LIVE from the MGMA Annual Conference: The "SGR Problem" Casts a Long Shadow Over MGMA12

April 10, 2013
As Medicare reimbursement issues create gloom for physicians nationwide, medical group leaders nationwide are facing profound 'chicken-or-egg' questions around how and even whether to invest in the critical IT investments, especially clinical ones, that will be needed to forge the new healthcare.

Was it just my imagination, or was this beautiful
piece of mobile art hanging in the Henry B.
Gonzalez Convention Center in San Antonio
purposely shaped like a backwards question mark?

This year’s MGMA Annual Conference, sponsored by the Englewood, Colo.-based Medical Group Management Association, and held at the Henry B. Gonzalez Convention Center in downtown San Antonio, Texas Oct. 21-24, offered a range of contradictory, even conflicting, impressions.

Indeed, even the opening panel discussion, featuring association leaders representing independent physicians, physician groups, hospitals and health systems, Blue Cross and Blue Shield health plans, and employers, presented a split-screen image of healthcare at the present moment. On the one hand, to a person, all of the panel members affirmed the determination of the members of their various associations to realize the dream of the new connected, metrics-driven, continuously improving, more accountable and transparent healthcare. On the other hand, every single one of the panel members also cited very significant obstacles to the achievement of that grand vision.

And, looming over everything this year was the specter of reimbursement uncertainty, an uncertainty that encompassed potential cuts coming out of the Budget Control Act, possibly very large Medicare provider cuts emerging out of the looming federal budget sequestration process (should Congress not move decisively to avert the nation going “over the fiscal cliff” in a few months), and most of all, the gigantic set of issues around what’s become known as the “SGR problem”—the need for Congress to address Congress’s having continued to avert Medicare physician payment cuts embedded in the program’s sustainable growth rate payment formula.

All these reimbursement-related concerns were such that, in a survey released on Monday, Oct. 22, MGMA member-organization executives cited payment uncertainty as having already forced them to reduce clinical staff, delay purchases of equipment or facilities, and cut back on charity care. And though the survey did not ask group practice executives specifically about investment in electronic health records, the responses of medical group executives certainly implied ongoing hesitation about moving forward with alacrity to implement the truly robust information systems that will be needed to support accountable care organizations (both federal and private), bundled-payment contracts, patient-centered medical homes, transitions-of-care programs, and other efforts.

Indeed, only 18 percent of survey respondents said that their organizations were involved in such initiatives, while the remaining 82 percent indicated that they would be interested in pursuing such arrangements, if they could rely on greater policy and reimbursement certainty.

Perhaps physician group leaders could take inspiration from keynote speaker Benjamin S. Carson, Sr., M.D., who shared his very inspiring personal story with conference attendees on Wednesday morning. Dr. Carson overcame poverty and family instability in his childhood, as well as some early problems with schoolwork, to graduate from college and medical school, and eventually become a pediatric neurosurgeon at Johns Hopkins Children’s Center in Baltimore, and ultimately the director of pediatric neurosurgery there, and the recipient, in 2008, of the Presidential Medal of Freedom, the highest civilian award in the U.S.

Benjamin S. Carson, Sr., M.D.

One thing I particularly liked about Dr. Carson’s address was his willingness to bring forward his own ideas and to be consistently outspoken in his views, based on his very self-motivated philosophy of life. As he told his audience Wednesday morning, “I’ve gotten involved in the healthcare debate: why? I know that in doing so, you make some enemies. But the fact of the matter is, we do need good healthcare reform in this nation. We spend twice as much on healthcare per capita than the next highest nation,” he added. “So it’s not that we don’t care, it’s just that way do it the wrong way.”

In a conversation following his keynote address, Dr. Carson told me, in affirming and expanding on the remarks he had made earlier about electronic health records, that he absolutely supports robust EHR and clinical IT implementations, and believes that specialists like himself are coming around to automation, provided that “all the bugs can be worked out first.”

I do wonder about many of his colleagues nationwide, though. For even as healthcare reform and the meaningful use process under the HITECH Act are either explicitly or implicitly demanding not only the implementation of core EHR and other clinical information systems, but also the very robust leveraging of data analytics, business intelligence, and population health tools to move healthcare delivery forward, physicians on the whole are still hesitant to make the full leap into the new healthcare IT world.

And though physicians obviously face tremendous financial and operational hurdles in moving forward to invest in these vital systems, one feels very strongly the “chicken-or-egg” aspect of the argument around clinical (and other) IT investment in the medical practice space, because it will only be through such investments that U.S. doctors will achieve the efficiencies they so desperately need to not only survive but also thrive in the emerging operational environment in healthcare.

So, as much as one would never want to trivialize the potentially devastating effects of Medicare reimbursement cuts, it is also exceptionally clear at this moment that America’s doctors hold in their hands the potential to play a huge role in creating their own future and the future of healthcare. And let’s face it: with the ongoing aging of the population, the accelerating explosion in chronic illness, and other adverse factors weighing on U.S. healthcare, will there ever be a “perfect” time to invest in the clinical IT that physicians need to help forge the new healthcare? The obvious answer to that question is, no; no, there never will be.

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