Innovation and Enlightenment: CV Conference Highlights and Insights

Thursday, November 3, 2016 | Larry Sobal

 

 

Last weekend a few hundred cardiovascular physician and administrative leaders from top heart programs across the country gathered in Austin for MedAxiom’s CV Transforum Fall’16 conference. It was our biggest fall conference to date, and by most accounts, our best. The meeting agenda leveraged the power of our members through the sharing of their successes along with external experts adding their insights. I always leave the meeting feeling blown away by the shared innovations, and enlightened by how programs are embracing and succeeding in a rapidly changing environment. I hope you were there, but in case you couldn’t make it, here are some of the highlights.

On day one, attendees had the option of two pre-conference sessions—either physician leadership training with Dr. Ed Walker from University of Washington or a deep dive into Cardiac Bundles. Since we are just a few days/weeks away from CMS releasing its Final Rule and naming the 98 locations that will be mandatorily exposed to AMI and CABG bundles, I opted for the Bundles session. The large crowd demonstrated the acute interest (and anxiety) about this topic; we were all engaged and educated by the presentation of Ed Bassin, PhD and Chief Analytics Officer of Archway Health Advisors and MedAxiom’s own senior consultants, Anne Beekman and Ginger Biesbrock.

Although bundled payment initiatives have been around since 2009, the Proposed Rule for the CV bundles will be a very different challenge for the chosen participants. Ed pointed out that success in CV bundles will require real innovation, and simply copying what others have done in the joint replacement bundles won’t be the best option. He emphasized the need to understand technical versus insurance risk in this bundle population and also noted that the CABG bundle will require very different hard-wiring of clinical and process changes from the AMI bundle.

Marcus Osborne, Vice President, Health & Wellness Transformation & Innovation with Walmart, gave the keynote talk on retail health care. He expressed that one reason the current health care model is struggling is because we are trying to equally align providers, payers, employers and patients. He offered his examples of how the system is not designed for consumer engagement and, with over one million insured employees and dependents, described what Walmart is doing to optimize the needs of these patients.

Dr. Fernando Triana, Medical Director of the CV Service Line for Methodist Healthcare system, presented the details around his innovative and groundbreaking Cardio-Hospitalist program. Although many heart programs have adopted a model of placing a cardiologist in the hospital to cover patient consults during the day, this program provides cardiologist coverage around the clock in 8-hour blocks, and has created impressive improvements in mortality, morbidity, length of stay and cost per case. 

Drs. Ed Fry, Chair of the Cardiology Division and CVSL at St. Vincent Health Center, and Stefanie Fry, St. Luke’s Idaho Cardiology Associates program, spoke about their organizations’ efforts to address physician and caregiver stress and improve the work environment that physicians and other caregivers are currently struggling with (the Quadruple Aim of health care). Aside from the Triple Aim goals of improved quality, patient experience and lowered costs, new legislative initiatives such as MACRA and Episodic Payment Models will require high levels of physician engagement. For many physicians, EHRs have not improved efficiency or simplified patient care workflows. The presenters pointed out how progressive organizations are stepping forward with honest conversations around this issue and taking formal steps to create environments that improve the joy and passion that drew people to work in health care.

I always leave the meeting feeling blown away by the shared innovations, and enlightened by how programs are embracing and succeeding in a rapidly changing environment.

Dr. Tom Klevan, Medical Director, CVSL, and Audrey Douglas-Cooke, Vice President, Patient Care Services, Sentara Healthcare, shared their experience in developing a comprehensive bundled payment model for Heart Failure. Creating meaningful and lasting clinical improvement is a competency many organizations have yet to master. They provided a clear road map and data supporting how Sentara has improved CHF patient outcomes, while reducing length of stay, and cost per case using targeted pathways and engagement of heart failure navigators.

Jim Pool and Joel Porter, both attorneys with Maynard Cooper & Gayle, offered valuable explanations of the financial mechanics of the new bundled payment initiatives and ways that physicians and hospitals may want to structure and align incentives to achieve success. Furthermore, they offered their insights into the tricky relationship between the expected bundle legislation and its potential conflicts with existing Anti Kick-back and Stark provisions, and shared whether the bundled payment program will include exceptions that reduce the conflicts. Just like with MACRA, the bundled payment incentives place emphasis on achieving high-quality performance to optimize potential rewards.

Finally, the conference included a lot of information sharing and insights into the recent MACRA Final Rule. Cathie Biga, CEO of Cardiovascular Management of Illinois, gave attendees the breakdown of what they need to be doing to be ready for MACRA on January 1^st. She stressed the importance of organizations knowing their 9 measures, and the degree to which Quality performance will impact the route to either a penalty or bonus starting in 2019. Above all, she hammered home the need to have a solid MACRA infrastructure in place, starting with Meaningful Use and PQRS-related processes.

Space does not allow me to cover all the important topics and engaging speakers the conference offered. We had an amazing three days in Austin with the largest Fall meeting attendance ever. If you were with us, let me know what you most enjoyed. And if you missed out, make your plans now to attend CV Transforum Spring’17, April 18-20 at the Ritz-Carlton on Amelia Island, Florida.

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

 

 

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