A year for change

Last week, the Medical Group Management Association's members welcomed a new leader and tackled the just-released rules on the Medicare accountable care program, the scramble for meaningful-use money, and the ever-present threat of slashes to the Medicare payment rate.

All of that against the surreal backdrop of Las Vegas lights and mountains made for a lively annual conference, held Oct. 23-26.

Total attendance—including exhibitors, media and guests—numbered 5,700 this year, up almost 24% from last year's figure of 4,600 at last year's conference in New Orleans.

The meeting was the first for new President and CEO Dr. Susan Turney, former CEO and executive vice president of the Wisconsin Medical Society. As she opened the conference less than two weeks after starting the job, she told attendees “advocating for physician practices is our bread and butter.”

“I'm so glad to be here; being your CEO seems like coming home,” said Turney, who was the 2005-06 chairwoman of the MGMA board. “Please tell me what's on your mind. I mean that, really.”

Dave Gans, MGMA vice president of innovation and research, said the two main questions attendees had on their minds were: How do all these new regulations apply to me? And what can I do to get ready for other changes coming down the road?

The answer to the second question can be expensive.

“We have to use technology,” Gans said. “Not just electronic health records, but also technology in the patient home—glucose meters, scales, blood pressure cuffs—that automatically transfer data back to a doctor's office that allows doctors and nurses to monitor patients. If the scale registers a weight gain two days in a row, the patient is having a water gain—that puts pressure on the heart and lungs—and you can call them in for a diuretic because, otherwise, they might have a heart attack.”

Keynote speaker Eric Dishman, director of health innovation and policy and a fellow at Intel Corp., echoed Gans' statements on using technology to facilitate home care, and he also raised a few eyebrows when he suggested today's healthcare system relies too much on hospitals and clinics.

Dr. Farzad Mostashari, the national coordinator for health IT, told attendees that implementing technology will prepare practices for whatever changes are coming ahead—even if it's just retiring and trying to sell a practice.

He also defended the decision to move ahead with adopting the more complex ICD-10 diagnostic codes, saying to delay implementation for another three years would only postpone realizing the system's benefits.

Mostashari also said his office is working to get quality measures of various government health programs to match and align.

“Every new regulation is an opportunity to harmonize a bit more,” he said, adding that failure to do so is a lost opportunity “to focus the message.”

If there are 12 different measures used for 12 different programs, Mostashari said, “it becomes white noise.”

The big “how does this apply to me?” question involved the recently released final rule on the Medicare shared-savings plan for accountable care organizations. A major change between the final rule, released earlier this month, and the proposed rule, released March 31, was the reduction in quality measures from 65 to 33.

Anders Gilberg, the MGMA's senior vice president for government affairs, said what should be “somewhat liberating” for members was that all of the hospital-specific quality measures were eliminated, which means practices can form stand-alone accountable care organizations (if they wanted to) without being tethered to a hospital.

Gilberg warned that there are still substantial startup costs—possibly between $1 million and $2 million. But, he said, while the concept may not work in every community, it was now more worthy of consideration. “Think about it,” Gilberg concluded. “It may be a good program for your system.”

Another hot topic (as usual) was what to do about disruptive doctors.

An overflow crowd of about 300 people listened to Dr. Alan Rosenstein, medical director of Physician Wellness Services in San Francisco, and Dr. Michelle Mudge-Riley, who owns a consulting business, Physicians Helping Physicians, based in Glen Allen, Va., explain disruptive behavior by physicians, and they drew a direct line between this disruption and poor outcomes for patients.

“Doctors are not happy,” said Mudge-Riley, a self-described “burned out” doctor who left clinical practice to consult. Factors causing unhappiness and disruptive behavior include the external challenges from healthcare reform, as well as internal concerns about efficiency, productivity, recruitment and retention, revenue cycle and patient satisfaction, she said.

During the meeting, the MGMA announced that it will merge with its aligned organization, the 6,700-member American College of Medical Practice Executives, to form one legal entity, the MGMA-ACMPE, on Jan. 1, 2012. The MGMA's 22,500 members lead 13,500 groups in which about 280,000 physicians practice.

Gans said he could tell his organization's members were focused on the meeting. “I observed, as a group, something I thought was very interesting,” Gans said. “Very few people in the casinos.”

—with Paul Barr and David Burda