Episode 43: Provider Wellness & Great ACO Performance

Mike: This is BACON, brief ACO news from the MaineHealth Accountable Care Organization. A hearty and satisfying monthly podcast for health care providers. I'm Mike Clark.

Heather: And I'm Heather Ward. Mike and I are practicing physicians who participate in the MaineHealth ACO.

Mike: Yes, indeed. And in this episode, we'll introduce you to the MaineHealth Medical Group's new Chief Wellness Officer, Dr. Christine Hein.

Heather: But first, MaineHealth ACO President Jen Moore will update us on our performance in MSSP and MIPS.

Mike: Well, way to get all those acronyms in there Heather.

Heather: Yeah, well, FYI Mike, it's not health care without acronyms.

Mike: Yeah, yeah, yeah. True. So, well, without further ado, let's dive right into this month's alphabet soup.

Heather: Dive in. Really, nice.

Mike: Sorry.

Heather: Every year around this time, Medicare releases annual financial and quality performance numbers for every ACO that participates in MSSP or the Medicare Shared Savings Program. We also get word on how we did in a related program the merit-based incentive payment system.

Mike: And here to give us the details and to help us sort out the alphabet soup is our own Jen Moore, President of the MaineHealth ACO. Welcome, Jen.

Jen: Thanks, Mike. Thanks for having me today. Nice to see you, Heather, and thank you for joining our BACON podcast.

Heather: Well, thank you. So, I'm going to start off and just ask you to please remind us what MSSP and the MIPS actually are.

Jen: Sure. So as you said, the MSSP is the Medicare Shared Savings Program. We're actually celebrating our ten-year anniversary in the program. We started back in July of 2012. It's really something to have been so invested for ten years in the program. And back in 2012, CMS put forth the Medicare Shared Savings Program model, aiming to reward providers for meeting measures around triple aim. So really, if we can demonstrate strong patient experience, attention to quality and cost, we are rewarded for doing so within the program. The MIPS program is the merit-based incentive payment system, and as you said, it's related, but it is a distinct program. Whether or not you're in an ACO, you can participate in the MIPS program. It is CMS's way to also reward for quality and cost. So some of the same concepts are there. They judge you on quality, on your interoperability with your electronic health record, based on practice improvement activities, and based on your attention to cost. So we're fortunate in that because we participate in Medicare Shared Savings Program, we get some credit for some of those categories within the MIPS program, and by virtue of reporting on quality for the Medicare Shared Savings program, we get credit in the MIPS program as well. So they work together in concert.

Mike: That's great. And remind us too, Jen, about the timing here. I know there's some lag, right? So so these results are from when?

Jen: These results are from calendar year 2021. And so, as it relates to the Medicare Shared Savings Program, I'm going to share some highlights about our performance around our total cost of care and our quality measurement in that program. And then for the MIPS payment, they also assess your performance based on 2021, and it impacts fee-for-service payments starting in 2023. So as you said, there is a two-year lag between the program and the payment.

Heather: And from what I understand, the results from both MIPS and MSSP were quite positive, right?

Jen: They were. I'll start with the Medicare Shared Savings Program results first. We always have a financial target that we first have to meet if we can be even eligible for shared savings. We beat our target by almost $6 million this year. So, successful. Whenever we beat a target, we say that is really good work. Unfortunately, we didn't beat the target by enough to earn shared savings. So they want us to beat a target by 2.2%, that would have been closer to $12 million. So again, we did well. We didn't do well enough to earn savings. Had we earned—had we beat our financial target by that 2.1% and earned savings, we would have had a strong result because our quality score was so high. We had a 99.22% quality score in the program and that was up from 96.8 in 2020. So, really, fantastic results despite not being able to share in savings in that program. For the MIPS program, we scored 100. 100 out of 100. So hey, we can't do better than that. You may remember that last year's adjustment was 1.74. This year our payment adjustment is 2.33. So what that means is that in 2023, instead of the standard fee schedule that will be published for CMS, which on paper now looks like a decline, hoping that will be changed, by the way, in the November final rule, we'll see, that means that you'll get 2.33% on top of that base.

Mike: Well, so that is really some good news. And it makes me wonder, as you and the team at the ACO began to kind of look at these numbers and do a little analysis. Have you found any trends, like other areas where we did do particularly well and where might there be room for improvement?

Jen: Yeah, we did very well in quality this year as we noted, and part of that is around collection data collection measures and processes associated with that. It's also, I think, from having ten years of experience in the program and really getting better and better at it. But when we bump up our quality scores to national results, we perform very, very well. So quality is definitely a win for us. The other big win for us is in clinical documentation. What we have previously called our aCDI Ambulatory Clinical Documentation Improvement Program. What we in the Medicare Advantage space refer to as our Burden of Illness program. We know that accurately and thoroughly documenting clinical conditions is really important to our contracts because they better understand the populations that we're serving. And in the case of the Medicare Shared Savings Program, 2020 documentation impacted 2021 scores. So as you can bet, 2020 was a tricky year. We didn't see as many patients and so we did see a decline in our coding of about 2.1%. But nationally, they saw a decline of 5.3%. So we did really well on coding given all of the complexities of the COVID year that we saw. So we should be really proud, that bump up, that delta between how the national ACOs did and we did, resulted in our target being bumped up by about $230 on a per year basis. So that's pretty significant and that helped to help us meet our target. The other thing I should suggest on the opportunity side is that clinical documentation is still an opportunity. The MSSP program maxes out at 3% in each of our enrollment categories. We hit our max in our age, non-dual population, but we have opportunity in our other populations still. And so, we really only achieved about 75% of our full opportunity in clinical documentation. So, it's both a success, but it does continue to be an opportunity.

Heather: Great. And so then, hearing all of that, what implications are there of these results? And really from a physician's standpoint, what is the impact on providers?

Jen: The fact that the Medicare Shared Savings Program works so well with the MIPS program means reduce burden, so they don't have an additional reporting burden to also satisfy the MIPS requirements. So obviously that's important given all the work on your plates already. And then the other benefit, as I mentioned, is that 2.33% adjustment. So you'll see that come through in your reimbursement for CMS coming in 2023.

Mike: That's great news. And Jen, thank you as always. You have a wonderful ability to take complex information and distill it down in an understandable way. And so thank you for coming back to the BACON microphone to bring us this important information and good news.

Jen: Thank you for having me.

Heather: Welcome to the sizzle. Our segment on ACO participants doing good things inside and outside of work. This month, we're talking to Dr. Christine Hein. Christine is a long-time emergency medicine physician and a huge champion for provider wellness.

Mike: That's right. And in addition to her clinical role at the hospital, Christine has served for several years as Maine Medical Center's Chief Wellness Officer. And, just recently, she was named Chief Wellness Officer for the MaineHealth Medical Group. Congratulations, Christine, and welcome.

Christine: Thank you. I'm so happy to be here.

Heather: Well, I'd love to get us started off here. I've been looking forward to this conversation. Part of the thing that I've been really curious about is what led you to this topic of wellness.

Christine: I really think it started over a decade ago. I was asked to join a small group of my colleagues who were working through the Medical Executive Committee at Maine Medical Center, and they were interested in starting a peer support group. So we had several meetings with Dr. Joe Shapiro from the Brigham, and over the course of about 12 months, we built out the structure and conducted the training that was necessary to launch a peer support program at Maine Med. And when it came time to select a director for that peer support program, I kind of threw my name in the hat and was ultimately selected as the director of the program. And I think that was really the beginning of a rapid-fire education in the science of well-being. And it became clear that we really needed to initiate some programs upstream from the peer support program to try and actually promote wellness and mitigate burnout. So, since then, our efforts have grown into an actual well-being program at Maine Medical Center. It encompasses— it's kind of the umbrella of many different initiatives that are meant to improve the culture of well-being and practice efficiencies, as well as individual resilience. We follow a model that came from the Stanford Well MD Center. I really have aligned pretty closely with that. There's a lot of research and evidence behind that model, and it had demonstrated success at other sites. But even recently, there's been a couple national models looking at enhancing professional fulfillment and diminishing burnout. With the most recent in May of this past year, there was an advisory release by the US Surgeon General on health care worker burnout. And then just a week and a half ago, there was actually the release of a national plan from the National Academy of Medicine on how to improve health care worker well-being and minimize burnout. So there's a lot of national attention to this that's probably, frankly, well overdue. And the pandemic has kind of shined a spotlight on this.

Mike: Yeah, it really certainly has. And like you said, some of the reports that are emerging really highlight that. So grateful for the work you've done that preceded the pandemic, especially now. And, so, what comes up for me is, I think about your role specifically and now the opportunity to touch more physician lives, impact more physician lives. What are some of your hopes of what you would like to see happen in your chief wellness officer at the medical group?

Christine: I mean, it's a great time to ask me that question because I just assumed the role at the beginning of the month. And obviously, this has been on my mind for some time, taking the work that we've been doing at Maine Medical Center and expanding it to the medical group is really something that I take a lot of joy in, and take that, hold it very close. So I have several objectives, but I think my overall objective is to really see that the well-being of our providers and our teams is not only a measurable quality metric for our medical group but also a consistently valued part of the organizational strategy and consequently, success. I think, as I said, the pandemic has really highlighted how important our workforce well-being is and we have organizational support right now to move forward on this and move the dial in a positive direction. So those are kind of my main objectives. I'm happy to speak to more specific objectives if we like.

Heather: I would love that, Christine. I am so curious to know really like what advice you would give us. What do you think we can do? Because the topic can be really overwhelming when you look at it as a whole from federal government changes to system changes to provider changes. What can we do as practicing providers but also as leadership as well?

Christine: I think that we have kind of a tiered system right now of resources that are available. If somebody is struggling acutely, there can be many precipitants of that. And so a good place to start, our peer support programs. We have a MaineHealth-wide peer support program for providers. There are also individual peer support programs at various local health systems. I can point people in either direction and if people in one region want to receive support from a different region, we do that all the time. So we are really aware and respectful of anonymity and confidentiality with that, with those programs. Probably next in the level of response is our provider support program through DocExecutive. We have a contract with an external organization that specializes in just this. This is the only work that they do and there is counseling, there is coaching available, and there's also the opportunity, if needed, to be referred for additional mental health resources. But DocExecutive really specializes in looking at work-life imbalance or professional challenges, interpersonal struggles or conflict, and helping an individual create a plan for how to address that in the here and now. Because it's not helpful to hear that the National Academy of Medicine released a plan that took them six years to write when you are struggling acutely. Right? So that is available to all MaineHealth medical group providers and it's free. Our contract covers four sessions with those individuals through DocExecutive. And then, probably even a little one step beyond or filling a different footprint is a contract that we have with Talkspace, which is a virtual mental health platform, and that is available to all Mainehealth employees, not just providers, but all Mainehealth employees and also their partners or spouses and children over the age of 13 and up. So that is getting at the understanding that the pandemic really caused significant stress and exacerbated stress that already existed. And that was a reaction to how do we help not just our staff but also the people in their immediate spheres who might be struggling as well. So that is also free. That's available to all MaineHealth staff. We are also working with groups that are looking at improving practice efficiencies. So I've done that at Maine Medical Center and I plan to do that with the medical group, looking at specialty counsels or those working with the electronic health record, Epic inbox management groups, engagement counsels. It sounds a little different to say, but honestly, practice efficiency is such a big piece of professional well-being and satisfaction that if we weren't involved in those efforts, I would really be missing a significant opportunity to make people's work lives better.

Heather: That is fantastic. Those resources are really important. I think the Talkspace resource for families just emphasizes that as providers we are human and also involved in our other lives that have nothing to do with medicine. And so, when that life is stressful or we have ailing family members, it's important to be able to get that support so we can be well in our family life as well as in our work life. That's fantastic.

Mike: So Christine, as an independent provider in the ACO network, what resources might be available to non-MaineHealth employed docs who might be listening today?

Christine: That's a great question. The peer support program is available to non-employed, non-MaineHealth employed providers as well as the DocExecutive program, but that contract covers all MaineHealth medical group providers, but that's also available. And then another resource that's available is a national Physician Support Line. It was founded several years ago to help physicians who are dealing with stressors and it's staffed by psychiatrists from 8 am to 1 am seven days a week, and that number is 1-888-409-0141. Again, that's 1-888-409-0141. And you can also find more information about that on the web at www.physiciansupportline.com.

Mike: Thanks, Christine. Links to these resources and others will be available on the BACON website tied to this episode, number 43. Thanks for listening to BACON this month. You can find all our episodes on your podcast app and at our web page, MaineHealthACO.org/BACON. And if you have questions, comments or suggestions, we really would love to hear from you. Please email us at bacon@mainehealth.org. That's bacon@mainehealth.org.

Heather: BACON is produced by the MaineHealth Accountable Care Organization with help from MaineHealth Educational Services. Thanks for joining us. See you next time.

Mike: See you next time.