Medical EducationPopulation HealthResearch
October 28, 2014

The Missing Dimension of Residencies That Will Affect Your Program’s Future

Residency programs need to change. I write this as a former family medicine residency program director who spent much of my professional life teaching residents and medical students. Specifically, residency programs need to get on track in the value-based health care world. To fail to do so is to become obsolete. Here‘s the problem: Like most residency programs, our teaching focused on individual patients, in both the office or in the hospital. While we treated specific conditions and used protocols, however, we never evaluated performance of a patient population, particularly over an extended time frame. Quality Measurement is Now Central…
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Population HealthResearch
October 22, 2014

Research Revolution: Why Everyday Medical Decisions Need More Science

How can a physician know when a treatment actually works? Let’s examine the case of outcomes for patients with asymptomatic bacteriuria. In a recent study, patients with the diagnosis were randomized to receive either an antibiotic or a placebo; the outcome measure was the proportion who developed symptomatic bacteriuria. The findings? Both groups had nearly the same proportion of symptomatic bacteriuria at the end of the study. Clearly, the antibiotic made no difference in outcomes. But this can be a hard sell, not only for patients who expect their physicians to “do something,” but also for physicians, who believe that…
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Medical Education
October 15, 2014

Asset or Liability? How Your Residency Programs May Affect Your Competitive Standing

At its core, value-based medicine is all about aligning physician and hospital costs with the quality and effectiveness of care. But all too often, providers ignore the impact of one of their greatest workforce resources: residency programs. In many environments, residents deliver much of the front-line care in hospitals, emergency rooms and in employed primary care practices. But who is measuring your residents’ unique contribution to quality and costs? Can you assess how resident-delivered care affects your bottom line?  And here’s the kicker: Will subsidized medical education continue to be a given in the future, if residency programs fail to…
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Value-Based Payment Modifier
October 8, 2014

The “Avoidable Admissions” Pitfall: What Your Physicians Must Know to Avoid Medicare Penalties

Hospital and physician groups, take note: If you’re admitting patients to hospitals for complications that could have been prevented by better outpatient care, your Medicare revenues are in jeopardy. Under the 2014 Value Based Payment Modifier (VBPM) formula, groups that admit more patients for conditions classified as “avoidable” will risk penalties if their admissions are higher than similar sized groups, and reap rewards if admissions are lower. ACOs have similar reward structures associated with their hospital costs; in 2015, groups participating in ACOs will also bear risk under the VBPM. This is one of the ways that Medicare is instilling…
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PQRS Reporting
October 1, 2014

Is Your PQRS Program “Old School”? Shift Your Focus to Competitive Performance in 5 Key Steps

It used to be that CMS rewarded providers almost exclusively on the reporting of PQRS quality measures. Providers received a Medicare bonus even if they did not meet a measure’s performance. Medicare still requires PQRS reporting to avoid penalties and receive a bonus, but CMS has now made it the first step in a larger quality measurement process. Performance on measures is now critically important for practices or groups falling under Value-Based Payment Modifier (VBPM) quality tiering or who participate in an ACO. This includes the vast majority of all physicians. Bottom line: It’s no longer enough simply to report…
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