EPtalk by Dr. Jayne 6/11/15

Only a couple of days remain to submit comments to CMS on the proposed modifications to Meaningful Use. Comments are due on June 15. Be sure to have them in by 11:59 p.m. if you’re submitting electronically. If you opt for mail, courier, or hand delivery, they need to be there by 5 p.m. I wonder just how many people submit them by hand? I’ve been watching episodes of “The West Wing” on Netflix and recently viewed one where they put a campaign volunteer in a chicken suit to heckle the opponent. I think it would be great to hand deliver comments dressed in ironically themed costumes.

In other news, CMS released the Medicare Shared Savings Program Accountable Care Organization final rule last week. It addresses beneficiary assignment methodology as well as beneficiary protection during data sharing. The rule also looks at measurement benchmarking and adjustments based on an organization’s previous performance. I’m still torn on whether I am on board with the whole ACO concept. I understand that we need to generate savings for Medicare and deliver more quality care to patients, but it seems overly complex.

In my market, the ACOs are all over each other and it’s confusing for patients, who may not be motivated to seek care in the way that the ACO wants them to. Some may not even realize they’re part of an ACO. Many of us who have insurance through our employers receive premium discounts for healthy behaviors. How about something similar for the Medicare set? Let’s split the savings between Medicare and the patients when diseases are managed through lifestyle interventions rather than drugs or surgery. I bet that would drive the needle in the right direction.

With the tagline “It’s time to rebuild medical education from the ground up,” the AMA launches an initiative called Accelerating Change in Medical Education. They’re accepting proposals for the ChangeMedEd 2015 conference in October. Additionally, a new policy statement calls for medical students to experience hands-on use of EHRs during training. I like the idea of actually teaching future physicians how to use EHRs well rather than just throwing them out on the wards and hoping for the best as many programs still do. Using an EHR well in the patient exam room is a learnable skill. Not everyone takes to it easily, but being able to interact well with patients while documenting and accessing information is a key skill that many end users still lack.

I hope that while they’re “rebuilding medical education,” they push for courses in the other key areas that none of us realized were part of the practice of medicine:

• Quasi-Mandates 101: Managing participation in federal and payer programs while keeping your sanity. (Prerequisite is “Zen Breathing 101: Skills to avoid strangling people who say this isn’t mandatory and that physicians have choices.)
• Open Wallet 101: Understanding all the outlays required to practice medicine. Includes coverage of AMA’s stranglehold on CPT code licensing as well as discussion of state licensing, DEA, state controlled substance permits, medical staff dues, professional liability coverage, specialty board fees, maintenance of certification, and more.
• Administralian 200: Learn how to speak fluent buzzword and translate what you are hearing from administrators. (Co-enrollment in Hospital Administrator language lab required.)
• IT Support Practicum: Learn how to work through help desk blockades and the magic words to getting administrative privileges so that you can install useful medical apps on your personal device.
• Medical Review Practicum: Learn how to navigate payer phone trees and multi-level case reviews to ensure your patient receives the care he or she needs.

Most of my professional friends know I’m pretty happy in my new role as a free-range CMIO, but that doesn’t stop them from sending potential opportunities my way. Some are serious and some are hilarious. They also send clippings form sites like Glassdoor with reviews of potential employers. One I received today wins the prize. It was from a hospitality employee at a major teaching hospital. “Pros: great benefits, discounts on meals, yearly bonuses. Cons: you have to interact with a lot of sick people at work.”

I’ve always been a sucker for Vespa scooters. After today, though, I know that if I decide to move to fewer than four wheels, it will have to be in one of these. Thanks to the intrepid reader who sent it, making my day. I’m sure I can get a matching helmet to complete the ensemble.

Email Dr. Jayne.