President's Perspective June 2016

Sean T. Grambary, DPM, FACFAS

Adapt and Focus
“The 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 Wooden
Sean T. Grambart, DPM, FACFAS
ACFAS President

Coach 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!

Think 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 never-ending cycle!

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 control freak).

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 in 2019.

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.

While 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.

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