Massachusetts Medical Society: Interview Excerpts with HHS Secretary JudyAnn Bigby, M.D.

Interview Excerpts with HHS Secretary JudyAnn Bigby, M.D.

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Physician Health Insurance Ratings
"I've heard the extremes of the argument about using administrative data to report quality on providers, not just individual physicians but even individual institutions. I do think there are limits to administrative data that were systematically designed for billing and reimbursement purposes and not to measure quality. So I understand that.

Bigby"However, I do think that there is enough evidence that some good can come from understanding some of those data when you have certain principles in place to make sure that they accurately reflect quality as much as you can. So, I think being clear about how many things you need to count in order to make a statement that a number or a measurement is valid… is very important.

"I think that understanding the implications of what you're measuring and that it really reflects something that is clinically important is a principle that anybody who is reporting these types of data should take into account. I think that understanding that the way that our health care system is designed right now, individual providers often don't always have control of specific entities that are the levers that would influence a particular data point that is being reported.

"I know that in the practice where I used to be, one of the measures being reported on for patient satisfaction was whether or not they could find parking. Obviously the physician has no control over that so you couldn't use a low score for your practice because the parking was terrible as a way to incent physicians.

"That's obviously a very extreme example of something over which a provider has no control so you can't really use that. I'm not suggesting that anybody does, but there are other things that you can imagine that a provider has no control over that might be an indication of a patient's experience with the system. That needs to be fixed and somebody should be incented to fix it.

"Those types of issues everyone should be talking about and it would be nice if we could come to some kind of agreement across all the entities… [on] the principles that we could adhere to in order to give confidence to providers and the public that the information being reported is actually good and relevant.

"The whole point of having transparency is not just to point a finger at a provider and say you're good or you're not good. But it should also be to let them know where they can do better. So, if the data is not reported back to providers and given to them in a form that is actionable then we're missing an opportunity to actually improve quality. The whole point of this should be, you have enough information to say where can I do better and the information should be helpful in helping physicians to understand that."

Massachusetts Health Care Reform
"A lot of people who have expanded access to these subsidized health plans are presenting for care, and they're people who have not been getting routine care… they present and they have all these problems that are really quite expensive to care for because they haven't been getting the care they need…

"I'm hopeful as Massachusetts continues its effort to make sure that people have universal coverage that we'll see that leveling off and that if people enter the system at an earlier time and we pay more attention to both prevention, wellness, and early diagnosis of treatable chronic disease… [we may be able to] avoid some of the expensive treatments for chronic disease complications that we see."

Access and Workforce Issues
"One of the other challenges of implementing provisions of Chapter 58 is access to primary care.

"I've heard from some providers that those in the community, especially in different parts of the state, do have more access, and they want people to understand that they are open to new patients and are willing to see people. People should not just assume that because everybody's talking about this problem that they shouldn't even try to access care. But I do understand that there's an issue, especially in the more populated parts of the state, or in areas like the Cape where there already was a problem. And we need to deal with that.

"We advocated for the funding that would allow community health centers to try to attract more primary care physicians… That program provides up to $75,000 in loan repayments for providers who agree to work in the community health centers for at least three years. I'm also meeting with a group of people who are primary care providers or advocates for primary care to look at more short term things that we could do, like make it easier for nurse practitioners to act as primary care providers in particular settings, and to see if there are things that we can do in the way we pay for primary care services that would make it easier for primary care providers to practice.

"Some of the initiatives the Medical Society has thought about, like partnering medical students with providers in the community so they can really see what its like to practice primary care, are really important… Most residency training doesn't really give young physicians an accurate outlook of what it's actually like to practice medicine because it's so hospital based.

"In terms of primary care, for many internists, the hospitalist movement has really attracted people who otherwise would have been going into general internal medicine. So, I do think the Society's efforts to get students out into the community to see what it is really like to practice outside of the hospital setting is very important."

Disparities in Health Care
"We know a lot about where disparities exist. I would say that while there's a lot of recommendations about how to eliminate disparities, there isn't as much data as I'd like to see on what's successful… I think that monitoring the quality of care that different populations see or experience will be helpful in understanding how to address disparities. So I think that recent regulations that require hospitals to report to the Division of Health Care Finance and Policy…will help us to be able to describe where disparities exist and feed the information back to institutions…

"I think the institutions are in the best positions to understand why they may have disparities in their own institutions and to develop strategies to address those. Solutions will entail cooperation and collaboration across private, governmental bodies, and also requires institutions to think about how their services are organized, because some of these disparities may simply be due to systems issues that have to do with having interpreters or a certain type of health educator.

"Eventually what I'd love to see [are] partnerships with health care providers and community health or public health entities so that they're looking at the whole continuum of health care and public health initiatives that would be successful in addressing disparities."

"We want MassHealth to efficiently serve a population of people who have very complicated lives, because many of them have multiple crises and other priorities related to housing or school for their kids…

"I'm very hopeful the new MMIS system will allow us to cut down on some of the inefficiencies in the system. I'm very concerned about the rate of denials for claims… There are also issues that I'm not sure any type of revamped computer system will allow us to address when you look at the details of the federal requirements. But I do think there are more efficiencies that we can gain, and I'm very hopeful this new system will help us."

Physician Involvement in the Political Process
"I think it's important for physicians in general to be more active in the whole discussion around health care reform… While there certainly are several physician advocates who have strong voices, I would like to encourage physicians to be more active in the discussion and the dialogue. They have so much to offer in terms of what their practice experience suggests about health care.

"I know that part of the problem is time. A lot of the meetings where we invite the public to give input are in the middle of the day and during the workweek. That's not a great time for physicians…but I just think their voices need to be heard more."

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