Category Archives: SOHL blog

In theory, theory and practice are the same. In practice, they are not.

MACRA, Medicare, health policy

Last month Modern Healthcare published an article titled: “Many Medicare ACOs would quit rather than face risk next year.” In fact, 71% of ACOs surveyed said they would disband if forced to assume risk. Six years after the program began, we’re reminded that policy is one thing—implementation is another.

In April, SOHL hosted a panel on translating policy into practice.

Dr. Ashby Wolfe, Chief Medical Officer of CMS Region IX, gave a special presentation on MACRA and the Quality Payment Program (QPP). She showed how the Centers for Medicare and Medicaid Innovation (CMMI)’s initiatives fit together toward a unified vision. There is, in fact, a method behind the madness.

Joining her were Vanessa Schatzberg from UC San Diego Health and Jan Sebring from Family Health Centers of San Diego. Nick Macchione, Director of San Diego County HHSA, moderated the panel.

Vanessa manages UCSD’s physician ACO and clinically integrated network. She shared lessons learned from the health system’s journey—tying together policy and practice from an operational standpoint.

A nurse practitioner by background, Jan works with providers to build order sets and decision aids in the clinic’s homegrown EHR system. Jan gave the boots-on-the-ground clinical perspective. She paraphrased a quote from The Martian (2015) to characterize implementing change in healthcare: You do the math, then work the problem, then do the math… and so on.

Judging from providers’ reactions to taking downside risk, it seems that the CMS needs to do the math and work the problem some more.

Christopher K. Lee, MPH, CPHQ is Clinical Solutions Marketing Manager at Family Health Centers of San Diego.

How much of healthcare is driven by self-preservation?

I think this is an uncomfortable question for many of us. We are committed to doing no harm. We view our professions as a calling and hold ourselves to high standards. We strive to do right by our patients.

At the same time, it’s a valid question.

I recently attended two events that made me ponder this.

The first was at the University of San Diego (USD). Navrina Singh, Principal Product Lead for Microsoft AI, spoke about the hope and hype of artificial intelligence. One healthcare example she gave involved lab imaging. Assisted by AI, one radiologist can potentially do the work of ten. That’s clearly a win for health systems and perhaps for patients. Yet it’s a stressor for radiologists concerned about job security.

The second event was at the California Endowment in LA. At lunch I chatted with Dr. Steven Steinhubl, Director of Digital Medicine at Scripps Translational Science Institute (STSI). He likened the disruptive changes in healthcare to the film processing industry.

Prior to medical school, he had worked at Kodak, which invented the digital camera in 1975. Kodak executives knew the future was digital photography, yet they weren’t ready to abandon traditional film. After all, their workforce of chemical engineers weren’t too excited by the prospect of digital imaging.1

Healthcare is caught at similar crossroads. How many hospitals want to maintain their heads in beds? How many physicians oppose scope of practice expansion for mid-levels? How often do we see knee jerk resistance against technology and reimbursement changes?

So we must ask ourselves: How much of healthcare is driven by self-preservation?

1 To their credit, Kodak did become the market leader in digital camera sales by 2005. Unfortunately, they were fixated on selling inkjet printers and didn’t anticipate that, in a few short years, consumers would no longer care about having physical photographs.

Christopher K. Lee, MPH, CPHQ is Clinical Solutions Marketing Manager at Family Health Centers of San Diego.

Safe travels to Congress!