President's Perspective June 2016
Adapt and Focus
more concerned we become over the things we can’t control, the less we
will do with the things we can control.”—Renowned Basketball Coach John
Sean T. Grambart, DPM, FACFAS
Wooden’s life lesson is a hard one to adapt to and live by because we
as surgeons can naturally be “control freaks.” If you’re like me, you
micromanage everything in our practice. I’ve become so bad that I’m
getting to the point of scheduling patients. No one knows your patients
better than you, and nothing ruins a day more than having back-to-back
“special” patients who will put you behind an hour. Minor things, such
as the heel not being off the blankets during an arthroscopy, can set
the day in the wrong direction; we are such creatures of habit!
of the last 10 years in your practice. What things do you no longer
have control over that still make you upset? For example, in the age of
electronic health records (EHRs), gone are the days of having
face-to-face conversations with my nursing staff about patients. Now,
“SOAP” notes serve as our communications for patient orders and
encounters. I respond with type notes, which sets off a chain of even
more “SOAP” messages between nurses, patients and myself. It feels like a
Remember the good old days when you cleared
your desk and left the office with a sense of accomplishment? Now
information and results are sent to you 24-hours-per-day, and I find
myself checking results at all hours (see the above paragraph on being a
And finally, what about the loss of control we
feel about our practice, the healthcare system and reimbursement in
general? I went from being a shareholder in a group to an employee of a
hospital. While I enjoy the security and collegiality of a hospital
group, I miss having the ability to provide input on decisions that
affect my practice.
One of the most recent out-of-my-control, “hot
topic” emails I’ve received from hospital administrators has been about
Medicare Access and the CHIP Reauthorization Act of 2015 (MACRA), which
will make sweeping changes to how Medicare pays for physician services.
In late April, CMS issued a 962-page proposed rule implementing key
provisions of the new physician payment system. The rule proposes that
the first performance period would start in 2017 for payments adjusted
MACRA sunsets three existing physician quality
performance programs—the physician quality reporting system (PQRS), the
Medicare EHR incentive programs (Meaningful Use) for eligible
professionals and the value-based payment modifier (VM)—and consolidates
aspects of those programs into the Merit-based Incentive Payment System
(MIPS). Starting in 2019, MIPS will be the default payment system for
eligible clinicians. MIPS will also assess eligible clinicians on four
performance categories—quality measures, cost measures, clinical
practice improvement activities (CPIAs) and meaningful use of EHRs.
Based on their MIPS performance, eligible clinicians will receive
positive or negative payment adjustments of 4 percent in CY 2019, rising
gradually to a maximum of 9 percent in CY 2022 and beyond.
we as surgeons may not have control over MACRA, the College will be
monitoring the changes and taking steps to prepare our members for the
implementation of this policy change.
In this ever-changing
medical environment, remember Coach Wooden’s advice—adapt in our
practices and focus on the things we do have control over instead of
those things out of our control. If we do, I believe we will begin to
see more positives and less stress in our work day—ultimately benefiting
our practices and our patients.