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Dr. Young is Back from Washington (Baltimore, actually)

January 29, 2012

A bunch of people have asked me what happened at the CMS Innovation Advisor meeting. I’ll share a few thoughts here, but I’ll write in generalizations out of respect to the CMS leaders and my fellow advisors. In no particular order of importance:

  • The CMS people – or actually CMMI (Center for Medicare and Medicaid Innovation) – are genuinely interested in improving the efficiency and outcomes of the U.S. healthcare system. They promoted a great spirit of idea-sharing between them and the advisors, and the advisors with each other.
  • The CMMI people are totally invested in the three-part aim: a better patient experience, better quality, and lower costs. Difficult decisions or trade-offs will not be part of this program, other than any change in a complex environment is always difficult.
  • 33 out of the 73 advisors are physicians. Other represented fields include nurses, health economists, hospital administrators, IT experts, and government officials.
  • A lot of the proposed projects are about care transitions. ICU to rehab, rehab to home, hospital to home, get palliative care involved sooner, get geriatrics involved sooner, etc. As I listened to their solutions, I kept thinking to myself that better solutions were family medicine, family medicine, family medicine – you get the idea.
  • A lot of the projects are small and focused. Examples include changes at a hospital to increase hand washing, and working with two hospitals to get their electronic systems to talk to each other better.
  • There were very few projects that addressed more fundamental issues. For example, in a sidebar conversation, two nurses spoke of their frustrations of how difficult it is for nursing homes to innovate because they are so heavily regulated.
  • Which leads to my only small disappointment with the program: I didn’t come away with a sense that the CMMI/CMS people were prepared to seriously question their existing rules and culture. Several people asked how their projects could receive some sort of safe harbor or waiver from an existing barrier, and the CMMI/CMS people did not seem prepared for this request. A project asking to hire a nurse to help with a hospital-to-home transition fit well into their pre-existing beliefs. A project asking that a burdensome regulation be lifted to increase care efficiency did not.
  • However, I have hope that their spirit of openness and free exchange of ideas will allow some real reform to occur.
  • It was a very good meeting.

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