If you want to know what people really think at a healthcare business conference, find the rooms where there isn't a PowerPoint presentation projected on the wall and instead moderators are walking around handing people microphones.
I was fortunate to be able to observe two of these: one for orthopedic practices and another for surgical group practice administrators. At these sessions, the moderators asked what people wanted to talk about and then proceeded to have free-wheeling discussions while walking around the room Phil Donahue-style and handing their microphones over to people who had opinions they needed to share.
The topics included health information technology, marketing, recruiting, and other issues dealing with the ins and outs of running a practice. Insurance companies and the CMS were expected targets for complaints, but if there was any one group whose ears must have been burning, it was physician assistants.
At the surgical roundtable, there was some discussion about how some insurance companies will not reimburse for PA services, while the ortho group had a lively discussion about PA salaries.
Moderator Jerald Forrester noted that he had two PAs making $105,000 and "they were still complaining."
The salaries that people mentioned ranged from $75,000 to $140,000 with a lot depending on production bonuses or whether the PA agreed to provide on-call service. A speaker from Missoula, Mont., said some patients are now saying that if they see a PA rather than an M.D., they shouldn't have to pay full price.
That's not to say the more traditionally formatted sessions weren't worthwhile.
The concept of patient-centered medical homes, which involves a physicianusually a primary-care doctorbeing reimbursed for coordinating the care given a patient by other specialists, was promoted at the conference. At one session, Cynthia Dunn, a practice management adviser with the MGMA's Health Care Consulting Group and Chad Boult with the Johns Hopkins Bloomberg School of Public Health in Baltimore, talked about Johns Hopkins' "guided care" model which is a version of a medical home, only Boult said it was developed before the medical home standards evolved.
David Gans, vice president of the practice-management resources division, said there are three main medical home models being promoted and these were developed by the National Committee for Quality Assurance, the CMS, and the insurance industry group America's Health Insurance Plans.
He explained that the NCQA's model is a result of the organization looking for an accurate assessment tool to define medical "homeness," so its model is more technology-driven; the CMS designed a model to fit its desire to insure success for both those that define themselves as a medical home as well as insure success for its project; and AHIP designed a model focusing on the chronic-care patients that consume the most of a health plan's resources.
While Gans was just a spectator at the medical home session, he and MGMA board member Elizabeth Wertz-Evans led a session on patient safety in nonhospital settings. Just in case people needed persuading, Wertz-Evans, the chief executive officer at the Pediatric Alliance, in Carnegie, Pa., told how taking steps to avoid patient harm was not only the right thing to do, but it can build a practice's reputation, which can pay dividends in the long run.
If you have one bad incident, patients find out about it faster than a hundred good things you do, Wertz-Evans said, and "if the reputation is there for a safe, high-quality practice, patients will know."
People were also looking for advice on what issues were on the horizon and lurking around the corner. At the "Hot Topics in Ambulatory Surgery" program, possible CMS and Joint Commission standards were discussed, including proposals for post-surgical care that might require assurance of a safe trip home.
Moderator Sandra Jones, an ambulatory surgery center consultant, mentioned stories in which elderly patients are driven home by even more elderly companions or spouses, leaving the ASC staff to gasp "Oh my goodness, he's getting behind the wheel."
Although the conversion to ICD-10 has been a hot topic, with the MGMA strongly advocating slowing down a proposed conversion timetable, a Tuesday afternoon program on the new coding system was sparsely attended. But, across the hall, chairs were being set up outside the door for an overflow crowd listening to Rick Rutherford, the American Urological Associations director of practice management, give his take on "Five Trends in Health Care that Will Change the Way Managers Manage."
To deal with patients who have high-deductible, consumer-driven health plans, Rutherford recommended researching what major employers in the area are offering their workers and adapting practices accordingly, training the front desk staff on "selling" the practice, improving the appearance of practice Web sites and even posting patient blogs, and consider offering VIP time slots to patients who pay in cash.
As healthcare costs become more transparent, Rutherford told his audience that, if they are the most expensive practice in town, the town will soon know that. So, instead of lowering or trying to cover up these high prices, he recommended publicly justifying the expensive charges.
His suggestions included mentioning things like robotic surgery being more expensive but produces better outcomes or "office visits are high because our doctors spend more time with their patients." He quipped that there was no need to add that they spend more time because they're so slow.
Rutherford also predicted that providers are going to face "shared reimbursements," and then rhetorically asked. "Who's going to be the winner?"
"Whoever gets the money first."