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October 24, 2012

MGMA 2012 Annual Conference - Small Steps, Big Changes

I spent a couple days this week at the annual meeting of the Medical Group Management Association, in San Antonio.  I had the opportunity to speak about health care social media to an engaged crowd (see synopsis here), and to attend a number of other interesting sessions.  As always, the hallway conversations, chats with vendors in and around the trade show booths, and the twitter back channel were among the most interesting parts of the experience. This meeting is larger than most that I tend to go to -- over 5000 attendees -- and there was quite a variety to the sessions -- ranging from the typical education sessions in parallel tracks, to general sessions with speakers who are as much performers as anything else, to presentations by sponsors/exhibitors both on-site and off-site. I encourage you to dip into the #MGMA12 tweetstream to get the full effect, and a better sense of the variety of what was on offer in San Antonio. 

Some folks with greater intestinal fortitude and more staying power than I can lay claim to -- including @IngaHIStalk -- made it to all of the vendor parties Monday evening. I was happy to make it to one, where Jonathan Bush of athenahealth was in fine form, braying as usual about the strength of his company's offerings and financial performance, and even donning WWF garb as athenaLibre to take on "The Meaningful Abuser."

One of the key takeaways from the meeting for me is confirmation of the introduction that I often include when I speak at outside of the Boston area -- I'm from the future.  Many basic assumptions that I have about the way health care works, the direction it's headed, and the things government does to it along the way are not necessarily built in to everyone's baseline thoughts about the health care environment.  National health reform is based in large part on the Massachusetts experience to date, and Part 3 of Massachusetts health reform is just getting underway, with a move towards limits on the growth of the health care spend (Mass. GDP +1%), ACOs for all, and an abandonment of fee-for-service reimbursement. These developments are necessary because we must all focus on improving quality while reducing cost. We will first begin to control the rate of growth in health care reimbursement, and then reimbursement levels will be heading inexorably downward. We can't wait until the health care spend cracks 20% of GDP. In order to address these hard truths, many theories and services and products are cropping up -- and they were all on offer at MGMA 2012.  

All the companies whose names begin with a lower-case "e" or are invented words were there to pitch their visions of integrated electronic management of the physician practice: including its patients, patient records, business intelligence, billing and collections. Meaningful use of certified electronic health records is just the tip of the iceberg.

They, and payor representatives, and a cadre of consultants, were there to highlight the many different ways in which practices need to get a handle on their patients, their patients' needs, their chronic and acute conditions, and the management of their care.  After all, doing so will contain costs, improve quality, reduce the need for hospitalizations, etc. Many tools and techniques were discussed to hep achieve the goal of improved communications with patients, which can improve the care that is delivered (and also to do things like reduce missed appointments, which add unreimbursed costs to the system), and improve patient compliance with physician recommendations for the lifestyle changes that are the key to reducing cost, improving quality, and improving health.

The American Hospital Association, American Medical Association, and Blue Cross Blue Shield Association representatives all said the things you might expect them to say (check out the tweetstream).  

Most practices represented at the conference seemed to be interested in maintaining their independence, even as speaker after speaker detailed the growth in numbers of hospital-owned practices (numbers bandied about ranged from 20% to 50% -- the twitterati, both on-site and off-site -- were able to confirm for me within minutes, with citations, that the 50% figure is closer to the mark; thank you @JMLineberger and @Cascadia).  One session, however, focused on the notion of increasing physician-hospital alignment through mechanisms other than practice acquisitions, and included several testimonials from the floor regarding the success of IPAs and PHOs from all over the country.  Speaking of alignment, I attended a good session on physician-hospital alignment presented by a representative of CHRISTUS Health, who was able to speak about her experience in building successful physician-hospital relationships.  (Again, check out the tweets for more detail.) It is a truism, but one of the general session speakers focused on the need to build trust as a prerequisite for physicians and hospitals to be able to work together productively. In general, many of the presentations and exhibitors were focused on the small, practical steps that practices need to take in order to succeed in the rapidly-changing current environment.

Some of my exhibit hall and hallway conversations with other speakers, attendees and vendors focused on the need for pathways to alignment other than practice acquisitions by hospitals, acquisitions by or mergers with other practices.  The proliferation of cloud-based software solutions brings sophisticated tools within reach of smaller practices, and enables them to participate "virtually" in the latest innovations in health care -- such as Accountable Care Organizations, both in the Medicare realm and in the commercial realm, by bringing powerful analytical resources to bear on the issues central to success in shared savings programs, including knowing one's costs and margins, and one's patients' profiles, and communicating with patients via text message, email, voice mail, per patient preference.  Since most physicians in the US (and among the MGMA's 13,000 members) are in groups of 10 or fewer physicians, the availability of these tools is a critical development.

I'll close with mention of two of the smaller companies whose services caught my eye in the exhibit hall -- MD Clarity and RegisterPatient.  Each is focused on a core offering with related items either already in the market or in the pipeline.  Each addresses a pain point in the experience of the physician practice, in a way that I have not seen elsewhere.

In my presentation about the risks and benefits of using social media in the health care realm, I asked (rhetorically) whether anyone in the room would want to have their patients post a prescription refill request on their practice's Facebook page, and suggested that if they didn't want that to happen, they should address the issue of waht's OK and not OK to post in policies and procedures accessible to visitors to the Facebook page.  Well, RegisterPatient has built a Facebook app for prescription refills, and for making appointments, replicating the functionality of its own website, and also sets up Facebook pages for its clients (often small practices without websites), where the app may be accessed as a "tab."  Kudos to this firm for addressing this need and for working on related needs of the small practice.

MD Clarity brings me full circle, back to the latest piece of health reform in Massachusetts.  One section of the new law requires that, if asked by a patient before an elective visit or procedure, a health care provider must tell the patient the cost of the service to the patient (including the rate paid by the patient's insurance company, if applicable, and patient copays and deductibles) - within four business days.  (As an aside, let me just marvel at the notion that a significant sector of the nation's economy does not regularly quote prices or rates in advance of purchases, and in fact cannot do so on less than four business days' notice. As an aside to that aside, let me note that the American Hospital Association, in response to the draft Meaningful Use Stage 2 regulation which sought to establish a 36-48-hour timeline for making medical records available to patients upon request, replied that a 30-day timeline would be more reasonable. Some of us think that as soon as someone other than the clinician making the entry has access, the patient should have access.) MDClarity allows a provider to provide the cost figures to a patient in real time, at the point of service.  A provider's payor contracts can be configured on this system, and patient enrollment, eligibility, deductible, copay and other infomation can be called up in real time. The information pulled by this product enables practices to improve the accuracy and timeliness of their billing and collections, and enables them to comply with laws such as the price transparency mandate in Massachusetts.

My story about MGMA 2012 ends here, but the bigger story about physician practices working towards success in an ever-changng environment continues.  Stay tuned.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 

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