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Many Mountains to Climb

September 26, 2011
by Mark Hagland
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Medical Group Leaders Face a Broad Range of Strategic IT Issues Going Forward

EXECUTIVE SUMMARY:

Medical groups of all types and sizes stand collectively at a crossroads in the evolution of the healthcare industry in the United States at this point in time. Faced with a welter of issues, from reimbursement concerns to mandates coming out of federal healthcare reform and the American Recovery and Reinvestment/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act and other legislative and regulatory developments, and competing to better serve the needs of both patients and payers and purchasers, the CEOs, CIOs, and others leading physician groups are working assiduously to find ways forward that meet the demands of stakeholder groups while also meeting the needs of their practicing physicians.

In order to get a sense of where the leaders in the field are at this point in time, Healthcare Informatics Editor-in-Chief Mark Hagland gathered together several leaders of pioneering medical groups nationwide through a “virtual roundtable” process late this summer, in which he interviewed successive leaders and “shared forward” their thoughts with the others around this “virtual roundtable.” Below are excerpts from the progressive interviews. Capsule profiles of the leaders and their organizations can be found below.

Among the many issues facing these leaders: how to plan for the development of accountable care organizations (ACOs), the patient-centered medical home model, bundled payments, and other federal policy requirements; how to make progress towards meaningful use, under the HITECH Act; how to plan for ongoing infrastructure, interoperability, and mobility development; and how to prioritize a variety of disparate efforts aimed at fulfilling different types of needs. No one medical group leader has all the answers; but our panel of leaders certainly has many important and useful perspectives to share.

PARTICIPANTS

Mark Shields, M.D.
Mark Shields, M.D.

V.P., Advocate Health Care, and Sr. Medical Director, Advocate Physician Partners, Mt. Prospect, Ill. 3,900 physicians across N.E. Illinois, affiliated with Advocate Health Care

Tina Buop
Tina Buop

CIO, Muir Medical Group IPA Walnut Creek, Calif. 700 M.D.s across three counties in Northern California

Craig Lanway
Craig Lanway

CIO, Hill Physicians Medical Group San Ramon, Calif. 2,600 M.D.s across several counties in Northern California

Tim Terrell
Tim Terrell

CIO, Cornerstone Health Care High Point, N.C. 200 M.D.s across 75 sites in the Winston-Salem/Greensboro/High Point Triad region of North Carolina

James L. “Larry” Holly, M.D.
James L. “Larry” Holly, M.D.

CEO, Southeast Texas Medical Associates (SETMA) Beaumont, Texas 32 physicians in Southeast Texas

Healthcare Informatics: What are the most important, urgent strategic IT challenges facing you right now?

Tina Buop: I really think there are four top components involved, and they're all equally competitive with one another. The first is developing a strategic approach to identifying and implementing quality metrics, such as those required for meaningful use, those that have already been required for pay for performance, those required for evidence-based care, and those required for CMS Star [a program created under federal healthcare reform and administered by the federal Centers for Medicare and Medicaid Services (CMS) that pays Medicare Advantage health plans differentially according to their beneficiaries' experience of care and quality of care].

There are also accountable care organization metrics; there are existing PQRI [the federal Physician Quality Reporting System, still referred to as the Physician Quality Reporting Initiative across the industry] metrics; and then there are metrics to measure against compliance, such as the [federal] e-prescribing cutoff that happened in June. And in 2012, there will be 1-percent penalties under Medicare-and though it's not a quality metric per se, it's a compliance metric in that case.

HCI: That's a lot of items to think about at once.

Buop: It's daunting. Then you look at our core menu of measure sets for meaningful use, and the existing pay-for-performance metrics, and there is then the challenge of creating a crosswalk between those two areas. With all these different metrics, we could customize them to our hearts' content, but then you'd lose hundreds of thousands of dollars on each customization, because of the data feeds, etc., for each measure. For example, if our organization chose to customize a hemoglobin A1C measure, we would have to customize all our reports in that area, and doing so would make the task of maintaining the system daunting.

WITH ALL THESE DIFFERENT METRICS, WE COULD CUSTOMIZE THEM TO OUR HEARTS' CONTENT, BUT THEN YOU'D LOSE HUNDREDS OF THOUSANDS OF DOLLARS ON EACH CUSTOMIZATION, BECAUSE OF THE DATA FEEDS, ETC., FOR EACH MEASURE.-TINA BUOP

HCI: What are the top issues for you at Hill Physicians Medical Group?

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