Interim Meeting 2014

Ethics Forum: Pay for Performance

Posted in Ethics Forum, Health Reform, Interim Meeting 2014, Payment Reform, Tiering on December 5th, 2014 by MMS Communications – 1 Comment

Since its introduction some ten years ago, Pay-for-Performance (P4P) has been the object of much confusion, conversation and scrutiny in the medical industry.

Such programs have raised a host of practical questions: What criteria do you use to objectively judge performance? How do you develop incentives for accomplishment and penalties for falling short? What principles do you use to guide such programs?

Practical considerations aside, the payment system has also raised some important ethical questions, and those were the focus of the Ethics Forum at the 2014 MMS Interim Meeting on Friday, December 5 presented by the Committee on Ethics, Grievances and Professional Standards.

Offering their perspectives on the topic of Ethics of Pay for Performance were Alyna T. Chien, M.D., M.S., a pediatrician at Boston Children’s Hospital and the lead investigator in four different projects focusing on the effectiveness of payment and quality incentives, and Sachin H. Jain, M.D., M.B.A., Chief Medical Information and Innovation Officer at Merck and Lecturer in Health Care Policy at Harvard Medical School.

“We are in a revolution,” said Dr. Chien, “as the entire organization of medicine is changing, progressing to one of integrated health care.” She noted that most incentives move from the payer to the hospital or physician practice, and that most of the data regarding the impact of P4P programs exists at the organizational level. There’s little data on how it works at the individual physician level.

Dr. Chien believes these performance programs can have one of three effects in delivering care: a neutral effect, where the status quo is preserved; a narrowing of care, where more attention is paid to quality and more programs are tailored to patients; or a widening of care, where gaps will occur between rich and poor and physicians will selectively pick their patients.

Dr. Jain acknowledged that the public perception of the profession has changed and that physicians should be at “a point of soul searching and questioning where we are in society.” He offered a scenario of physicians as either “knights” (motivated by altruism and being the ultimate champion of the patient), “knaves” (driven by self-interest and financial gain), or “pawns” (pushed by rewards and penalties of the system in which they operate).”

While he pointed out that such a framework can also be applied to others (for example, patients, health plans, pharmaceutical companies, nurses, and hospital executives), Dr. Jain believes organized medicine has focused too much on reimbursement and that physicians are perceived not to be trusted to do what’s right unless there’s a carrot or stick approach.

“We are losing our more intrinsic value in favor of pay-for-performance,” Dr. Jain says, “and the intrinsic motivation of doing what’s right for the patient must be preserved. It is what differentiates us from other professions. It is what tells others that we will do the right thing whether we get paid or not.”

His prescription is direct: a proper system of reimbursement must offer a reasonable salary, reject incentive contracting, focus on clinically meaningful measures, make it easy for physicians to do the right thing for patients, and find ways to honor and reward the intrinsic motivation of what’s best for the patient that most physicians have.

Presentations at the Ethics Forum may be viewed here.

2014 Annual Oration: Medical Education Across The Continuum

Posted in Interim Meeting 2014, MMS Oration on December 5th, 2014 by Erica Noonan – Comments Off on 2014 Annual Oration: Medical Education Across The Continuum

This year’s Annual Oration, Medical Education Across The Continuum: A Snapshot in Time, focused on changes in medical school curriculum have impacted residency training, how residency training influences change in practice, and how clinical practice now informs continuing medical education.

The speaker Michele P. Pugnaire, MD, professor of Family Medicine and Community Health and Senior Associate Dean for Educational Affairs at the University of Massachusetts Medical School, spoke of the changes in the medical education process over the past century. “We are what I am calling `forever learners’ because that is what is expected by the public, our patients and our students,” said Dr. Pugnaire.

There are four drivers in medical educational change: team-based learning, practice-based learning/simulations, outcome-based learning, and improvement based learning, said Dr. Pugnaire. Today’s medical schools are embracing all of them, and some programs are switching from timeline-based programs to more flexible curriculum that judges competency rather than time spent in a classroom, she said.

The future will inevitable cause the educational driving forces to converge on a shared goal  for learning: patient safety and quality medical care, she said.

“We are training the next generation of future physicians – our replacements. They will be taking care of us and our families, so we had better do a very good job,” she said.

The MMS Annual Oration dates back to 1804 when Dr. Isaac Rand delivered his dissertation entitled, On Phthisis Pulmonalis, and the Use of the Warm Bath.  For more than 200 years, MMS orators have addressed a wide spectrum of topics germane to the evolving practice of medicine.


At MMS Interim Meeting, Leaders Urge Physician Leadership in New Era of Health Care

Posted in Interim Meeting 2014 on December 5th, 2014 by Erica Noonan – Comments Off on At MMS Interim Meeting, Leaders Urge Physician Leadership in New Era of Health Care

To open the 2014 MMS Interim Meeting of the House of Delegates, President Richard Pieters, M.D, recounted the changes and challenges in health care in the second year of  the Commonwealth’s health care cost control system.

The 2.3 percent rise in health care spending in the first year of the system — well below the state’s target of 3.6 percent — is “evidence that the entire health care community took the challenge of affordability very seriously,” said Dr. Pieters at the meeting’s opening session Friday morning.

Yet Dr. Pieters cautioned colleagues that the changes involve more than just cost control.  “This new era of health care,” he said, “is transforming almost everything we do.”

He cited significant changes in the state’s health care system, such as the emergence of new payments models, with new technologies being developed to support them; the continued consolidation of hospitals and physician practices, including more physicians moving from independent practice to employed status; and changes in prescription drug use, as successful new medicines are coming under intense scrutiny because of soaring costs.

The Society’s activity has also changed, he said, as advocacy has shifted from legislative to regulatory efforts. He called attention to the Society’s successful efforts over two years to ensure that the state’s mandate on physician proficiency with electronic health records was implemented with care and without disruption to physician practices and patient care, and he cited efforts in working with health officials in enhancing the state’s Prescription Monitoring Program in the face of a rising drug epidemic and without creating barriers to care.

Dr. Pieters also spoke of the Society’s new strategic direction regarding the advent of team-based health care, noting the formation of a Task Force on Interprofessional Care, led by Past President Ronald W. Dunlap, M.D., that will include representatives from other professions on the team and the preparation of legislation to “ensure that physicians are in the leadership positions of these teams.

“Physicians have the broadest and deepest training of anyone on the team, and the buck stops with us,” said Dr. Pieters.

Finally, Dr. Pieters acknowledged the Society’s efforts in assisting physicians in practice management, continuing medical education, membership development, and a renewed effort to engage young physicians.

“We must prove our value to our colleagues and our external stakeholders each and every day,” Dr. Pieters said, “because that what they have to do in their world, too. It’s a challenging world, but the MMS is in the right place at the right time to make a difference. ”