Surviving the “Change Fatigue” of Health Care Reform

Although change has become a constant in health care over the last decade, 2015 has been an especially momentous year. Physicians who submitted their 2014 quality data and attested to Meaningful Use Stage 2 by the March 20, 2015, deadline barely had time to breathe a sigh of relief before making their last big push to convert to the International Statistical Classification of Diseases, Tenth Edition (ICD-10), by October 1.

In addition, the Meaningful Use and Physicians Quality Reporting System (PQRS) programs will begin penalizing practices for past performance. Practices that haven’t started both of these programs may face penalties in 2016.

Thus, many physicians are experiencing “change fatigue.” According to Kellyn Pearson, manager of practice support for the American College of Physicians, “clinicians and practices are struggling with the amount of change.”

She adds, “There is so much going on, and it affects different clinicians in different ways,” depending on patient and payer mix, practice size, location, and specialty. However, a common theme exists: a move away from fee-for-service to more of a performance- and value-based payment model. The emphasis on electronic health records (EHRs), quality reporting, and ICD-10 are all part of achieving a more efficient, patient-centered health care system.

Although some physicians may see health care reform as an attack on the practice of medicine, others see it as a painful but necessary alignment of payment incentives with more effective care, says James Reschovsky, PhD, senior fellow at Mathematica Policy Research. “[Many] physicians want to do right by their patients and want to see an improved health care system,” he says.

But even those who see the need for an enhanced health care system can become overwhelmed with the administrative complexity of carrying out these changes. So, to prepare themselves and their practices for the next phase of health care reform, physicians can take the following steps described below.

Coordinate Your Calendars
With Meaningful Use, PQRS, ICD-10, the Value-Based Payment Program, and various other health care reform programs on the state and federal levels, as well as in the private sector, practices face a slew of deadlines this year. Although some progress has been made in aligning submissions (eg, practices could submit data for Meaningful Use Stage 2 and PQRS at the same time in 2015), juggling the different programs can quickly become overwhelming.

The American College of Physicians has a timeline of important dates that is a good starting point for practices; it will also be necessary to check state and local program deadlines. Putting all those dates on a single calendar can help practices identify the most efficient way to coordinate efforts and stay on top of deadlines.

Know the Data Source
As physician payment increasingly becomes based on quality and outcomes data, practices must collect, compile, and report the right information at the right time—all of which may differ according to payer mix, practice location, and other factors. Pearson advises physicians to take the time upfront to understand exactly what quality measures payers are using and the data source for that information.

Are the data being pulled from EHR or claims records? Knowing this information will help physicians make sure that they are collecting the correct data and accurately reflecting the practice’s quality of care. Physicians can also engage in performance improvement activities to improve the targeted outcomes.

Watch for Changes
Pearson warns that there are several moving targets in this field, especially regarding Meaningful Use attestation. For instance, Pearson says, “Practices that are doing Stage 2 in 2015 report on the entire calendar year." But, she explains, the Centers for Medicare & Medicaid Services (CMS) may change the requirement to 90 days of data.

Review Practice Model Results
The big organizations that are ahead of the curve (eg, Kaiser Permanente, Intermountain Healthcare) have shown that it’s possible to provide high-quality care at a lower cost, says Reschovsky, but they’ve been working at it for decades.

How this would apply to individual practices is still up in the air, he points out. Practices that haven’t moved to a new model should monitor the results of different pilot programs and demonstration projects launched at the state and national levels.

While many of the new practice models emphasize patient-centered care, care coordination, preventive care, and population management, no "one-size-fits-all" model exists. Before joining an accountable care organization or moving to a patient-centered medical home model, physicians should look at how different models share risk and savings. For example, physicians should know what risks they might be exposed to and whether they have some control over those variables.

To monitor what’s happening in their areas, Pearson suggests that physicians consult the CMS Innovation Center, choose their state from the dropdown menu, and review a list of models and innovations currently under way. Another source for information about practice models is the Patient-Centered Primary Care Collaborative, which features an interactive map of public and commercial practice transformation projects.

In the meantime, it seems that physicians shouldn’t settle into a new routine any time soon—unless they’re willing to accept change as their new routine. “The times, they are a-changin’,” says Reschovsky. “How it’s all going to play out is anybody’s guess.”