Medsider: Learn from MedTech and HealthTech Experts

Demystifying Value-Based Healthcare – A Physician Expert Explains All (with Real-World Examples)

July 17, 2016 Scott Nelson
Medsider: Learn from MedTech and HealthTech Experts
Demystifying Value-Based Healthcare – A Physician Expert Explains All (with Real-World Examples)
Medsider: Learn from MedTech and HealthTech Experts
Demystifying Value-Based Healthcare – A Physician Expert Explains All (with Real-World Examples)
Jul 17, 2016
Scott Nelson

CMS has an objective to shift 50% of all reimbursement services from fee-for-service to alternative, value-based methods by 2018.  And bundled payment models, according to Dr. Dan Mazanec, will be the principal driver of this transformative initiative. But the topic of value-based healthcare can be pretty confusing , right?  Comprehensive Care for Joint Replacement.  Medicare Access...[read more]

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Show Notes Transcript

CMS has an objective to shift 50% of all reimbursement services from fee-for-service to alternative, value-based methods by 2018.  And bundled payment models, according to Dr. Dan Mazanec, will be the principal driver of this transformative initiative. But the topic of value-based healthcare can be pretty confusing , right?  Comprehensive Care for Joint Replacement.  Medicare Access...[read more]

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Scott Nelson:   0:08
Welcome to Med Cider, where you can learn from experienced medical device and med tech experts through uncut and unedited interviews. Now here's your host, Scott Nelson. Hey there, ladies and gents, it's Scott Nelson and welcome to another edition of Med Cider radio. If you're new to the program, Med Cider Radio is where we learn from med Tech and other health care thought leaders through uncut and unedited interviews. Just a few quick messages before we get started with this particular episode. First, if you've enjoyed these interviews of the last several years, please head on over to iTunes and rate our show. It's pretty simple to Dio. Once you're in iTunes, just click on the right. A review button. You can check the number of stars, preferably it's all five, and write a few sentences if you feel like it. Trust me when I say that reviews really help, so if you feel up to it, please do us a favor and head on over to iTunes when you get a chance. Second, I sent out a free email newsletter about two times per month, highlighting my favorite med tech and or health care related stories. The ones that I personally get a lot of value from. I don't send the newsletter out very often, but when I do, I really try to make sure it's valuable. So if you're interested, head on over to med cider dot com and enter your email address, and as a bonus, I'll send you a free digital book that I think you'll find pretty interesting. Okay, so on to today's episode, CMS has an objective to shift 50% of all reimbursement service's from fee for service to alternative value based methods by 2018. That's a significant percentage in bundled payment models, According to Dr Dan Mez. Nick will be the principal driver of this pretty transformative initiative, but this stuff is kind of confusing. You know you've got programs like the Comprehensive Care for Joint Replacement, Medicare Access and Siege I P. Reauthorization act. MIPS versus a PM I mean, the list goes on and on, so how do you begin to understand it all? And if your leader within your med tech or biotech organization, how should you begin to prepare your company for the future? So to help answer some of these questions I invited the aforementioned Dr Dan Mazanec to join Met Side a radio. Dan is currently the chief medical officer for Door Sada. But prior to joining door Sada, Dr Mazanec was the associate director of the Center for Spine Health at the Cleveland Clinic Board, certified in internal medicine and rheumatology. Damn lead the development and implementation of the spine care path across the entire Cleveland Clinic health system here for the things that we're gonna cover this interview, how did the original concept of bundled payment model start? And what was the original intent, too? Early examples of bundled payments from the eighties and nineties, the shifting financial risk in health care and why care coordination will be so important with the Medicare access and C H. I. P reauthorization act or otherwise known as Mac Ra. What that means for health care and really, more specifically, the two paths. A reimbursement for physicians. MIPS versus a PM Those are the two paths that will cover in this interview. And in regards to really this overarching concept of bundled payments and reimbursement, what are the top 2 to 3 things that med tech companies need to consider right now? All right. So without further ado, let's get right to the interview. Dan, Welcome to in that cider program. I appreciate you coming on.

Dr. Dan Mazanec:   3:24
My pleasure.

Scott Nelson:   3:26
Let's get right after it. CMS has an objective to shift 50% of all reimbursement service's from fee for service to alternative value based methods by 2018. I know you wrote recently in one of your pieces that bundled payment models will be the principal driver of this disruptive or transformative initiative. And so let's kind of start with that, and then we'll dive into some other topics along the way. But can you kind of provide an overview of the original concept for bundled payment models? Padded the start and maybe what was the original intent? I

Dr. Dan Mazanec:   3:59
think you go all the way back to the early eighties, at which point the CME Mass Medicare Medicaid reimbursement too hot petals on positions was entirely cost based, so there was no cost control. If you went in the hospital

Scott Nelson:   4:13
for a nap, conduct

Dr. Dan Mazanec:   4:14
may, the hospital essentially passed all the charges. The lab tests the nursing care, the room, et cetera, based on whatever they were charging directly to Medicare at that tape

Scott Nelson:   4:25

Dr. Dan Mazanec:   4:26
what Medicare was seeing was a tremendous increase over a period of just a few years. I think the cross American across to reimbursed for that type of care had increased more than 50%. I think was approaching 80%. So in 1983 Medicare introduced so called diagnosis related group with the RG concept which said, we're not gonna pay you for the hospital for individual cross. We're gonna pay you by diagnosis. So they came up with about 500 different diagnoses and, for example, that protective mate. Now the hospital got a fixed amount of money which obviously happed the exposure of Medicare CMS and it forced hospitals effectively forced hospitals to bundle all the charges associated with that procedure. And if the hospital was successful and came in, the actual cost of the appendectomy was $2000. The hospital had $1000 profit margin. On the other hand, the hospital is at risk. If their costs obviously exceeded that figures. I think that was where the original concept of bundling comes from. Medicare essentially made hospitals bundle all their charges for a sing us etc. And clearly the original intent of the program was to reduce costs later and not too much later. In all fairness to Medicare, they added, Really, the phrase deserve cost and preserve quality. And now, I would say, as bundling has evolved, I would say that they're not only controlling costs, but they're actually improving quality. And they show called value paste system other than the Argies, some opposition groups. A good example is the surgical global Paige. It's so Sometime in the nineties, Medicare started paying surgical fees in a global package. So this is not the hospital. Now. This is the surgeon would get a set amount of money for all the care associated with a procedure, beginning with first day in the hospital, in the first pre op day through the surgery, in anywhere from 10 to 90 days afterwards. That model is still out there today, and so on. Irrespective of how many visits that person had to make to the surgeon, the surgeon had to take the person back to the operating room. There was a single set C, and our so called global fee for that service is by the surgeons. That's another example of bundling. Those were too early examples of this concept, associating all the costs of a so called episode of care into a single figure and essentially shifting some of the risk. We're taking the risk away from the Medicare system or seeing last and shifting it to the provider's. Or that

Scott Nelson:   7:15
you mentioned this notion that, you know, this was early. I think that's what may be his most surprising. As I hear you explain sort of the origins of bundling and that this concept, it's not necessarily new. I mean, you mentioned that it's it really started in the early eighties, whereas we read so much about it in today's headlines. There's so much focus on it, it's really not necessarily that knew of a concept. It's been around for 30 plus years now, having said that, before we get into the newer models like the Comprehensive Care for Joint replacement, CMS has changed. But ling quite a bit over the past few years. Can you quickly can highlight that for us? There

Dr. Dan Mazanec:   7:50
really two trends I would say that CMS has focused on in the last several years and really, these trends were accelerated with Affordable Care Act and 2013 but the two trends really are folding physician's costs into the hospital as well. So as I said, T R G's was reflected hospital cross, but they did not include professional fees for the physicians caring for the patient in the hospital, the new bundling model. All the fees involved the anesthesiologist be the if involved in the surgeon's be the position Steve tend to be now incorporated in the same bundle with all the other hospitalizations related costs. Other major trend is the definition of an episode of care which DRG purposes was related to a single period in the hospital. Now the episode of Care really extends through the hospitalization into the post acute phase of care, so really going up to 90 days after discharge. So for someone hospitalized, for example, a total knee replacement, that episode of care begins with admission into the hospital and extends after discharge into rehabilitation in any post acute care all the way out to 90 days. So the bundle now involves the whole continuum of care and involves both the doctors as well as the hospital or health care organizations. The other aspect of bundling is that this has now been applied to outpatient care. Dogg is related to inpatient experience. Now outpatient chair in a variety of models is being bundled as well. Yeah, the objectives. Same as with the Argies, obviously control costs or reduce costs and incentivized quality and Dr Mawr integration of tear that relates to quality as well, but really forcing health care organizations providers at multiple levels to coordinate care within these bundles.

Scott Nelson:   10:04
A couple of those points that you recently mentioned are part of that comprehensive care for joint replacement program that C C J R. That acronym that we often see correct. That's

Dr. Dan Mazanec:   10:14
correct. What's different about there? There's some differences, but basically that program briefly is for people what patients who are going to have either knee or total hip replacement surgery. And

Scott Nelson:   10:27
this program

Dr. Dan Mazanec:   10:28
actually is just being introduced, and the rules were just rolled out literally this year. But this program involves 800 hospitals, unlike some of the other bundling projects, which you could look at as pilots or experiments, so to speak, The C C. J R. A. Confidential care for joint replacement program is mandatory for these 800 hospitals, they said, for hip and knee replacement which is a big ticket item. You know there's 400,000 hit the knee replacements a year. Hospitalization alone is probably upwards of $78 billion there's a lot of variability and costs. So what game S. S said, it is all the care for your joint replacement from

Scott Nelson:   11:13
David Mission

Dr. Dan Mazanec:   11:14
through 90 days, meaning the surgeon in the hospital, the physical therapist, the home care, the rehab facility if required. All of that care is bundled together and a targeted prices set based on historical data and the total of totaling up the cross is done sort of after the fact. But if the hospital or this organization comes in under target, they will get some, obviously, that incentive. There they get some money back. Give back. On the other hand, if their cost of providing the care throughout the whole spectrum of care exceeds the target, then there will be penalty in the hospital organization Plaster give money back. So it's really bundling of multiple providers positions across the whole continuum of care. The goal is to obviously reduce costs, and it will certainly drive better coordination of care That certainly should. If the organization expects to be successful.

Scott Nelson:   12:20
Sure, that's why you know this concept of reducing readmissions for hospitals is so important because that's such an expensive event. For, you know, if a patient is going to be re admitted into the hospital and is part of that 90 day window, as you mentioned, it could be so expensive for the hospital. They're gonna miss their economic targets, right? That's absolutely right.

Dr. Dan Mazanec:   12:41
What the health organization has to do is in the hospital. It certainly has to make sure that complications are. What did I mean? Joint replacement? A big complication. DVT, a blood clot in the leg, Very common after knee replacement, less so after hip replacement. But managing people in the acute hospital to ensure that you minimize those lists and getting them out of the hospital these days get out of the hospital anywhere from 1 to 4 days, depending on whether it's a hipper need and then in that post acute space, avoiding rehospitalization. Unnecessary care. The post acute space is one that's been somewhat overlooked in these bundling packages until recently, because and it's an important one because that's where

Scott Nelson:   13:27
40 50

Dr. Dan Mazanec:   13:28
percent of the cost of that total episode of Care resides, And that's the portion of the continuum where I think it's fair to say somewhat uncoordinated care. People would kind of pick where they wanna go for their rehab. But this really will force better care and in that post acute space, whether it's home care or in a rehab facility. And it's the place where the hospital's also have to focus if they're going to be successful economically in this new reimbursement model.

Scott Nelson:   14:00
God and you said just to confirm, you said 50% of the cost is going to be in that post that acute post care face cracked

Dr. Dan Mazanec:   14:08
depending on the nature of the procedure. For example, hip replacements just It's a contrast Tiffany hip replacement surgery. Very little you have is needed. Most people have a hip replacement in our

Scott Nelson:   14:22
kind of rehab themselves. At

Dr. Dan Mazanec:   14:23
home. They may need some home care, but that's a lot cheaper than having to go to a rehab facility for a week or two. And that's more common after a knee replacement. So I would say

Scott Nelson:   14:34
that post acute

Dr. Dan Mazanec:   14:34
space is more costly after a knee replacement than 1/2 but it's upwards of at least 40% of the cross of some care of the colt episode of Care can be tied up in that post acute space.

Scott Nelson:   14:48
In terms of the economics in the financial risk, that's a whole nother shift that's happening because of some of these changes, right? That financial risk is shifting out to a different party. One

Dr. Dan Mazanec:   14:59
of the issues, You know, that for a health care organization hospital, they traditionally have had less control over what happens after discharge. And even within the hospital, I mean in foot again, going back to joint replacement. Some hospitals, depending on the surgeon, has had pretty free rein in terms of choosing the hardware, so to speak. The prosthesis for the hip. Ernie, you know, you may have six orthopedic surgeons choose six different brands of hardware at considerable variants and cross. One of the things hospitals are now doing is negotiating harder and agreeing, getting the surgeons to agree on using a brand A rather than brand A, B, C and D, and to save money in the hospital. That way, there are ways to control costs at the hospital are beginning exercise. But the idea of managing that post acute space where you may have physical therapists who don't work at the hospital who are in private practice. You may have a rehab facility that's not necessarily within your system. It's a little harder to control and coordinate the care in the post acute space. And that's where the information highway, as I like to call it, the Elektronik Medical record,

Scott Nelson:   16:11
sort of serves as the

Dr. Dan Mazanec:   16:12
backbone because these handoffs so called handoff from the hospital to the rehab facility or to the home carriers or to the physical therapist, transferring information and keeping communication open between the surgeon and the therapist after discharge is critical to success in this new reimbursement world.

Scott Nelson:   16:34
I could definitely see the importance of health I t would play in solving for some of these, you know, these care, coordination challenges, especially post procedure. So let's talk about that more specifically, how there are a couple things that come to mind When we really focus on that point of health, I t being able to help facilitate or overcome some of these challenges that hospitals and other health care providers will encounter.

Dr. Dan Mazanec:   16:54
I think we were, This is, and we'll talk maybe more about some of the some of aspect later. But I think in terms of these models the Bungling Mile, for example, information. Again, the information highway is what's going to be the glue meeting the EMR that will really hold together these various components of that episode of care. So it really has to be. You have to have all the providers in the loop so that you can track and record data events provide practice, clinical decision support within the hospital and after. So I mentioned the blood clots. There's good evidence based medicine that needs to be built into a smart EMR that helps clinicians make the right decisions in the hospital to keep those complications down and reduce the length of stay, which is very like this day is a critical cost driver. And then the EMR has to be able to guide the post acute care that the home care nurses, the rehab directors or providers in maintaining continuity of care and avoiding errors in those handoffs. The depository of information, whether it's the drugs the patient is on or what the other co morbidity czar that whether it's diabetes or hypertension that need to be managed to avoid those visits to the E R. Re. Hospitalizations in the worst case scenario are really glued together by the M R. For example, one of the things that attracted the door side it was the fact that the Assad is kind of ah unique information technology company in terms of building very user friendly interface is that sit on top of the M R and really engaged conditions? Because one of the things that we certainly have seen in the post acute space is that some of the documentation requirements and in the hospital as well are unwieldy. And the decision support isn't their CMR has to have a user friendly interface, so to speak, to engage the conditions, to collaborate, to cooperate, and really, I'm sure the best possible outcome. I mean, I think the other

Scott Nelson:   19:07
thing that I

Dr. Dan Mazanec:   19:08
would say is that there is likely going to be a significant role for telemedicine in the post acute space. So there was just a study looking at Madison from the standpoint of behavioral health and people just discharged after a heart attack on my cardio infarction. This study showed tremendous benefit in terms of reduced re hospitalizations, reduced E R visits and a almost $1,000,000 saving in this particular study costs as a result of those reductions based solely on a telemedicine intervention in patients who had just on discharge. So I think telemedicine will be years to help manage the post acute space increasing way to provide better care, but also to save money. And that's gonna be critical, obviously, on the new healthcare world.

Scott Nelson:   20:00
And on that note you mentioned or Sada where you're at currently, I would encourage if you're interested in these topics, if you're interested in learning learning more about them, Dan Post quite frequently to the door Sada block. It's D o r s a t a door sada dot com and just go to the block. You'll see it there on the top portion their navigation on their website. I would encourage you to check out a lot of those posts. A really, really good, very informative. And if you're thinking well, this stuff is great, but I don't really the use of that much. Or maybe I don't have a you know, necessarily an interest. I would encourage you to take a step further because you know If you're at a vet tech company, you're in customers or, most likely, hospitals or health care providers, right in general. So this is the kind of stuff that they're thinking about, right? This is what's on their radar. And so if you can speak to them intelligently about what matters to them, you will probably be a lot more effective in communicating, So I would definitely encourage you to check it out. So, Dan, before we move on, a couple of these other programs fit under this bundling sort of umbrella. Anything else to add that you think is worthy of mentioning with respect to the c C J R. The comprehensive care for joint replacement program?

Dr. Dan Mazanec:   21:05
I think the thing is, it's mandatory. It's being rolled out all across the country. I think there's 60

Scott Nelson:   21:11
seven different geographic

Dr. Dan Mazanec:   21:13
areas on. It's going to be interesting. It's certainly going to drive better coordination to care and between not only hospitals and surgeons, but again this whole post acute pace. I mean, I think this certainly for surgical care is really where reimbursement and CMS is going, and it's going to be the way this whole concept of value based there in that

Scott Nelson:   21:38
world is going to be sure. And I could see how some of those changes that you mentioned regards to the episode of Care. The fact that almost every single stakeholder in terms of health care providers take holder is gonna be incentivized to hit these targets. I mean, you can see come all of these pieces, all of these puzzle pieces sort of beginning toe fit together. And I think, you know, most people that are listening this audience are, you know, are in med tack or biotech. And I think it would behoove everyone to kind of considered all of these different puzzle pieces and how you can best serve them, you know, moving forward in this kind of new era of not just bundled payments but also, you know, value based care. So let's move on to a couple other programs. One is the the acronym is mackerel, but it's the Medicare access and C H I P reauthorization act. That's that's the lengthy program. Yeah, go figure that it's confusing to actually say, Can you kind of cover that? And maybe you start out sort of the two paths to reimbursement for physicians under this new program. So

Dr. Dan Mazanec:   22:37
the mackerel law is the law that was passed, I think in late 2015 and they could have been early January that really replaces these holes. Str sustainable growth Medicare's the fix that every year there was a panic in December January and Congress had to pass a patch law to fix this law. So this is the new law 900 pages that really rewrites the reimbursement rules for physicians in American health care. It's really based on three drivers or values. One is that reimbursement is going to be based on value, not volume again. So it's moving away from the fee for service. The more procedures you do, the more you get paid to. You know, the value based model. It has a strong emphasis on I T. And the focus shifts from Just process in I T. V to performance and then it again, much as the c. C J R. Bundling concept. It really Foster's movement towards integrative practice. So it identifies two paths to remember the two ways factors will be paid. You'll be in one of these two groups. One is the so called myths or merit based incentive payment system.

Scott Nelson:   23:52

Dr. Dan Mazanec:   23:52
this program is gonna affect 800,000 doctors. So probably it's estimated 85 to 90% will be under the myth model, which again is called merit based incentive payment. The other model, which exists now, and I would still look as more of a pilot test that is being done across the country and various practices, is the so called advanced Alternative Payment model 8 p.m. And for example, C. C. J. M. Is an example of that. These are programs accountable care organization is one. A patient centered medical home would be another. These are again. I think it's fair to, say pilots, where CNS is saying, You know, we're going to reorganized care saying a patient centered medical home where there are multiple specialists, position social workers, behavioral specialist nurses, nurse practitioners who provide care to a population of patients in again coordinated care, you might say with the same goals of reduction and costs an improvement in quality. But these are the two pass to reimbursement under the Naqura Law, in most positions will be dealing. Since most positions are not in, these pilots will be dealing with this so called MIPS program, which again is incentive based and essentially and it sounds complex, and it ISS. The positions will be scored in four categories that will essentially determine their reimbursement. One is quality, and that's 50% of your score quality measures, which now there's a myriad of them. Actually, one good thing about Mac wanted One important thing about mackerel, which is certainly good from the physician's perspective, is reduced and standardized to some extent and gives the physician some input in the selection of these quality metrics. One of the major complaints the positions is that there's just so many quality metrics they have to report on, and they differ from player to player. And there's an effort to standardize those and reduce the number. But 50% of your scores quality 25% of the score is based in what's called and I don't like the name, but it's advancing care information or a C I, and this is a big transition. This program, a C I replaces meaningful use, which we can talk about if you want. But meaningful use has been a program that CMS has had for the last several years to essentially incentivize the adoption of electronic health records in position practices. And it has succeeded. 80 to 90% of physician practices now have electronic records, but the program itself was widely disparaged, not and disliked by physicians. Sometimes instead of meaningful use. It's been called meaningless abuse, largely because it's focused so much on process on, you know, what percentage of prescriptions air sent electronically. And did you have the patient to printed after visits? Summary. It really wasn't focused on what clinicians might consider the important outcomes of quality. But this is a shift that program has replaced by a C I, and then 15% is on clinical practice improvement activities and costs 10%. So the big change with myths is some changes in the quality metrics and then certainly a major change in this so called advancing care information and those air going to drive how you are reimbursed.

Scott Nelson:   27:27

Dr. Dan Mazanec:   27:27
program is budget neutral, so at the end there will be some rolls out in 2017 and by 2019 the data will be in and physicians will. The reimbursement will be adjusted upward or downward by as much as 4% in 2019 and I think by 2027% which in a Medicare player environment is a huge amount of money, so there will be winners and losers. So since the program has to be budget neutral and efficient, high quality practices that can provide

Scott Nelson:   28:00
coordinated care

Dr. Dan Mazanec:   28:02

Scott Nelson:   28:02
probably succeed in this programme, I suspect that will begin to hear a lot more about these programs. You know, come 2017 especially, you know, in 18 4019 when some of these penalties come to permission is probably the best best way to describe that. So that's really good information. And so, with some of those changes, like the Advancing Care Information Act as well, it's kind of the two different reimbursement pathways. Physicians for four physicians How will that, in your opinion, effect you know, solo or smaller physician practices?

Dr. Dan Mazanec:   28:33
When this was published a month or so ago, maybe six weeks ago, that was the immediate reaction. Waas A lot of outcry about smaller and solo position practices, so practices solo positions or practices up to 78 physicians in the law itself. In the 900 pages somewhere is a table that CMS itself, projecting that 87% of solo practices face negative adjustments in reimbursement totaling up to $300 million so

Scott Nelson:   29:07
long amassed

Dr. Dan Mazanec:   29:08
in the document is actually predicting that the losers so to speak, will be the small groups and solo practices. So from that perspective, this is really to be successful with this program. If they're going to participate and there's a risk that some positions will just in that category will say, You know, I'm taking early retirement. I'm not gonna see Medicare patients. I'm gonna do a concierge practice or whatever, but which obviously has implications for health care delivery, since many solo in smaller groups are in rural areas are underserved areas and there's a real threat that the access to care could be compromised. But the alternative for those practices is to really what this program requires and what they need to do is two developed a capability to collect this information in terms of quality, to demonstrate the ace under the A C. I of the advancing care information that they to acquire the technology to meet the requirements. Essentially, it means building and acquiring the technology to meet all the reporting requirements, and that's the objection of the smaller practices that that's expensive and difficult. And there's some truth to that. But if they're going to succeed economically, they need to be able to do that. And that's another area, actually, where I think our company like their side of it, and how, with the kind of condition smart technology that we're building

Scott Nelson:   30:38
actually about that next, Dan before we get into the kind of the last three rapid fire questions. But for those those interested in learning learning more about door Sada, I would presume that you could just direct them. Thio Dorsa dot com That's a D o r s a t a dot com Correct? Correct. And the way I would explain to her sodding and feel free to step in. I think it's what you guys are doing. It is really unique. It's you sort of sit on top of a traditional M r. I think is everyone that's probably gonna be listening to this is encountered a health care provider that complains about their EMR. Whether the using, you know, sooner or epic is probably the two primary players. But I personally think when unite first talked. I mentioned this, but I personally have never come across a health care provider that's actually enjoyed working with their AM ourself. That's one. That's one of the reasons I think you guys are on to something there. With

Dr. Dan Mazanec:   31:29
the electronic medical record, these dinosaur products are a significant factor in position burner. It's very hard to find physicians who you

Scott Nelson:   31:39
know, our happy

Dr. Dan Mazanec:   31:40
working with the medical records. So you know what? Their side trying to build a technology that really thinks the way the clinician thanks documents and provides sort of seamless clinical decision support. You know, you have happier physicians, happier patients, more productive physician. Certainly economically, you give time back to the doctor and the patient could. The patients don't like a record where you're clicking away and standing at a computer screen. So the Assad interface is really very slick and that some of the things that when I left the clinic, I think

Scott Nelson:   32:15
I'll take a look at the website. Yeah, sure, And if you're not at ideal customer for door Sada, I would definitely encourage you to take a look at their blogged. It's highly informative. The trends that are happening right now within healthcare. So regardless, definitely check out your santa dot com and at the very least, learn a little bit more through the articles, that confidence there. So, Dan, just to summarize if you can, I know you're a health care your position yourself, your healthcare provider. But if you can, let's pretend almost like we're sitting down for dinner. I'm someone in med Tech, maybe a senior level executive, and I met tech company, and I want your opinion on what I should do, you know, other are they're a couple things that I should consider do moving forward. In light of some of these, you know these major changes, whether it's the c, C, J R or the Back RA program, Do you have any given, maybe two or three insights to summarize our conversation? The

Dr. Dan Mazanec:   33:03
person you know, whether you're a provider or whether you're involved in the health care organization or and really at just about any level, or if your ah manufacturer of ah, healthcare technology or healthcare hardware, you need to be aware that the bundling of service is along the entire continuum of care involving all providers, not just positions, but physical therapists is really the direction that is PMS is taking to really reshape care along the lines of value meaning crossed quality over cost and that from the health organization standpoint, having robust finish in friendly and smart health care. I t. Is the glue throughout this process that throughout the continuum anyway, that will facilitate meeting the demands of the terms of reporting just on the outcomes on the important elements of care provided and at the same time moving efficiency and quality. And it's critical. I mean, I would look at health i ke, and this whole thing is the backbone of this bundle. Really, that ties it together. And I think that that's I think that's really my primary message.

Scott Nelson:   34:21
Very good. Let's finish off with the last three rapid fire questions. Now the questions are rapid fire that your answers don't necessarily have to be the same in the same fashion. But let's start out with Number one. What's your favorite nonfiction business book? You

Dr. Dan Mazanec:   34:35
know, I would have to say, and it's not a new book, and it's really relevant over time, but it's redefining healthcare by micro quarter. You know Michael Porter is Ah, Harvard professor economists whose book I think it's probably now close to 10 years old, and I've actually gone back and reread some of it really embodies the elements of the whole revolution in health care. Redesigned. Many of his concepts have been adopted, adopted in the Affordable Care Act, have been adopted by See a Mass, and it's really ah, critical, very important book from the standpoint of the business of healthcare and redesigning health care.

Scott Nelson:   35:16
The title of that is really redefining our redesigning, redesigning, redefining health here. Okay, that's great. I've never heard of that great,

Dr. Dan Mazanec:   35:25
he wrote a paper which was actually I'm in a logical in The New England Journal of Another Son published Think back in 2009 or so. It was something like a strategy for health care reform. But if you read that article, it's almost like a road map for the direction that CMS is taking. Health care in this country

Scott Nelson:   35:46
got very good. So second question, is there a business leader that you're following right now or one that is inspiring to you? I'd

Dr. Dan Mazanec:   35:53
be very provincial, as you know. I'm at the Cleveland Clinic for more than 30 years. And I would say that the business leader that references actually, Toby Cosgrove, who wasn't here, is the CEO at the Cleveland Clinic. I mean, he's a heart surgeon. You became CEO maybe 10 years ago, but amazingly insightful and innovative CEO, visionary. And I think he from the health I t standpoint he was several years ahead of the game.

Scott Nelson:   36:21

Dr. Dan Mazanec:   36:22
certainly from this whole focus on value based care and on patients first on. A lot of this is business. Can't forget that the center of it all is the patient. And Toby, just to give you a brief example of several years ago, recognize that access to care. It was a big problem. I mean, it's not that that's a new idea. But his answer was somewhat disruptive, he said at the kid. And quick was huge organization where people sometimes we're waiting to three months for unemployment, he basically said, literally, almost overnight, we're gonna offer same day apart. If you call the Cleveland Clinic before noon. You get seen that day and he said, This is the way it's gonna be and make it happen. I mean, it was a very I can tell you from my perspective, as a lot of people said what? It's impossible. We can't do that. How are we going to do this? But the bottom line is, I think the last time I heard and I know it's much lighter now go with more than a 1,000,000 same day appointments scheduled since he instituted this a couple years ago. So tremendous, very out of the box.

Scott Nelson:   37:30
That's great. I think most people are probably familiar with him in name only. But that sort of anecdote that you just share it is pretty cool gives. It gives us a better feel for kind of his style in terms of running that the Cleveland Clinic. So last question for you, Dan, is when you think about your career in health care, if the opportunity to kind of use a time machine and rewind the clock, is there a piece of advice that you tell your you know, your 30 or 40 year old self?

Dr. Dan Mazanec:   37:53
I reflected on a question like that. You know, I think about my own career, and, you know, I started out as a board certified internist rheumatologist, practicing arthritis care, probably about when I was 30 or 32 then an opportunity came along. I don't stay out of the blue, but was asked to become involved in spine care nonsurgical spine care. And that led to becoming the director of the Center for Spine Health of the Cleveland Clinic until I left, really probably for 15 20 years and then in the last five or six years at the clinic. But I was basically asked because into some degree nobody else wanted to do it to become involved in building care paths, which is kind of what we're talking about, building a chemical pathway and then enabling it in the m. R. So I got into sort of the health I t area that way. And what I would say, the advice I get is reflecting on all that. I'd say You just have to be open to change opportunity, be flexible. I would have never gas 30 plus years ago that I'd be working for a health. I t start up as I am now. It was really a matter of being flexible, willing to take on challenges and not being locked in a box and be inflexible on, and I think That's probably the best advice I would give myself.

Scott Nelson:   39:13
Yeah, that's that's good stuff. Well, I can't thank you enough, Dan, for coming on the program. All as I wrap this up here, I'll have you hold on the line. But again for those listening and that want to learn more about the topics that we just discussed? I would definitely encourage you to check out the door. Sada Block. That's all linked to it in the show notes for this particular episode, but door Sana dot com It's D O r s a ta dot com click on their block and Dan Post articles fairly frequently that are really, really good. It's not a boring read it all. They're actually really, really informative. You've got a knack for explaining things in an easy to understand fashion, and if you got an interest in your sanity, check out the product was pretty cool. It really would help us out. If you go to iTunes and give us a rating. That just helps in terms of raising the overall visibility for this radio podcast. So that's it for now. But again, thanks for your listening and attention until the next episode of Med Cider. Everyone