A Recipe for Clinical and Financial Success

Stop me if this sounds familiar:

“I don’t want some bureaucrat in Washington, D.C telling me how to practice medicine.”

This common complaint is echoed across the nation as primary care doctors begin to work in community-based Accountable Care Organizations (ACO). I will agree that the Medicare Shared Savings Program (MSSP) is very formulaic. The Key Performance Indicators do indeed guide and direct the ACO providers toward clinical and financial success.

The stated goal is to move the care you provide to the Triple Aim – better care, lower cost, and higher patient satisfaction.

The CMS prescription insists that doctors be available so that office visits can replace emergency room visits. Furthermore, if patients are hospitalized, they have a transition care visit after discharge, in the office within one week – it does save money and keeps folks from ending back in the emergency room or even worse, back in the hospital.

The MSSP formula guides doctors into arranging annual wellness visits, keeping key immunizations up to date, scheduling timely mammography, and guarding GI health with appropriate use of colon screening tools.

Some may argue that the practice of medicine is personal and individualized so that cookbook medicine does not apply.

On the other hand, physicians know that many healthcare problems can be treated using “standard” therapy. In fact, many common and ordinary healthcare issues can be skillfully managed by a lower level provider. These providers work with practice guidelines every day so they can understand their limits and get it right every time while they are providing care to the patient.

CMS has set standards and goals for the practitioner, group, and ACO to reach in order to receive shared savings. The formula is not just focused on the money, but also on the quality goals. These goals are reached by playing within the “rules” that CMS has prescribed.

My mother made the best chocolate chip cookies that I have ever tasted. Each batch was perfectly prepared, and the results were consistent.

One day, I noticed that she had the recipe on the counter where she was mixing up a fresh batch of my favorite cookies. I asked why she was using a recipe when she was already an expert chocolate chip cookie maker. She responded by asking me if the cookies were important. Of course, I responded that yes, they were! She then explained that while she was, indeed, a “board certified chocolate chip cookie maker,” consistent results were important; and the recipe made sure that she got it right every time.

Do you think that the MSSP care formula will help you “get it right every time?”

Craigan Gray

About the Author

Craigan Gray, MD, MBA, JD

Dr. Craigan Gray, Salient Healthcare’s Chief Medical Officer, brings rich experience from private practice, hospital leadership, and governmental health-benefit programs. Prior to joining Salient, Dr. Gray was director of North Carolina’s $12 billion Medicaid program. His time as VPMA at Bon Secours Our Lady of Bellefonte Hospital in Kentucky was distinguished by moving the facility into the top-quality performance tier for Health Grades and CMS health quality indicators. Dr. Gray is a Stanford University trained Obstetrician/Gynecologist. In addition to an MD degree, Dr. Gray holds an MBA degree and a JD degree. He is a Certified Physician Executive and is published in various medical journals.

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