Physician innovators among those advising on health delivery reforms

Those chosen as CMS innovation advisers are expected to quicken the pace of system reforms for Medicare, Medicaid and CHIP.

By — Posted Jan. 16, 2012

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Some of the first participants in a federal program to test and disseminate health care delivery innovations are tackling projects to increase emergency department efficiency, improve coordination in palliative care and decrease avoidable hospital readmissions.

The Centers for Medicare & Medicaid Services on Jan. 3 selected 73 participants for the Innovation Advisors Program. It will allow physicians, nurses and other allied health professionals, instructors, and certain nonclinicians to refine and share their ideas for improving the delivery of care under Medicare, Medicaid and the Children's Health Insurance Program. The initiative was created by a provision in the national health system reform law.

"We want them to discover and generate new ideas that will work and help us bring them to every corner of the United States," said CMS Center for Medicare and Medicaid Innovation Director Richard Gilfillan, MD.

The advisers will begin their six-month orientation and applied research period on Jan. 23, during a three-day orientation in Baltimore. The year-long program includes in-person meetings and remote sessions to educate advisers on health care economics and finance, population health, systems analysis and operations research, according to CMS.

CMS received 920 applicants for the positions. The agency expects to select a second round of participants later this year, for a total of up to 200 advisers.

Advisers must work at a public health or health care facility, institution or department. The sponsoring institution will receive a stipend of up to $20,000 to support the individual's participation costs, including travel. Participants will maintain their full-time jobs but are expected to set aside up to 10 hours a week to work on their projects.


Chris Baker, RN, PhD, MBA

The Innovation Advisors Program is being managed by the CMS innovation center, also created by the health reform law. The center is receiving $10 billion through 2019 to test models that could help improve quality and lower costs in Medicare and Medicaid.

Testing a variety of reforms

Some of the clinicians selected to be innovation advisers said they are eager to connect with others working on health care delivery reform. Their stories highlight the increasing attention hospitals and other care centers are paying to quality improvement, even if there are not yet many explicit financial incentives for doing so.

Srikant B. Iyer, MD, MPH, an assistant professor of clinical pediatrics at Cincinnati Children's Hospital Medical Center, helped implement a resource prioritization program in 2011 that so far has reduced certain patients' length of stay by at least 25% and increased the capacity to see these patients by 25%.

Traditionally, hospitals prioritize their resources for higher-acuity patients and allow lower-acuity patients to wait, creating backups. But now Cincinnati Children's has a fast-track channel through which kids with lower-acuity illnesses -- such as ear and respiratory infections -- are seen promptly and efficiently. Those overall efficiency gains allowed the hospital's emergency department to devote more resources to the higher-acuity patients and decrease their lengths of stay by about 8% to 9%, Dr. Iyer said.

Dr. Iyer wants to learn more about the economics of health care and the payment system. He's hoping his experience as an adviser will help him judge the bottom-line impact of this and other programs.

Dr. Iyer reported that administrators at Cincinnati Children's have not pushed back against ideas that effectively could reduce the facilities' revenues through lower utilization. He said patient safety is a very high priority at the hospital, and hospital managers believe they have a responsibility to improve the facility's value to patients, including by lowering costs and improving outcomes. "What we're doing aligns with some of the institutional goals," he said.

Sharon Tapper, MD, medical director of palliative care and support services at the Palo Alto Medical Foundation in Santa Cruz, Calif., is following a different issue. A majority of larger hospitals have inpatient palliative care programs. But patients in these programs often don't receive very good care coordination after they are discharged, she said.

"When you get really sick, you see lots and lots of doctors," Dr. Tapper said. Sometimes communication breaks down among those physicians.

So in February 2011, she helped launch a pilot program to improve care coordination for palliative care patients at the foundation, where she is director of outpatient palliative care. An interdisciplinary team follows patients regardless of their physical locations. Staffers track patient medications, visit their homes, and generally ensure that patient care is continuous and appropriate.

"I would describe it as a palliative care medical home," she said. So far more than 300 patients have participated.

Dr. Tapper, like Dr. Iyer, says she wants to find the true cost of caring for her patients. She also wants to share ideas with others doing similar work. Dr. Tapper said her hospital is supporting this program because it expects that bundled payments will require facilities and doctors to adjust their delivery of health care. Keeping people out of the hospital will reduce overall spending. "But there's no way for my program to be rewarded for that right now," she said.

Chris Baker, RN, PhD, MBA, administrative director of quality and safety systems at St. Mary's Hospital in Madison, Wis., wants to learn innovative methods to improve patient outcomes, beginning with chronic obstructive pulmonary disease patients.

Baker is interested in the intersection between innovation and high reliability, and how health care organizations can learn to innovate reliably. For example, nuclear power plants, submarines and aircraft carriers have systems in place to prevent human mistakes because "the cost of failure is so high that they can't tolerate" an error, she said. These organizations try to anticipate failure, recover quickly from mistakes and learn from them.

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