Issue link: https://beckershealthcare.uberflip.com/i/301968
26 infections, but we don't know how to get patients to change their behavior. The other is herding the doctors. They're like cats; the only way is by using a lot of tuna. The tuna is the incentive for the doctors. Transparency is also an important piece of the puzzle. When you publish doctors' data side by side, they're professional and will respond accordingly. Dr. Shabot: Anything in which the emphasis is on patient-centered care is in conflict with traditional care. Those can be very difficult to change. We've seen some of these challenges, and we're doing well, but they're not easy. All of us on the CMO side, we love technical challenges, where we can just pro- gram something differently. Those are the easy changes — the difficult ones are the ones that cut across culture. But as CMOs, that's our job, to change culture. Dr. Slonim: The biggest challenge at the moment is in the ambulatory en- vironment. Up to this point, we have had large volumes of data to assist us in improving inpatient care, but we have not had the data available to un- derstand the ambulatory environment. Now, through our accountable care organization, we are finally tapping into data about physician performance in the outpatient arena. With that comes a realization of all of the improvement opportunities that exist in ambulatory healthcare to fulfill the triple aim. Q: what are your thoughts on the current federal quality report- ing requirements and reimbursement reductions for readmis- sions? How has your job changed in the past few years because of these changes? Dr. Arredondo: The quality reporting requirements are a fact of life, and we cannot escape them. As an integrated system with hospitals, a medical group, a health plan, homecare, etc., the sheer volume of required measures to report upon is daunting — more than 200 — and the resources required to develop the capacity to report these and improve upon them is costly. Our organiza- tion has devoted significant resources to understanding these requirements and has committed to succeeding with these measures. We find ourselves spending much more time understanding and prioritizing the requirements. We then have to engage our providers and support staff in executing on pro- cesses that have been designed to meet requirements. Dr. Mossallam: The federal quality reporting requirements and initiatives are well-intentioned. Obviously, a lot of work goes into compiling the data and the metrics and that changes some of our processes, but it's often change for the better. As painful as they are, they have led to process improvements for us and other [hospitals]. As for the readmission issue, it's been something we've been working on for the past couple of years. Here in Detroit, it's a socioeconomically depressed area, and a lot of what prevents readmissions isn't about healthcare. It's about ensuring patients get home safely, that they have transportation to their fol- low-up appointments and are able to keep them. It is about ensuring that they do not have to choose between spending money on medications versus food and shelter. It's made us rethink the 'episode of care' — it doesn't end at discharge, but at the safe handoff of the patient to the next care team. We can argue about whether or not that's fair on us, but it has shifted our focus and caused us to engage more with our community partners. Dr. Orr: There are benefits from this, and that's standardization of what is important. We're behind other industries because we saw medicine as special. Doctors had judgment and didn't need standards. It's a welcome change to hold doctors to standards like in other industries and have them prove the work they do. However, this policy lags behind technology by 10 to 15 years. We can tell how well doctors perform from EHR data but the current require- ments are based on claims data. These reporting requirements need to catch up to technology so we're measuring things that matter. Dr. Shabot: I'm in favor of quality reporting requirements. Any CMO will tell you there are some requirements that are not well thought out and comply- ing with those does not ensure the best care for the patient. An example is a finally retired core measure that required community-acquired pneumonia patients to receive antibiotics within four hours of arriving in the ED. For patients with pneumonia, that's a good thing. The problem was that we were doing diagnostic testing and getting X-rays and lab work back, and complet- ing that within four hours was challenging, especially with other emergency patients arriving in the ED at the same time. The net effect was that many patients who ultimately didn't need antibiotics were getting them anyway, forced by compliance with that measure. The reporting measures, along with transparency about them, are important. I also think the reimbursement reduction for excess readmissions is fair; oth- er CMOs might disagree. At Memorial Hermann, we're different from most hospitals and systems in that we started a campaign to reduce readmissions eight to nine years ago, long before it became a national quality measure. We identify patients at high risk for readmission and have case manager assigned to make a timely follow-up physician appointment, and follow up with them at home to make sure they are taking their medications and doing well. To do this well, you need to have started long before readmission reduction became a requirement. Dr. Slonim: Anytime we're faced with new reporting requirements, it focuses a large segment of our industry on specific bodies of work. Unfortunately, the number of new regulatory requirements becomes burdensome if not organized effectively. In addition, there is an opportunity cost that accom- panies new mandates. More measures means less time in the day to manage other important elements of patient care that are operative in our hospitals. I believe that there needs to be a balance between the things we have to do in quality improvement and the things we know we need to do to help our hospitals provide better care. Q: what is the best decision you've made as CMO in the past year? The worst? Dr. Arredondo: The best was the a decision to retain and continue support of a surgical specialty program that had been a collaboration between an inde- pendent physician group and PHS. This program had been in place for many years and, though the long-term financial implications were not entirely clear due to the complexities involved, we committed the resources to retain the program. This entailed some difficult negotiations and a willingness to com- mit, but in the end, the value to the community will be worth the work. The worst was the decision (or lack thereof) not to move more forcefully and expeditiously with the scenario described above. Fortunately, this will play out well and we will preserve the program. "it's a welcome change to hold doctors to standards like in other industries and have them provide the work they do." — Dr. Jeremy Orr, CMO, Humedica