From reimbursement challenges to figuring out what makes some physician practices great, the American Medical Association's new president, Ardis Dee Hoven, MD, vows "significant change" for doctors in the year ahead.
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The state of medicine isn't pretty. Physicians are annoyed about reimbursements, disgruntled about ICD-10 billing codes, and electronic health record systems, and worried about the confluence of a looming doc shortages and a growing population of aging and chronically ill patients.
In the meantime, older physicians are bolting from their practices, while younger doctors face funding shortfalls in medical education.
The nation's largest physician organization, the more than 220,000-member American Medical Association, has been keeping a keen eye on these volatile issues. This week during the organization's House of Delegates annual meeting in Chicago, the organization introduced Ardis Dee Hoven, MD, an internal medicine and infectious disease specialist from Lexington, KY, as its 168th president.
Since 2005, Hoven has been in leadership positions at the AMA, first serving as secretary from 2008–2009, and then immediate past chair for 2011–2012. Hoven says her career treating HIV/AIDs patients through the early 1980s motivated her to become involved in organized medicine.
Hoven talked with me this week about her views on issues the AMA will be confronting over the next year.
HLM: What are your top priorities for the AMA?
Hoven: The first is stabilizing medical practices, and being sure our physicians can navigate the changes in the way healthcare is being delivered, [second] to be sure our patients are doing well and getting the highest quality care possible. I love the work we're doing around improved health outcomes. And thirdly, a huge one, is accelerating the change in medical education.
HLM: What has to be done with medical education?
Hoven: We've been talking change in medical education for years, but in fact we haven't done it. We know change needs to happen. In the long term… we have to address GME (Graduate Medical Education). The horrible thing is that Congress put a cap on available graduate medical education slots.
The number is still the same as it was in 1997. We've got to look at funding for GME, and it's potentially in crisis mode."
HLM: A lot of physicians aren't happy, and are uncertain about healthcare reform. What are you going to do about this?
Hoven: We're looking at delivery reform and payment change. For instance, we are evaluating 30 practices across the nation: big ones, little ones, multispecialty and single specialty practices. These are the [physician] practices that are perceived to be, in their states, thriving and sustainable, with good outcomes and happy patients. What makes them different? What's working for them? We need to put our arms around that and translate [it] into tools and methods for other physicians throughout the country to learn and understand this.
For me, this is extremely important—putting our boots on the ground, helping doctors get to this [degree of success] and making practices sustainable and thriving. That is very much on our radar screen. So hopefully, by July we're going to have the first report on this particular work and I am looking forward to that.
HLM: What about the Sustainable Growth Rate formula? It has been a matter of frustration to physicians for years.
Hoven: That is broken, the whole payment thing. Some physicians have quit practicing medicine, called it quits and have gone into other careers. We've got to get the SGR repealed. It's been a quagmire.
HLM: Is it going to happen?
Hoven: I'm much more optimistic about the SGR being repealed than I've ever been. There is now bipartisan talk to do it. There is movement. The important thing is that Congress has said to the AMA, "Please help us with this," and we are doing that. It is just not feasible to continue the way we have been, so we are very optimistic about it.
HLM: There are clinical issues on your agenda, too. Can you talk about your plans? [This week, the AMA adopted a policy that recognizes obesity as a disease requiring a range of medical interventions; supported a policy to ban the marketing of high stimulant/caffeine drinks to adolescents under 18; and adopted a policy recognizing the risks of prolonged sitting.]
Hoven: Let's take one or two that we can really do a good job around, such as type 2 diabetes and hypertension. You are going to see a lot of movement in those two areas in particular.
HLM: What kind of movement?
Hoven: We have developed a partnership, for example, with the Sustainable Growth Rate and Quality [at Johns Hopkins Medicine in Baltimore, MD,] focusing on hypertension management. Why do we have 30 million people who have hypertension, yet have no control over their hypertension?
What are the dynamics, what is happening there that we need to address, and what do physicians need to do about it? I think it's going to be an exciting challenge to make realtime, practical tools for physicians.
On the pre-diabetes part of it, we are partnering with YMCAs throughout the country, and dealing with exercise, [and] weight issues. You are going to see more action coming out on this over the next year. I'm excited because I'll be able to talk about it."
HLM: How will you address physician shortages?
Hoven: We will be delivering team-based care, utilizing our allied health professionals. Teams can be small, two people; that's our minimal definition of a team. So using physician-led team-based care will allow us to deliver a high quality of care. [A physician] doesn't need to be the one who is there every day to talk to the somewhat overweight patient about diet. A doctor has well-trained personnel, a dietician and a care coordinator who can help do that. [They] can probably do a better job than I can do."
HLM: So much of healthcare is data-driven, such as quality metrics. What is the growing impact on physicians?
Hoven: I think clearly what we have learned in the last 10 or 12 years on quality measurement [is that] doing process measurement is the key. The outcomes are important. We need to minimize the noise. Just doing the process measurement isn't the key; the outcomes are important. We have 400 to 500 measures out there. We've got to streamline and get it down to the measures that matter, that improve outcomes. We need to cut out all the noise.
HLM: Do you see the ICD-10 as part of that "noise"? In October 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.
Hoven: Doctors are concerned about ICD-10; they are concerned about the cost of their practices, about having to hire extra administrative people to make this happen. I think many practices are now feeling put upon by ICD-10.
HLM: There's a lot happening.
Hoven: I'm excited to be in this position and I'm excited for physicians and for our patients. We're in a good place to make significant change.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
