quality-based, as opposed to volume-based.
Dr. Margo says TMA's July 27 MACRA Tele-Town Hall meeting, hosted by Dr. Fuller and John T. Carlo, MD, chair of TMA's Council on Socioeconomics, shed some light on quality reporting, Medicare payments, and health information technology. Nearly 70 percent of the physicians participating in the call said they either hadn't heard of MACRA or hadn't made changes to prepare for the new Medicare payment model. Listen to a recording of the Tele-Town Hall meeting.
"Physicians are so busy they may not be aware of how they need to make changes," Dr. Varkey said. "And you have to start now." (See "5 Steps to Prepare for MACRA Now.")
While larger practices may have heard of the changes and have the resources to make the shift over to the new system, Dr. Margo says it will be harder on smaller offices, which is why it's vital to learn about putting quality measures in place now. The goal of the summit, he adds, is to allow physicians and other health care professionals to walk away with a nuts-and-bolts understanding of how to implement the concepts of quality improvement and patient safety and prepare for the new quality reporting metrics and payment systems.
Kate Harrington is an Austin-based writer and principal of Thumbtack Communications.
An Exercise in Quality Improvement
The Nov. 18 Quality Improvement and Patient Safety Workshop will start off the Texas Quality Summit. The workshop's agenda includes a 45-minute group exercise that examines quality improvement methods, such as the Plan-Do-Study-Act (PDSA) cycle, a tool that can be used to accelerate quality improvement. According to the Agency for Healthcare Research and Quality, "the PDSA cycle is shorthand for testing a change by planning it, trying it, observing the results, and acting on what is learned."
The four steps in the PDSA cycle are:
- Plan the test or observation, including a plan for collecting data;
- Try out the test on a small scale;
- Set aside time to analyze the data and study the results; and
- Refine the change based on what you learned from the test.
For more information, visit the Institute for Healthcare Improvement website.
Take Leadership to the Next Level
TMA launched the Accountable Care Leadership Program at the same time it unveiled TMA PracticeEdge, a physician services organization designed to help physicians take advantage of new payment models. This intensive leadership course covers current health care topics, such as the Medicare Access and CHIP Reauthorization Act and the Merit-Based Incentive Payment System.
The program meets the needs of busy physicians, with coursework consisting primarily of lectures, readings, quizzes, and case studies accessible online 24/7. Participants in the 10-month certificate program get schooled in topics like communication skills, teamwork, and population health management, meant to help physicians adapt in a rapidly changing environment that demands more accountability and proof of value for the health care dollar.
The curriculum imparts practical skills relevant to all medical specialties. After successful completion, physicians earn a certificate from The University of Texas at Dallas, plus more than 95 continuing medical education credits from the American Medical Association and TMA.
To apply for the 2017 program, visit the TMA website. The application deadline is Jan. 6, 2017. The program features:
- Access to colleagues for networking and mentoring;
- Opportunities to hear from industry leaders and visit with payers;
- The ability to work at your own pace, from your desktop; and
- Two weekend trips to Austin to share best practices and learn from experienced physician leaders.
The program is supported by a grant from UnitedHealth Group. If you have questions about the program, contact Christina Shepherd at (800) 880-1300, ext. 1443, or (512) 370-1443, or email ACLeadership@texmed.org.
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