This episode highlights some of the key perspectives from participants at the 2019 CMS Quality Conference in Baltimore, Maryland. The 2019 CMS Quality Conference convened 3,000 thought-leaders from across the healthcare spectrum to share insights and ideas on how we can all continue putting patients first, promote healthcare choice, drive value, and unleash innovation – all of which was underscored by the 2019 conference theme of “Innovating for Value and Results.”
Bill: Polglase, Host: Welcome to the CMS Beyond the Policy podcast. Today’s edition of CMS Beyond the Policy podcast will highlight some of the key perspectives from participants at the 2019 CMS Quality Conference in Baltimore, Maryland. The 2019 CMS Quality Conference convened 3,000 thought-leaders from across the healthcare spectrum to share insights and ideas on how we can all continue putting patients first, promote healthcare choice, drive value, and unleash innovation – all of which was underscored by the 2019 conference theme of “Innovating for Value and Results.”
Bill: We were thrilled to have Administrator Seema Verma provide the keynote on the opening day of the conference, outlining her strategic direction and priorities for the agency as we move into 2019 and beyond. Let’s listen to a few highlights from her speech:
Administrator Seema Verma (From recorded speech)
Administrator Verma: All of our initiatives focus on implementing a vision to transform the healthcare system into one that delivers better value to patients through competition and innovation. To achieve this, we will focus on three main objectives: empowering patients, focusing on results, and unleashing innovation.
Our regulations are critical to ensure safe, high-quality patient care, but over time they have become too prescriptive.
To address this problem, we made proposals last year to streamline our requirements across settings, reduce duplication and focus on outcomes, not process. And you can expect more of these kinds of proposals later this year.
And as we rollback unnecessary or overly-burdensome regulations, we know there remains an important regulatory role to reduce waste, fraud, and abuse.
Last year, we overhauled the Meaningful Use Program so that it focuses on promoting interoperability, or allowing medical records to be transferred seamlessly through the healthcare system. For the very first time, hospitals trying to avoid penalties and doctors looking for incentive payments have to meet standards for privacy and security, use the new edition of electronic health records that allow data to be shared electronically with their patients, and ensure that they are communicating seamlessly with other providers about their patients' care – and the fax machine doesn’t count. With this flow of information, we will reduce duplication and harm in the healthcare system and advance coordinated care.
The challenges we face are immense. They have confounded past administrations and experts who have relied too heavily on government-centered rather than patient-centered solutions. And we can’t accept the status quo. Because if we do, the best health care in the world will be undermined by an unsustainable, expensive delivery system.
And I know, that by empowering patients, focusing on results, and unleashing innovation, we will move toward a patient-centered health system that delivers higher value.
This is a call to action. It is incumbent upon every American to take control of their health care. To seek out high-value care from providers who are competing for their business. To demand their health care information. And to make the decisions that will lead to better, healthier lives.
Bill: Following the keynote, we had an opportunity to connect with conference participants to hear their reactions to Administrator Verma’s strategic direction and priorities for CMS. To kick things off, we have Dr. Anna Loengard, Chief Medical Officer with Caravan Health.
Dr. Loengard, what excites you the most about what you are hearing from CMS leadership?
Dr. Loengard: I work with ACOs and participants and hospitals across the country. So, I’m really excited about seeing what innovation there is and seeing what we could actually take and bring to the large audience that we have with Caravan Health. You know, I think that Administrator Verma had a very positive message this morning about, you know, how do we empower patients? How do we simplify the system we have? How do we make sure that, you know, the majority -- how do we work towards having even more of our population covered? How do we make this a more logical system? You know, I think that there’s a lot of hope in what she describes and I think simply admitting that we have a very broken system is part of the process, you know?
I think we have to really look at, what are the economic drivers that are causing burden and then how do we change them so there more in sync with providing high quality care to patients and reducing the burnout and burden on our physicians? Because I see that really front and center. You know, it’s a huge problem, particularly in rural America, but I think everywhere you see it and you hear it. And so I think we’ve got to figure out, what are those burdens and how do we change financial drivers so that the people who are, right now, in large part, employing those physicians have incentives to do the right thing?
Bill: We appreciate your time, Dr. Loengard, and it sounds like there are a few important focus areas for you: empowering patients, aligning incentives, and burden reduction.
Turning now to Dr. Dale Bratzler, Enterprise Chief Quality Officer for O.U. Medicine at the University of Oklahoma. Dr. Bratzler, what were some of the takeaways you heard from Administrator Verma’s keynote?
Dr. Bratzler: So, I really enjoyed Administrator Verma’s presentation this morning talking about the three directions that they’re focusing on to empower beneficiaries to improve care. I’m particularly interested in some of the things that they’re doing to reduce burden for clinical practices. I’m in a large group practice of more than 1,000 clinicians and we know that burnout is a real problem within our practice and we’re really looking at ways to reduce the overall burden for our clinicians so that they can improve patient care, have more time to actually be with patients, and actually not spend all their time doing documentation and the other many administrative burdens that come with healthcare today.
Bill: Do you believe that the recent changes to the Evaluation and Management coding will help to reduce administrative burden?
Dr. Bratzler: I actually like some of the ideas around reducing burden particularly related to coding and the E&M codes for billing in the future. I’ll be interested to see how that plays out in 2021. I think there is the potential that it can reduce some of the administrative burden of delivering care. I do hope that they work with the electronic health record vendors that will actually help us reduce some of the burden of documentation because many of those programs and platforms were built around the billing requirements for E&M coding for primary care and other types of care.
Bill: Let’s focus on the topic of Electronic Health Records, or EHRs, for a moment. Dr. Bratzler, I’m going to bring in Dr. Ralph Atkinson, a nephrologist from Tennessee, who also has a few thoughts on EHRs, especially as a clinician who participates in an Alternative Payment Model.
Dr. Bratzler, what challenges do you currently experience with EHRs?
Dr. Bratzler: Many of our patients see optometrists or eye professionals or gastroenterologists or other doctors that don’t link directly with our electronic medical record. So, I receive many, many faxes. Our practice receives these faxes and we have two full-time staff that do nothing but take those documents that are faxed to us and convert them mechanically by hand into structured data in our electronic medical record. It’s truly not interoperability, but it’s the only way we’re able to incorporate that information into our charts so that we can do quality reporting for CMS and also so that the decision support at the point of care for our clinicians actually works.
We were an early adopter of one of the commercial products that now has become almost obsolete, and it's the most dropped EMR in the nation now. We're looking at more than $100 million to buy a new EMR. And even if I sign the contract tomorrow, it will be at least two years before we have it fully implemented. And so, it worries me about penalties and programs around promoting interoperability when I'm working with a vendor that simply said, "We're not updating anymore" and I'm stuck.
Bill: Dr. Atkinson, any thoughts or challenges from your perspective as a participant in an Alternative Payment Model? Do any of the changes to the Evaluation and Management codes alter your interaction with your EHR?
Dr. Atkinson: With your collapsing of the codes that we hope to talk about today too, I mean, because these EMR's are billing and coding machines, I can't skip screens. So, you can collapse all you want to, but I've still got to click through everything. And it's the clicks that are driving us crazy. And so, I mean, I think we've got to go back to ‘95 and change that whole process, and that's a heavy lift. But right now we're dealing -- because these were MU-envisioned, right. And so, we have what we have and it's expensive to change.
Bill: Thank you, Dr. Bratzler and Dr. Atkinson. These are very valuable points. There is work that remains, and it’s important to point out that promoting interoperability is an agency priority given both the successes and concerns we have heard about adoption and use of the technology. Not only is it a priority for CMS, but we have been working closely with the Office of the National Coordinator for Health IT under the 21st Century CURES Act to really breakdown the challenges associated with EHRs.
Dr. Bratzler mentioned the notion of interoperability as it relates to EHRs, which was a focus of Administrator Verma’s keynote this morning. I would like to bring in a few new guests to share a bit of perspective on the discussions related to promoting interoperability.
First up, we have Leila Volinsky, the Quality Payment Program Regional Lead, from Healthcentric Advisors. Leila, you spend time working with clinicians and clinician support staff as a part of the Quality Payment Program, what are your rapid reactions to the push from CMS to focus on interoperability amongst EHRs?
Leila: So, promoting interoperability, that whole performance category for the merit-based incentive payment system has been fantastic. I think there’s a lot of opportunity still for EHRs to come together and make it a little more of a seamless process for clinicians and organizations. But I think sort of the horizon is out there and there’s lots of opportunities to make data sharing and data availability really seamless and kind of uniform across the board.
Bill: We also have Georgia Comer, a software development business analyst, with us. Georgia, from an Information Technology perspective, how do you view the path forward for EHRs?
Georgia: One of the things that’s always great about this conference particularly coming from sort of the IT side is to get insight into the business and what’s going on with the business and where they’re going and figuring out how then we can, you know, meet them there and help them accomplish their business goals. The EHR or the, you know, path towards getting more folks to adopt the EHR was really interesting. That would be -- a lot of what we do is sending and receiving medical records. So, being able to do that electronically would be a great path forward for us.
Bill: In general, between Dr. Bratzler, Leila and Georgia, it sounds like the focus on promoting interoperability is certainly an agency priority that could lead to the increased adoption and usage of EHR technology to the benefit of the beneficiaries that we serve.
Now, we’ve heard several different perspectives on a variety of important priorities, such as empowering patients, aligning incentives, burden reduction, and interoperability. Yet, we know there is also so much more happening at CMS right now. At this time, it’s my pleasure to introduce a few additional conference attendees to discuss, in a rapid reaction approach, some of the other exciting priorities and messages they are hearing from CMS leadership.
Let’s start with Jaz King from IPRO, a representative from one of CMS’s Quality Improvement and ESRD networks. What are you finding most exciting right now?
Jaz: Oh, everything, everything CMS is doing is exciting right now. I’m a big fan of price transparency personally. I’ve built some price transparency tools over the years. So to see CMS really getting behind it is good. Patient-centered human design surrounding everything we do I love. You know, a lot of the quality work we do is driven by what we think works, but given the world we live in and the amount of data we have access to, we should be paying more attention to that data and working from the patient up and knowing what kind of impact we’re having.
Bill: Great! Let’s turn to Dr. Troy Sturgill, a rural chiropractic physician in Oklahoma.
Dr. Sturgill: Mostly for me, what it’s about is trying to figure out how I can go back to my practice because it’s very rural. It’s very small and I have a, you know, transient population. It’s a difficult economic environment and it’s medically underserved. And so what I’m learning here is about how to make those connections when I find and need to make those referrals and how to make that a soft transition and a smooth flow and try to see where everything’s headed for the future.
Bill: Are there any priorities that you find personally valuable to your practice or patient population?
Dr. Sturgill: There’s a couple of things: one, I’m very excited about the telehealth portion because we are medically underserved and that would give me an opportunity to help promote that in my office to make sure the patients are compliant with their medical care, or if they have decided not to be compliant, to help reinstitute it before they get back with another primary care provider. Two, the other thing I really appreciate is I heard this morning the American College of Radiology was publishing a synopsis for patient education for appropriate care use and I think that’s an excellent step.
Bill: We also have Dr. Karen Smith, a rural family physician in North Carolina, and we’d like to hear your perspective as well as a rural provider.
Dr. Smith: The QPP program was exciting for us as an independent rural physician. We finally said, "We're going to get some leverage in the playing field. We're going to be able to connect with our patients." We felt like we were finally going to be able to be part of the delivery of healthcare as a business, that we're finally going to be able to participate in our rural communities, that we'll finally be able to communicate with our hospitals. It was a challenge, but we were successful. We appreciate all of the support services that came out of the SURS and, quite frankly, I don't think we would have been able to be successful had we not participated with our QIO and with the SURS program.
Bill: Thank you, Dr. Smith. As a point of clarity, you mentioned “SURS”, which, for our listeners, is the Small, Underserved, and Rural Support initiative that provides no-cost technical assistance to clinicians in small practices who are required to participate in the Quality Payment Program.
Turning, quickly, to Roger Wells, a physician assistant in a critical access hospital in Nebraska – you also have thoughts on the Quality Payment Program.
Roger: I really think you're on the right track. I applaud you for it. QPP's on the right track. The whole thing is on the right track, but we should be cautious that we're just not studying data to do data. And that's what I'm hearing at the Quality Conference. Everybody has great ideas, God bless them, but at the same time, we're getting ourselves into a data machine and not what you would say a human-focused delivery system.
Bill: That’s such an important insight because, as you may be aware, CMS is highly focused on incorporating elements of human-centered design in all of its programs and making sure we are understanding our customer’s values and preferences and putting them first.
For final thoughts I’m going to look to Dr. Deepanshu Garg, an internist with a small practice in Arizona. Dr. Garg, any major takeaways on some of the goals and priorities that you’ve heard your peers highlight during our discussion today?
Dr. Garg: Yes. You know, the most important thing that I heard this morning is that the higher administration is committed to those goals. It is recommending that, you know, the administration was committed for changing the payment model so that we can have the physician burden can be reduced and the quality can be improved, so that physicians can spend more time with patient rather than on the computer on the chart. You know, I learned that all the changes that come from the CMS are not the random changes. They are the changes that are well thought and those changes are towards better quality care, better affordable care, and it actually also cares for the physician burden. It is not just for the patient but CMS do care for the physicians.
Bill: That is an excellent way to wrap up our coverage and review of the 2019 CMS Quality Conference. Thank you to all of our interviewees for making the time to speak with me about their conference experience and instant reactions to the CMS strategic priorities, and thanks to you in the audience for listening.