Monday Musings

Last week I started talking about what I learned at the annual National Quality Forum meeting in Washington, DC. On the final day we heard Patrick Conway, MD, Chief Medical Officer for the Centers for Medicare and Medicaid Services (CMS), who is still a practicing pediatrician (which I find kind of funny given that he is the CMO of Medicare).  He is an impressive guy and after hearing him speak, I am never going to whine again about how hard it is to practice medicine and have some other demanding job in addition. His overarching message was that our current fee for service outpatient payment system is “producer centered,” has no links to quality and is unsustainable from a cost perspective. We must transition to a system which is patient centered, quality driven, and sustainable.

To accomplish this, CMS is focused on 3 areas: incentives (through quality programs and risk sharing), care delivery (through improved integration of services), and information (transparency on quality and cost). We are starting this transition by linking fee for service (FFS) to quality. As I’ve discussed before, FFS is over and Dr. Conway reiterated this. He reminded attendees of the uniqueness of the recent Obama Administration announcement to publicly set such a clear and unambiguous goal —at least 50% of Medicare payments to be tied to quality in some way by 2018.

I am just going to throw out some words here so that when you hear them again in the near future, you will be listening for them. Start preparing yourself for the concept of “bundled payments” on the outpatient side. There are already 48 conditions for which there is a single payment for the entire “episode of care” from inpatient through rehab care to outpatient care (e.g. knee replacement). Many hospitals are moving to “population based payments” (think about a reimbursement model that is about 20 cents on the current Medicare dollar) and are investing in community support to keep patients OUT of the hospital. CMS is investing in outpatient clinician support for “practice transformation networks”. I can’t tell you yet what that is going to mean to wound centers, but if you have not talked to the CEO of your hospital about how your hospital based outpatient wound center can help reduce the length of inpatient stay and reduce readmission rates, you should get on his or her meeting calendar.