- Joined
- Apr 16, 2012
- Messages
- 17
- Reaction score
- 7
I found the below video interesting/useful and tried to summarize the highlights as accurately as possible.
Summary:
1:30 – Medicare SGR (Substantial Growth Rate) repeal issues.
5:50 – Independent Payment Advisory Board (IPAB) he calls the single most dangerous thing in HCR (Health Care Reform).
8:15 - Value-Based Payment Modifier (VBPM) will result "value" based payment system. How do you define "value:" quality measures. The difficulty with quality measures for PRS is only have a lot of level 3 or 4 evidence (=bad).
12:10 - Train has left the station, so plastic surgeons need to be at the table of decision makers
12:35 - The effect of accountable care organization on surgeons is unclear because it is run by primary care physicians.
14:50 - Quality reporting will result in payment reductions for not reporting. Same for electronic medical records tied to quality reporting.
17:40 - New language of post ACA (nice summary list), with most important being 'efficiency.' Efficiency no longer only means good care and outcomes, but is also linked to costs.
19:00 - If you don't change, you will go away. This is especially if in private practice. In any context as a physician (even academics), you need to know how your individual results are coming out because this may determine your sustainability.
20:00 - Health care consolidation may mean the end of private practice. Plastic surgery will be the "last bastion" of private practice. Organizations are bringing in hospitalists because some data shows they can provide "better" care.
22:55 - Need to change how we think. To preserve our independence in clinical care (i.e., private practice) we need to follow evidence based approaches. No one will buy the response anymore: This is how I do it or this is how I was trained, etc.
23:55 - Efficiency means: improved outcomes and decreasing costs.
24:30 - Significant changes can result in 'never' events by taking a systematic approach with decreased cost and better care. Gives a nice example with infections and how surgeons can get involved. Surgeons will get dinged if antibiotic usage is not followed according to SCIP protocol. Hospitalists offer cheaper and better care.
30:05 - Physicians vs. Hospitals vs. Insurers. They are bigger and stronger, but they can't do it without us. Collaboration is the key. We need to be a part of the process.
31:05 - What do we need? We need more outcome-based data. Only a small percentage of plastic surgeons give data to TOPS. Have to buy into clinical/critical pathways.
32:20 - Decrease complications, decreased length of stay (this is biggie), increased patient satisfaction (another biggie, but plastic surgeons are way ahead of curve here), degreased costs. End result = 'Efficiency'
34:40 - New definition of care delivery: standardize to the science. It's an art about us as a whole.
35:10 - True clinical integration is all about the group.
35:25 - Critical pathways: checklist/cook book down to every detail. Very much like pilot industry.
36:35 - Need to think about how we can minimize risk in our practice. What we can be done preoperatively: tobacco AND alcohol use, nutrition, obesity, diabetes, steroid usage, remote site infection, colonization with microorganisms.
39:45 - Interoperatively: medical devices, operative time, minimize risk (e.g., O2 saturation levels, hypothermia).
41:55 - Postoperative: length of stay (biggie), early ambulation, early removal of indwelling devices, early postoperative instructions when coherent.
42:50 - Examples
43:40 - Summary: change way of thinking, build efficiencies into our practices, this is the only way to survive.
44:50 – Questions.
Summary:
1:30 – Medicare SGR (Substantial Growth Rate) repeal issues.
5:50 – Independent Payment Advisory Board (IPAB) he calls the single most dangerous thing in HCR (Health Care Reform).
8:15 - Value-Based Payment Modifier (VBPM) will result "value" based payment system. How do you define "value:" quality measures. The difficulty with quality measures for PRS is only have a lot of level 3 or 4 evidence (=bad).
12:10 - Train has left the station, so plastic surgeons need to be at the table of decision makers
12:35 - The effect of accountable care organization on surgeons is unclear because it is run by primary care physicians.
14:50 - Quality reporting will result in payment reductions for not reporting. Same for electronic medical records tied to quality reporting.
17:40 - New language of post ACA (nice summary list), with most important being 'efficiency.' Efficiency no longer only means good care and outcomes, but is also linked to costs.
19:00 - If you don't change, you will go away. This is especially if in private practice. In any context as a physician (even academics), you need to know how your individual results are coming out because this may determine your sustainability.
20:00 - Health care consolidation may mean the end of private practice. Plastic surgery will be the "last bastion" of private practice. Organizations are bringing in hospitalists because some data shows they can provide "better" care.
22:55 - Need to change how we think. To preserve our independence in clinical care (i.e., private practice) we need to follow evidence based approaches. No one will buy the response anymore: This is how I do it or this is how I was trained, etc.
23:55 - Efficiency means: improved outcomes and decreasing costs.
24:30 - Significant changes can result in 'never' events by taking a systematic approach with decreased cost and better care. Gives a nice example with infections and how surgeons can get involved. Surgeons will get dinged if antibiotic usage is not followed according to SCIP protocol. Hospitalists offer cheaper and better care.
30:05 - Physicians vs. Hospitals vs. Insurers. They are bigger and stronger, but they can't do it without us. Collaboration is the key. We need to be a part of the process.
31:05 - What do we need? We need more outcome-based data. Only a small percentage of plastic surgeons give data to TOPS. Have to buy into clinical/critical pathways.
32:20 - Decrease complications, decreased length of stay (this is biggie), increased patient satisfaction (another biggie, but plastic surgeons are way ahead of curve here), degreased costs. End result = 'Efficiency'
34:40 - New definition of care delivery: standardize to the science. It's an art about us as a whole.
35:10 - True clinical integration is all about the group.
35:25 - Critical pathways: checklist/cook book down to every detail. Very much like pilot industry.
36:35 - Need to think about how we can minimize risk in our practice. What we can be done preoperatively: tobacco AND alcohol use, nutrition, obesity, diabetes, steroid usage, remote site infection, colonization with microorganisms.
39:45 - Interoperatively: medical devices, operative time, minimize risk (e.g., O2 saturation levels, hypothermia).
41:55 - Postoperative: length of stay (biggie), early ambulation, early removal of indwelling devices, early postoperative instructions when coherent.
42:50 - Examples
43:40 - Summary: change way of thinking, build efficiencies into our practices, this is the only way to survive.
44:50 – Questions.
