With so much at stake, why didn’t GM act sooner?
The answer, according to many people familiar with the automaker, is a corporate culture reluctant to pass along bad news. “These investigations always reveal the person(s) who dismissed potential problems,” said Maryann Keller, an independent consultant who wrote a book about GM. Keller said GM has long been known for hiring people who “individually were the best and brightest but who were later channeled into a system that rewarded conformity.” (I refer to this as drinking the punch.)
In terms of healthcare, here are some facts from the national MGMA’s July, 2014, newsletter, Medical Practice Today:
“Three of the biggest challenges to providers in this year of all-consuming and more legislation than I have ever seen in healthcare are Meaningful Use, ICD-10 and Administrative Simplification. This year is expected to be a watershed year in the area of health information technology.”
“Processes upon processes with a changing target, there can be no positive outcomes, the providers and patients will most definitely know consequences why the Affordable Care Act will fail. It is really not if it will fail it is when it will fail, unless change and management with HHS/CMS changes and changes fast.”
“The NCQA (National Committee for Quality Assurances) recognizes that more than 6,800 physician practices are medical homes.
In a study in JAMA, Rand researchers compared 32 NCQA-recognized practices in southeast Pennsylvania with 29 that were not. Over three years, a significant association with utilization of costs was found.
In March the NCQA announced it will unveil revised IT standards to show IT recognition process value. They will shift their focus to align with HHS ( I think that is sometimes referred to as the fox watching the hen house) requirements for information technology, enhance team-based care, target high-need populations and advance the triple – aim goals of increasing quality, lowering costs and improving patient experience.”
“This is not just the Affordable Care Act under the Obama administration, but goes back to Clinton, and W. Bush. (Three two term presidents equals 24 years. The Clinton administration, with the failed attempt of Hillary Care, but with programs and increased regulations that led to falling off the cliff. Under the W. Bush administration, the announcement made at Vanderbilt Hospital that medical records would happen during the next five years. Then the Affordable Care Act which added an always-moving target with overwhelming processes and regulations for health care providers.” (source; “CMS Hasn’t Got a Clue!,” Memphis Medical News, April 2014, J. William Appling)
“The ability to plan for the future is increasingly difficult for MGMA members, who are overwhelmed by new rules and regulations in addition to regular responsibilities, which include keeping practice doors and supporting the delivery of high-quality care, according to this year’s Medical Practice Today (MPT): what members have to say survey.
“I feel like there are so many guns pointed at my head,” said one member. “I increasingly see my job as a risk manager.”
“Expecting digital sharing between providers when no network exists is unreasonable,” said another member. “Many of the requirements are ahead of existing technology.”
Respondents to the 2014 MPT survey cited an onslaught of issues – from frustration with duplicate quality reporting measures and onerous regulations to mandated technology changes before industry partners and infrastructure are ready.
Since 2008, MGMA has created an applicability-weighted index. It showcases challenges to colleagues that are the most pressing. In other words, these are the most intense challenges that are applicable to the most members. Here are the top 10 2014 AWI challenges for all organizations.
(Category, Challenge, AWI rank and AWI score)
Other – Preparing for the transition to ICD-10 diagnosis coding. 0.75
Financial management – Dealing with rising operating costs. 0.67
Financial management – Preparing for reimbursement models that place a greater share of financial risk on the practice. 0.65
Financial management – Preparing for value-based payments (e.g. shared savings, capitation / global payments, quality / outcomes. 0.64
Financial management – Managing finances with the uncertainty of Medicare reimbursement. 0.64
Payer relations – Understanding payers’ criteria for physician performance ratings and the impact on provider networks and tiering. 0.58
Financial management – Collecting patient due balances (self-pay, high deductibles and HSAs) 0.58
Information technology – Preparing in the CMS HER Meaningful Use Incentive program 0.53
Payer relations – Negotiating contracts with payers. 0.53
Financial management – Understanding the total cost of an episode of care. 0.49
One of the biggest challenges beyond the financial aspects of practice management is developing a highly functioning team with effective group dynamics and a culture that supports collaboration. Integrating patient-centered care concepts into the organizational and operational culture is more than lip service. It involves a dedication to doing the right thing even before the financial rewards are evident in the changed reimbursement environment. No one is better-suited for this task than administrators who have demonstrated their knowledge and skills.
Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood. For more information contact Bill at j.william.appling@outlook.com.