Final Word: The Colorado Medical Society strives to fulfill “its” job protecting “our” profession

Monday, January 01, 2018 12:42 PM

by Alan Kimura, MD

This issue of Colorado Medicine shows how CMS shed light externally and internally: the Colorado Health Institute (CHI) Drivers of Change 2018, and the CMS Member Survey, respectively. (See pages 6-10.)

CHI’s 10 Drivers of Change 2018 – distilled. Six of the drivers (1-4 and 8-9) described in this issue’s cover story speak to the costs that different stakeholders in society must somehow pay for – the winners and losers are yet to be determined.

Three of the drivers illuminate hidden relationships: Drivers 5-6 focus attention on the importance of behavioral health for the patient, as well as for the providers of care. Driver 7 reframes the conventional thinking of “one patient – one doctor care,” now linking population health care to public health. Finally, driver 10 aims to shift knowledge towards action (advocacy): physicians must engage or have their fate decided by others.

Physician engagement ideally occurs at three levels. Deep engagement in clinical work is axiomatic to provide empathic, patient-centric care, and to obtain meaningful, personal satisfaction. Engagement at the medical society level aggregates many physician voices to achieve greater advocacy impact, in pursuit of our professional goals.

The pillars of physician engagement consist of autonomy, mastery and purpose[1].

Autonomy: Physicians often choose between different job settings depending upon their relative need for autonomy. A health care organization’s culture deals with issues of governance, leadership, compensation and data-driven decisions – all influencing the willingness of physicians to engage. Our profession is fortunate to retain these practice choices, though the independent versus employed ratio is changing due to external pressures detailed in the drivers.

Mastery: The “practice of medicine” aims to achieve mastery through thousands of hours of training and continuing education. Our experience summated over a long career is transferred to the next generation. In turn, the next generation must adapt their practices to the Drivers of Change, or risk obsolescence.

Delivering health care at the highest level requires that the practice’s internal operations are optimized. Data-driven outcomes (quality, patient satisfaction) and understanding costs are fundamental to transitioning practices from fee-for-service to new, value-based payment schemes.

As managing partner for our practice, I have engaged broadly outside of clinic, seeking ideas that will reposition our enterprise in anticipation of new opportunities. Our practice is the first practice in Colorado to have completed the Transforming Clinical Practice Initiative (TCPi) training . TCPi is a program within the Center for Medicare and Medicaid Innovation (CMMI). Data and outcomes to improve quality and lower costs are some of TCPi’s goals.

Key staff and I attended a workshop on data visualization, learning from business professionals how to model our data. After modeling, we will analyze and display the information visually to tell a compelling story, informing our business intelligence. Value-based care mathematically is an outcome per cost – good data, properly analyzed is fundamental – yet beyond our grasp. We all must learn to “skate to where the puck will be” (Wayne Gretzky, Hockey Hall of Fame).

Intrinsic practice improvements are being undertaken in clinic, embarking upon a long journey of cultural change incorporating Toyota Lean processes. Elimination of waste and inefficiencies in our own practices are vital as we transition to value-based care. These necessary changes, known best by you in your own practice, tie into the principle of autonomy, in turn allowing you to achieve clinical mastery.

Purpose: How can you expect to perform at a higher level (better outcomes, less waste, more satisfied patients) if you have no data or performance metrics, and instead rely only upon intuition? These practice-level improvements allow you to achieve mastery, that in turn allows you to achieve the ultimate purpose – empathic service to our patients.

The existential question is simple and stark: “Can our profession adapt as quickly as the world is changing?”

While health care is delivered “one doctor-one patient” at a time, increasingly it will be delivered by coordinated teams seeking continuous improvement – yet the future is still to be written. Indeed, the future of our profession undoubtedly rests upon physician engagement, collectively.

The ask: CMS needs you to join and renew your membership annually, and encourage your colleagues to join and renew. In election years, your support of candidates screened through COMPAC creates further advocacy impact. For CMS members (young and old) desiring greater engagement, a variety of roles within CMS are possible.

Closing the circle: It is time for “us” to do “our” job in support of CMS.

1. Kathy Kennedy, DrPH, MA. Director of Regional Institute for Health & Environmental Leadership. Associate Clinical Professor, University of Colorado – Colorado School of Public health.
2. www.colorado.gov/pacific/healthinnovation/executive-support-sim-tcpi-practices