Can quality leaders see regulators like CMS as an ally in their mission, rather than an adversary? A recent report suggests one can and might see improved results.

A survey from Proskauer Rose asked healthcare leaders to rank CMS on a scale of 1-10 for effectiveness in fostering and driving innovation. The results were encouraging for a sense of cooperation, with more than half scoring CMS 8 or higher. (Key findings from the report are listed at the bottom of this story. The full report is available online at: http://bit.ly/2S8REaa.)

CMS’ average score of 6.49 outperformed state health departments, which scored an average 5.94. The surveyed healthcare leaders also said compliance is getting easier, with only 15% of those surveyed citing compliance as a top three business challenge.

The survey reflects the healthcare community’s commitment to the Triple Aim promoted by CMS and the Institute for Healthcare Improvement (IHI), says Richard J. Zall, JD, partner and chair of the healthcare department at Proskauer Rose. The Triple Aim refers to simultaneously pursuing improvements in the patient experience of care, the health of populations, and the per capita cost of healthcare.

“We thought it interesting that the survey indicated these leaders as focused on quality, access, patient satisfaction, and cost effectiveness are really important objectives, as opposed to just getting bigger,” Zall says. “In the past, there was a focus among executives on just improving scale as opposed to becoming a high-quality organization with existing services. Now, we see people adding services to their core organizations rather just getting bigger” through mergers and acquisitions.

Healthcare leaders cite the Triple Aim objectives even when they talk about acquiring cutting-edge technology like artificial intelligence and machine learning capabilities, Zall says. They see challenges in training their workforces in this new technology, and also ensuring their business partners have interoperability in the same technology.

“We still have some distance to go in terms of having common data systems through which you can transfer information readily when referring a patient to someone,” Zall says. “Unlike the financial services industry, where that has become very standardized, there is still a long way to go in healthcare.”

CMS Seen as Partner

Zall says the most surprising finding from the research was that the healthcare leaders showed more consistency in looking at CMS and other regulators more as a partner in achieving the Triple Aim.

“The ranking of CMS contrasted with how they saw state health departments. CMS in particular controls payment and it has really supported innovation of the last half a dozen years in a way that is a departure from how they behaved in the past,” Zall says. “In the past, Medicare and CMS were very focused on fee-for-service payments, making sure there wasn’t overutilization or abuse of billing practices. As part of the Affordable Care Act, CMS promoted innovation and meaningful use payments. The more innovative healthcare companies have seen CMS as interested and supportive because of its grant money, bundled payment initiatives, and promoting population health.”

State health departments, on the other hand, are seen as pure regulators, Zall says. They oversee licensing and certificates of need, and they conduct surveys in which hospitals are told exactly what they are doing wrong, he says.

Look to CMS for Resources

The research findings could influence the daily efforts of quality improvement professionals, Zall suggests. “When you are thinking about initiatives that would improve quality, reduce variation that isn’t necessary, you can look to CMS to provide funding, support, and ideas.

The Center for Medicare & Medicaid Innovation has a lot of money allocated to it every year [and] is interested in funding and supporting clinical innovation on the ground,” Zall says. “Staying in close touch with what they’re doing, what funding they’re offering, is a way for someone in clinical improvement to have a catalyst for your desired activities beyond just going to the CFO and asking for more staff or more money.”

Zall expects the trend toward cooperation to continue with CMS. The move toward value-based care will spur more efforts by CMS to fund innovative projects and provide other types of support for quality improvement, he says.

“Improving outcomes in support of the Triple Aim are going to receive support from CMS not only because it is important to improve the health of the public. I do think CMS is interested in that, but also because that will then bend the cost curve,” Zall says. “We continue to have increases in spending for healthcare in the United States that is dramatically above the rate of inflation and the rates of spending in other countries. We will continue to see incentives and financial support to try to push the industry to be more cost effective and quality- [and] outcome-oriented.”

Top Survey Findings

“Checking Up on the Quest for Triple Aim” revealed these important results:

  • To better promote a coordinated, innovative, and value-based care approach, healthcare executives cited the need to improve employee training of technology (43%), incentivize participation in existing information-sharing groups (38%), and incentivize vendors to offer electronic health record products that are interoperable (35%).
  • When it comes to what keeps hospital executives up at night, 32% of executives noted streamlining operating costs and improving data privacy. These concerns are guiding a majority of their business decisions, including mergers and acquistion (M&A) strategy. Specifically, 31% of healthcare executives are focusing on tech-related M&A to improve the patient experience and boost efficiency.
  • Cybersecurity remains a critical concern for healthcare executives. No more than one-third of organizations leverage any single cybersecurity best practice to protect their data.