Collaboration in Groups Improves Care, Averts Pay Cuts

Steve Berkowitz, MD

Urologists who are members of LUGPA are doing the right thing by being part of large group practices. But are they participating in these practices as effectively as possible, through strategic collaboration and sub-specialization? That was the question posed during LUGPA’s annual meeting by Steve Berkowitz, MD, founder and president of SMB Health Consulting.

During his presentation, Berkowitz suggested that the biggest potential adversaries in practices are not the Affordable Care Act (ACA), Congress, or managed care, but the groups’ own doctors. They are crucial players when it comes to determining a practice’s success because they affect how well the group is integrated clinically and financially, and whether the practice has the right infrastructure and governance in place.

Healthcare change is governed by what is mandated; the market takes care of the rest. Patient outcomes and metrics, transparency, and patient experience are part of the natural evolution of the healthcare sector, he said, and would have become a focus with or without the ACA.

Manage the Patient Population

Today’s practice environment may not be what doctors signed up for, Berkowitz said, but change is coming anyway. Here are some of his suggested ways to stay ahead of the game:On the clinical side, the goal is population management. More and more consumers are making decisions on the basis of value. Just as consumers look to sources such as Consumer Reports before they buy a car, they look for data and reviews on doctors, Berkowitz said.

“The data is significant, whether it’s significant or not,” he said. The consumer isn’t asking how many of the respondents are disgruntled patients or how many total respondents there were; they are simply looking at the numbers of stars next to a doctor’s name.

The good news is that medical practices improve when data are reported publicly. If doctors are judged on readmissions, patient satisfaction, wrong-site surgeries, and never events, care just gets better, he said.

“That’s why your goal has to be 100 percent” on core measures, he said. “It’s not enough to just get better. Your competitors are all getting better.” Groups should have regular meetings with all members in which data are shared and each member educates the others on what’s working.

Best practices should be at the heart of those discussions. Berkowitz pointed to the American Urological Association’s most common clinical scenarios for urology, and challenged doctors gathered at the Drake Hotel to ask themselves whether they are following best practices in each of those areas.

Avoid Financial Penalties

Doctors can take a note from pilots, who are good at embracing checklists and guidelines, he said. While pilots and copilots often have never met each other, each knows what the other will do in an emergency situation.Performance issues increasingly will be tied to reimbursement, most immediately through the value-based program run by the Centers for Medicare & Medicaid Services, Berkowitz noted. Penalties for inefficiency will start at 1% in 2015, but may hit 12% by 2021, he said.

“Who in this room wants to risk 12% of their salary in the next 8 years?” Berkowitz asked.

Managing costs and bundling payments will involve taking risks where they make sense, so that doctors don’t have to take a pay cut, he said.

Doctors throughout each group should know the costs for an episode of care or for a particular diagnosis and have protocols in place, which should be laid out with data in a public forum, he said.

Berkowitz encouraged practices to take a look at who’s doing what as more practices begin to offer a full array of services to larger communities. Doctors who do more of one procedure may be experts in that area, and it might make sense to have them do all such procedures for the group, he said.

Doctors working in population-based medicine will need to ask these questions, he concluded: “What is our need in the community? What is our capability as a group? And then how do we start practicing more in line [with those factors]? Every one of us will have to give up something to some degree.”