Stanley Feld M.D.,FACP,MACE
The following is a special message to members of the Dallas
County Medical Society (DCMS) from Dr. Cindy Sherry. Dr. Sherry is a very smart
woman and an excellent physician.
She is also extremely tactful. If you read between the lines of
her message, you will sense the difficulty and mistrust physicians have for
hospital systems. You will also
understand the government’s lack of interest in physician innovation.
If physicians threaten hospital system’s vested interest even if
it is to improve patient care in a community the hospital system is against it.
There is no need to ask why physicians should mistrust the
promises of hospital systems. Hospital systems must prove their sincerity to
the physicians in the community and not the other way around.
Dr. Sherry describes the way Centers for Medicare and Medicaid
Services (CMS) received the Dallas County Medical Society (DCMS)
representatives. The DCMS has a plan that can help the indigent patients in our
I think the plan will work.
The message I got from Dr. Sherry’s special message is CMS is too
busy to listen to physicians.
They simply do not have the time or the bench strength to work
on something that might capture the imagination of medical communities in other
cities and other states. The physicians’ ideas might lead to additional
innovative ideas that could markedly decrease the cost of delivering medical
care in America.
However, the government has its mind made up and is not
“DCMS News: Special
Message from the Dallas County Medical Society President
Fellow Members of DCMS:
president, I would like to tell you about your DCMS executive committee’s May
visit to the national headquarters of CMS (Centers for Medicare and Medicaid
Services) in Baltimore. Joining me were Immediate Past President Rick Snyder
III, MD; President-elect Jeff Janis, MD; Secretary-treasurer Jim Walton, DO,
and CEO Michael Darrouzet.
with, getting into CMS was more complicated than getting through security at
DFW airport. At the gate, our car was thoroughly checked, including under the
hood, in the trunk and inside all suitcases, and all passenger IDs were
examined. IDs were rechecked at the building entrance, plus we and all our
belongings passed through metal detectors, overseen by armed guards and guard
preparation for the trip, we acknowledged that the Medicaid 1115 Waiver
opportunity had passed to transition Project Access Dallas to a physician-led
ACO (accountable care organization) called My Medical Home. Therefore, the
intent of our meeting with CMS was not to create a last-minute effort to revive
the program, but rather to keep our concerns about the Waiver alive, and to
express these concerns to the people in charge. We wanted to inform the CMS
policymakers about how their plans and goals for the underserved population of
our region are being interpreted and implemented in the offices of physicians
and in the halls of hospitals. Furthermore, although we remain sorely
disappointed in our Big 5 Dallas-area hospital systems for their role in
thwarting the transition of Project Access Dallas to My Medical Home, we did
not make this trip to air dirty laundry or to ask CMS to intervene in a
concerns are centered on the reality that health care is in transformation
across this country, including Dallas. Now is the time for DCMS physicians to
assert our leadership and to work to ensure that the transformation occurs
according to guiding principles — principles that will lead to programs that
provide quality care to all of our citizens; principles that will ensure that
resources are deployed across the healthcare continuum, not only for
hospitalizations and ER visits. We had embraced the principles and goals
espoused in the Waiver, including collaboration, accountability, transparency,
and a focus on access, wellness and quality.
Baltimore, we spent about 90 minutes voicing our concerns with CMS representatives,
including Steven Cha, MD, chief medical officer; Rob Nelb, Texas 1115 Waiver
project officer; Therese DeCaro, senior adviser to Cindy Mann, deputy
administrator, responsible for development and implementation of national
policies governing Medicaid; and Julia Hinckley, acting deputy director of the
Children and Adults Health Program Group. We realized that they are
office-based, policy personnel who have no interaction with patients or
physicians that would enable them to fully grasp how their plans play out
across communities. We also recognized that a resolution to our immediate
problem would not be forthcoming, so we remained focused on constructively
sharing concerns that have the potential to impact future programs and
emphasized our belief that a truly transformative plan would create a new
financing and delivery model that would include outpatient clinics, specialty
and primary care physicians, community care transitions, community health and
pharmacy navigation and transportation, referral management and case
management, and preventive and wellness services.
stressed the need for more balance in the use of funds. With current funding
focused on hospitals, how could one realistically expect the transition to more
affordable and more coordinated outpatient care? The current focus on hospital
funding disregards the recent results of the needs assessment completed as part
of the Waiver process, which largely is outpatient-focused. This funding
imbalance omits ambulatory care clinics, care coordinators and physician
compensation from the equation.
the CMS staffers respond to us? They pointed out the depth of the problem they
face — each state is submitting numerous proposals, adding up to innumerable
programs from across the country. They simply don’t have the bench strength or
depth to adequately oversee the programs in the detail we described. They used
glorified terms of transformation such as “collaboration,” “innovation” and
“transparency” in the Waiver, but also acknowledged that these are long-term
goals, and that they do not expect their immediate fulfillment. They have no
plan or capability to police the programs, instead relying on state and local
administrators. They acknowledged that the letter from county medical societies
represented a desirable component of a region’s proposal, but the medical
society did not possess veto power, and that the letter would be considered as
one piece of information among many in the proposals. In point of fact, the
medical society letter was a requirement added at the state level; it did not
originate at the federal level.
CMS officials also acknowledged that the dispersal of funds should be more
balanced. However, they said there is no mechanism or pathway for the funds to
flow differently, and integration of outpatient care truly is a big challenge.
To the CMS
officials, our visit was a reality check for them to hone in on questions such
as, “How is the process working? Can it be improved?” Our visit served as the
launching pad for them to begin a conversation for future policies. Based on
our initial conversation, they have bolstered some of their regulations for
interim follow-up reports and they have incorporated requirements for learning
collaboration plans. These midcourse corrections now allow for future 2-year
funding windows rather than 5-year approvals.
their best take-home message for us was that we (physicians, in general, and
DCMS, specifically) need to strengthen our voice and increase our clout through
our political connections, and that we should have been able to recruit
political allies locally and statewide to help us be more effective and support
conclusion, the visit with CMS strengthened the DCMS executive committee’s
resolve that the Blue Ribbon Task Force for the Underserved is heading in the
right direction. We remain committed to moving forward and creating an
innovative plan through activating leaders — including physicians, hospitals,
outpatient facilities and services, midlevel providers, and business leaders—
from all corners of the community to work together to blaze a trail for a more
cohesive plan to provide health care for the underserved citizens of Dallas. It
was an honor to represent the 6,500 members of DCMS in Baltimore.
Cynthia Sherry, MD
President, Dallas County Medical Society”
throughout the country have said, “Why bother?” The answer is because you cannot give up. Some how Americans will wake up.
Our government is by the people for the people. We are the people.
Not government bureaucrats!
There you have it. Leonard
Cohen is right. “The Dice are Loaded.”
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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