“As with any government program, they made it harder than it should be. But they are in the right arena in terms of trying to drive toward quality,” says TMA Council on Health Care Quality member Michael Ragain, MD. The family physician is chief medical officer at University Medical Center (UMC) Health System in Lubbock.
The world of value-based care is at physicians’ doorstep. Here are some tools and resources TMA recommends to help you step confidently out into this evolving arena.
TMA PRACTICE HELP TMA’s Practice Help webpage,
www.texmed.org /PracticeHelp, has a host of practical and educational resources to get you started with Medicare’s value-based care programs.
kTHE QUALITY IMPROVEMENT RESOURCE CENTER (
www.texmed.org /QualityImprove ment) connects you with TMA- approved vendors to guide you through the Physician Quality Reporting System (PQRS) and provides clinical quality improve- ment tools to engage your patients. ™
PHYSICIANS WILL HAVE TO DO THEIR OWN MATH to determine the cost of the programs ver- sus the penalty of foregoing participation, he says. “Many physicians may not have the option not to participate based on their pa- tient population, now that so many patients are covered by Medicare. So they definitely should pay attention. It will hurt financially
— and by reputation — if they get a bad mark from Medicare on a quality report. But it won’t be that great doctors aren’t doing a great job, just that they are not putting the systems in place to manage it.” When it comes to quality improvement
in general, physicians can’t afford to give up on the process, adds Austin otolaryngologist Jeffrey B. Kahn, MD, a member of the Coun- cil on Health Care Quality. “As difficult as it is, when it comes to de-
termining what quality is in health care, we need to be the ones defining it. We need to continually think about ways in which we can improve,” he said. “But we should not pretend the process is easy, and we need to be aware that the complexity — espe- cially when there are penalties involved or we have metrics thrust upon us — runs the risk of drawing our attention away from the most important thing: Ultimately this whole process should be about making pa- tients healthier and providing the best pos- sible care they can get.” Medicare’s Jan. 26 announcement of spe-
cific goals and timelines for transitioning to a value-based payment system also should create a sense of urgency and opportunity for physicians, says Harold D. Miller, an ex- pert on health care payment and delivery reform. The president and chief executive officer of the Center for Healthcare Quality and Payment Reform spoke at TMA’s Win- ter Conference Jan. 30–31.
28 TEXAS MEDICINE April 2015 “Under any system, you have to have phy-
sicians thinking about quality, as well as cost. And particularly, one of the challenges we have today is, if you try to convince an employer to contract with you, the ques- tion that gets asked is: ‘Well, how do I know these are good doctors?’” he told Texas Medicine. Everybody knows there are sav- ings to be had, and value-based care “is the direction [the system] is going. The ques- tion is, is it going to be a good version or a bad version? And physicians need to stand up and say: We recognize there’s an issue with spending and there’s an issue with quality, and we are going to address it. But here’s what we need to be able to do that. Physicians can and should bring solutions to the table that will work, and patients will be a whole lot happier.”
WHAT IS VALUE-BASED CARE?
Simply, value-based care means achieving the best outcomes at the lowest cost, says Ronald S. Walters, MD, a member of TMA’s Council on Health Care Quality and associ- ate vice president of medical operations and informatics at The University of Texas MD Anderson Cancer Center in Houston. “You want to provide the best quality
product at the lowest price. Most people want affordable, high-quality health care. And just like other markets, the people who can do that will be the winners,” he said. That’s where analyzing processes, measur- ing outcomes, and changing practices come into play: “Most doctors think they already deliver high-quality, affordable care. But if you don’t measure it, you don’t know it.” Achieving value also requires restructur-
ing how health care is paid for, Mr. Miller says. “It’s redesigning the way care is deliv-
TOOLBOX Your
value-based care
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