Colorado Medical Society

Cover: Taking a closer look

Sunday, January 01, 2012 12:00 PM

Evolving your practice for the future

Sara Burnett, CMS contributing writer

Trying to keep up with all of the changes in heath care today – much less anticipate what’s coming next – is enough to make any physician’s head spin.

There’s physician profiling and payment reform, EHRs and ACOs, plus ICD-10 and the ACA – and those are just for starters. (*See the copy box below for a glossary of terms to serve as a guide to this paragraph).

“It’s a lot of moving parts,” says Jennifer Wiler, MD, an emergency physician at University of Colorado Hospital and a Colorado Medical Society member who speaks nationally on reimbursement issues.

“The concerns I hear from my friends are that it’s hard enough day-to-day just to keep the door open … So trying to think about all of these other changes that are coming is overwhelming.”

But with health care costs continuing to rise, there’s no doubt that change is on the way and, in many cases, already has arrived.

For several years, CMS has worked with component and specialty societies and other stakeholders to help physicians navigate this new, often uncertain environment, a process CMS has come to refer to as “practice evolution.”

Understanding how critical this work will be for physicians and their patients, CMS leaders formed the Council on Physician Practice Evolution. The council is made up of 20 physicians from across the state, representing specialists and primary care physicians from multiple practice settings.

The council’s aim is to inform physicians, help them prepare and evolve their practice, and to ensure they have a voice in how these changes occur.

Four key areas
Practice evolution may be broken down into four key areas: transparency, payment reform, delivery system redesign and administrative simplification. Colorado Medicine will delve deeper into each of these areas in future issues, but here is a brief explanation:

Transparency: Public and private payers want physicians to prove they’re providing high-quality, cost-efficient care. Through profiling, or designation programs, private payers are rating doctors, largely using claims data, and putting those designations on their websites. (CMS has been working with health plans to develop a fair and consistent process for these programs). Medicare also is making data from PQRS (Physician Quality Reporting System) available online. And an effort also is underway to utilize an All-Payer Claims Database, which would compile data from all public and private payers. These efforts make it more important than ever that physicians be able to track and use their own data.

Payment reform: There is a growing consensus that the fee-for-service reimbursement model is not the best way to provide quality, safe, cost-effective care, particularly in cases of chronic conditions and high-risk patients. Instead, options such as bundled or episodes of care payments, gain sharing and global payments are actively being explored.

Delivery system redesign: Linked closely with payment reform, delivery system redesign looks to provide better-coordinated, more patient-centered care. It includes the use of electronic health records (EHRs), health information exchange and models such as the patient-centered medical home and medical neighborhood. CMS also has done work around a “care compact,” which helps facilitate better care coordination.

Administrative simplification: A major way to cut waste in the health care system is to reduce the administrative burden on physician practices. CMS is working on an initiative that would create a uniform system for claims edits and is helping physicians make the transitions to HIPAA Version 5010 and ICD-10.

Facing the future
Michael Keller, MD, a primary care physician in private practice and immediate past president of the Denver Medical Society, sees value in many of these changes, such as the need for physicians to prove through data that they’re providing quality care.

“It’s good for the patient and it’s good for me and it’s ultimately good for the system,” Keller says.

But Keller, who also sits on the Council on Physician Practice Evolution, said he’s living proof that what may sound like a great idea in theory doesn’t always translate easily into one’s practice. Because of concerns about cost and productivity, his six-doctor practice hasn’t invested in an EHR.

“It is very difficult to bring changes to the individual level,” he says.

Dennis Waite, MD, chair of the council and chief medical officer at The Medical Center of Aurora, hears from physicians every day who are so frustrated and anxious that they’re talking about quitting medicine.

Waite likes to use an analogy of a sailboat tied to a dock. Many physicians today have one foot on the boat, he said, and the other safely planted on dry ground.

“You tend to say, ‘Well, I’m gong to hold on to my position on the dock a bit longer until I figure out where this sailboat is going,’” Waite says.

Still, there are things physicians can do to prepare, from having conversations with colleagues about how to better coordinate care, to coming up with a system to track quality and cost measures to seeking guidance from state, local and specialty societies.

“No one really knows for certain what’s going to happen, but in some way, changes are going in this direction,” Keller says. “We have to make sure that it doesn’t come as a shock.”

Thoughts? Questions? Contact Dennis Waite, MD, chairman of the Council on Physician Practice Evolution at

Glossary of terms

Physician profiling: Programs used by payers to “designate” physicians based on quality and efficiency measures.
Payment reform: Changing the way that health care is reimbursed.
EHRs: Electronic Health Records
ACOs: Accountable Care Organizations
ICD-10: New diagnosis and procedure codes; must be used as of Oct. 1, 2013
ACA: Affordable Care Act