Dr. Patrick Conway, Deputy Administrator and Chief Medical Officer of CMS, spoke to members of the Pierce County Medical Society on June 17, 2016 about transformation of the health care system on a PCMS Practice Success Forum webinar.
In his remarks to PCMS clinicians, Dr. Conway outlined the characteristics from the historical state of the health care system and how they are evolving in to the future system. He also reviewed elements of the vast movement in payment away from fee-for-service to payment for value and quality with patient outcomes at the center. Dr. Conway noted that in addition to payment reform, efforts have been underway within the CMS Innovation Center that he directs to focus on delivery system reform. He spoke about the roles that ACOs and bundled payments are also playing to transform the health care system. The State Innovation Model (SIM) grants and Accountable Health Communities Model were noted as more recent initiatives coming out of the agency to achieve improvements in population health along with the Transforming Clinical Practice Initiative designed to assist practices over the coming years with quality improvement and entering alternative payment models. As a practicing physician on weekends, Dr. Conway stressed the importance of physician leadership at this time of large scale change and thanked physicians practicing in Pierce County for all they do. He reflected that while he was trained to be a good clinician in medical school, he was not fully trained to think about topics such as population health management, quality improvement, and system redesign which are now at the heart of 21st Century medicine in the United States and elsewhere. He said that while this is changing in medical schools today, he is aware that his own experience is the same as many other physicians too but concluded his remarks by enumerating ways that physicians can overcome this gap in training and help achieve the goals of Better Care, Smarter Spending, and Healthier People in addition to being leadership partners in the transformation effort such as being fully engaged in the development of new innovations, quality initiatives, and payment models.
After Dr. Conway’s presentation, PCMS President Brian Mulhall, MD asked about what other engagement CMS is undertaking with the physician community on an ongoing basis to collaborate on system transformation. Dr. Conway noted an aggressive plan to consult with physicians that had led to the MACRA implementation regulations that the physician community seems largely pleased with but acknowledged that with the massive numbers of physicians practicing in the country, the agency needs to continue to be aware of the importance of outreach and conversation with physicians on health care policy matters.
PCMS Executive Director Bruce Ehrle followed up on that by stressing the importance of CMS leaders such as Dr. Conway being available on an ongoing basis moving forward to explore modifications to certain initiatives if potential harmful or unintended consequences began to result from implementation of MACRA such as negative impacts to the internal environments of health care systems that would include undue harm to employed physicians, metrics being used that don’t translate to the realities of better front line care for patients, small independent physician practices being placed at an unfair disadvantage in their ability to succeed in the new systems, and patient behavior being taken in to account when measuring payment for patient outcomes when the physician or health care system had fully delivered the proper care yet patient behavior still led to a poor outcome. Dr. Conway agreed that this type of dialog and feedback will be very important.
Tacoma-Pierce County Health Department Director Anthony Chen, MD requested that CMS consider better and more detailed alignment of the multiple initiatives that have come out of the agency. Dr. Conway acknowledged the myriad programs that have come out of the agency in recent years including from the Innovation Center as they launched things to address various policy and program topics but now that the programs are all up and running for the most part that it is an appropriate time to examine how they can be better aligned.
The Society's time with Dr. Conway wrapped up with PCMS Executive Director Bruce Ehrle noting that what CMS leadership has heard so much about regarding the importance of full interoperability of EHRs and having such records contain both medical and behavioral information on every patient in a unified easily accessible manner across the health care provider spectrum is constantly raised because it is so critical in order to achieve the kind of success that CMS and physicians want with regard to quality improvement and better patient outcomes. Dr. Conway stated that interoperability of complete patient records is also at the top of the priority list for CMS as well as with their partner in the process, the Office of the National Coordinator.
The WebEx platform for PCMS Practice Success Forums is made possible through a generous grant by Physicians Insurance.