Out in the Desert with the CMA—ruminations on ACOs, patient satisfaction, and more

  • Pauker, Kenneth, MD
| Jun 20, 2011

The first weekend in June, I drove out to the Renaissance Esmeralda Resort in Indian Wells, a lovely property that was graced that weekend with almost perfect weather, even for a heat-shy coastal Orange County guy like me. However, I did not go for the invigorating drive, nor the balmy desert atmosphere, nor the luxurious embrace of this fine resort. Instead I was there to attend the California Medical Association’s  (CMA)14th Annual California Health Care Leadership Academy, this year’s theme: “The Next Step: Successfully Negotiating Health Reform.” This time, my third as a participant, was for me the most informative and productive.

In the materials for the conference, the CMA states its purpose like this:

“The California Health Care Leadership Academy was created in 1997 to help physicians and other health system stakeholders better understand leading-edge trends and developments in the rapidly changing health care marketplace. Since its inception, the Academy’s focus has expanded to promote effective medical practice management and to facilitate the development of essential health care leadership skills. Recognizing that leadership demands access to and command of current and relevant information, the Leadership Academy is designed to arm participants with knowledge that will enable the development of creative, proactive and collaborative solutions to the challenges of the evolving health care environment.”

Well, this philosophy and the program particulars certainly spoke to my interests as a CSA leader. The only similar program in this subject area is the annual ASA Practice Management Conference, another highly recommended resource, but the CMA program includes the essential perspectives of who and what is unique to California. And so, I went, and found roughly 300 pre-registered participants and 30 faculty, but just 4 anesthesiologists—Drs. Narendra Trivedi and Lee Snook (a CMA trustee and candidate for CMA office in 2012), Brian Cross (a CSA Delegate) and me. What’s up with that?

A few Interesting kernels to bring home were:

Mark Smith, M.D., President and CEO of the California HealthCare Foundation

  • “One man’s waste is another man’s mortgage payment.”
  • “Accountable Care Organizaions (ACOs) are a little like unicorns—no one has actually seen one. And how do they save money, exactly?”
  • “it’s a little like the underpants gnomes from South Park, whose business plan is (1) collect underpants, (2) ???, (3) profit.” http://en.wikipedia.org/wiki/Gnomes_(South_Park)

Tony Schiff, attorney, Professor at the UCLA School of Public Health:

  • He discussed capitated medical groups and IPAs (250 in CA, 90% of which have < 25,000 “lives”), ACOs, joint ventures, medical foundations, and outpatient departments.
  • “The speed of health care delivery changes in a given geographic region will be significantly impacted by the amount of competition between/among hospitals and the numbers and types of physicians.”
  • “The Medical Foundation Model evolved over time.”
  • “The governance of a Medical Foundation Model is as big a nightmare as operating a hospital, and more.”
  • Culture eats Strategy for lunch.”
  • Be sure to read in The New Yorker Atul Gwande’s The Hot Spotters: Can we lower medical costs by giving the neediest patients better care?http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande
  • “With ‘Grouping Up,’ there are many key questions—know your key strategic goals, which models are right for your community, what transitions and accommodations are needed, is there a significant group of practitioners who share the same professional values?”

Herb Schultz, former Schwarzenegger Health Policy Guru and now Western Regional Director for U.S.  Department of Health and Human Services (HHS):

  • “Call or write me with your questions. I am accessible.”
  • Cell: 415-265-7049
  • Herb.Schultz@hhs.gov
  • “ACOs are also known as ‘Advancing Cartel Opportunities.’”

Fred Lee, a consultant in patient relations and service excellence, formerly with Disney:

  • “If Disney ran your clinic, you would consider patient satisfaction a fool’s gold.”
  • “Research on satisfaction shows… One a scale of 1 to 5, people who mark 4 are six times more likely to defect to the competition than those who mark a 5.”   —Harvard Business review, Nov-Dec, 1995.
  • “If Disney ran your clinic, you would clarify the link between risk management and patient loyalty.”
  • “Instead of feedback being used to impress, it should be used to improve.”
  • “In tracking feedback by physician, the two best feedback questions (rate1-5) are: (1) How well did your doctor explain things in words you could understand?  (2) How well did your doctor listen and respond to your concerns? And a third (with no scale): Is there anything else you’d like to tell us about?”

Being a member of and becoming involved and engaged with the CMA is something we in the CSA have not emphasized enough. And so, there was a meager turnout by anesthesiologists at this conference. The CSA and CMA are bound together and support each other in many critical ways. In California, as regards medical politics, the CMA is where the rubber meets the road. On every issue, our state legislators will ask, “Well, what does the CMA say on that matter?” The CSA can look to the ASA to represent us nationally, but here in California, to accomplish our objectives, we must work with and support the CMA. We are partners with CMA in our lawsuit aginst the Governor on his opt out action. I attended a CMA Scope of Practice Partnership Committee meeting during this conference, and was reminded that there are many comparable issues where the CSA must support our colleagues in the CMA. FYI, I did mention the concept of Anesthesiologist Assistants (AAs)—described their role, but explained that the CSA is not be ready to advance AAs just yet. The committee was receptive to the AA concept.

Going forward, please consider becoming a member of the CMA. I know what we all spend to be members of the CSA and ASA, and the Political Action Committees  (PACs). Moreover, joining CMA requires membership in your county medical society. However, there is high value here.  CSA members at all levels, especially present and future CSA leaders, need to think about the CMA statement of purpose for this conference (quoted above near the beginning of this blog) and participate, particularly now when the landscape is changing for all of us so rapidly and in so many ways.

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