2017—the Year of the Huddle?
In 2017, more than ever before, oncology practices of all sizes will ultimately be responsible for the quality and the continuity of the care that they provide to their patients. Notably, under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Merit-based Incentive Payment System (MIPS), Medicare will be tracking performance and scores that practices accumulate through self-reporting or Medicare claims tracking. These performance metrics include quality measures, resource utilization, Advancing Care Information under MIPS, and the Clinical Practice Improvement Activities of MACRA. Practices that are participating in the Medicare Oncology Care Model (OCM) are subject to the MIPS measures, as well as the requirements and expectations for practice transformation under the OCM, although some OCM activities may also facilitate performance for the MIPS measures.
It typically falls to the practice administrator to keep track of the new rules, and to disseminate this information to the practice team. However, the MIPS, OCM, and any other performance measures that may be required in coming years affect so many players of the practice operations and patient contacts that the new order of business for practices will be the “huddle.”
In fact, the Practice Transformation Plan Attestation and Self-Assessment, which the Centers for Medicare & Medicaid Services provides specifically to OCM practices, to help them identify opportunities for improvements that are necessary for OCM success, includes a specific reference to “huddles” as a concept of change, citing “frequency of team huddles to review and discuss management of patients.”1
It is interesting that the dictionary definitions of “huddle” vary from the physical (“a disorganized and densely packed crowd”) to the act (“crowd or draw together”) to the purposeful (“a quick private conference”).2 I propose a new definition of “huddle” for those involved in healthcare, “a virtual or physical review across the care team for individual or collective patients that touches on coordination, communications, care goals, and updates.”
Historically, your daily operational and clinical planning centered on physicians and their schedules and the needs for the day. Under the new overarching patient care, communications, and accountability models, your daily operational and clinical planning will shift to the patients—patients who are in the office, and those who are under your care but who are not physically in the office.
Internal, External, and Global Huddles
Let’s look at 3 scenarios of how these huddles (virtual or physical) can transform the approach to patient and practice management.
Internal Huddle: Patient Care Inside the Practice Walls
Internal huddles involve the various departments of the practice discussing who is coming in for care, what their needs may be, which patients may require particular attention to different coordination and communications, review of the goals and status of the patients, and the interaction between the departments (eg, front desk, laboratories, imaging, pharmacy, and clinical care). More practices are beginning to have these reviews on a daily or a weekly basis.
External Huddle: Patient Management Inside and Outside the Practice Walls
External huddles involve various departments within the practice and external entities, such as hospice care, visiting nurses, social work, and patient navigators, to review the management and navigation needs of the patient outside of the practice office hours, including transportation; social needs; work or family life coordination and support; and communications or coordination with the patients, caregivers, and any other health or support professional who interacts with the patients during their cancer journey.
Global Huddle: Population Management
Global huddles involve the payers and providers of care (or the members of an accountable care organization) who are responsible for patients with cancer in that population to review the various trends, including disease severity at presentation; opportunities for screenings and prevention education; alternative sites of care delivery, including home care; and work and productivity discussions.
Gone are the days when oncology practices treated the patients’ cancer and didn’t need to look at what happens to them once they left the office. Today, you have to worry about patients’ adherence to treatment, their symptoms and side effects, and how to keep them out of the emergency department and, ultimately, the hospital.
You also have to consider whether the costs of the entities to which you refer them (for services, imaging, or diagnostic testing) are reasonable, and that these entities are working with appropriate healthcare professionals to manage the patient’s comorbidities. Everything that affects patients once they become your patient matters, and you are asked to report on communications and follow-up outside of your 4 walls.
You can only manage these patients through huddles, through actively connecting and talking with the diverse members of the care teams and the greater community. Cancer care has never been a solo sport, but the concept of “team” has grown dynamically in recent years.
One of the most difficult parts of this transformation is that the technology—the electronic health record (EHR) system—has generally not grown enough to catch up with these new demands. Oncology practices have to reach outside of their 4 walls to communicate with the other team members, and also to track that the communication is received as well as obtain a response in turn.
Practices have to document that they are navigating and communicating, as well as be able to track what they find, and how they respond. The EHR systems are needed to facilitate these activities, or to recognize when they are too limited to do so, and to allow practices to utilize other software to manage these communications, monitoring, and processes, while freely (and at a reasonable cost) sharing data with their EHR system.
The New Norm
Huddles are going to be the new norm, and oncology practices need a new mind-set to make these huddles happen on a personal level, as well as to maximize the technology options to make them happen in a virtual manner.
Oncology practices still have a long way to go on both fronts to ensure that they are achieving the type of huddle that is “a virtual or physical review across the care team for individual or collective patients that touches on coordination, communications and care goals and updates” and to avoid becoming a huddle that is a disorganized and densely packed crowd.
- Centers for Medicare & Medicaid Services. Practice Transformation Plan Attestation and Self-Assessment. This document is only available to OCM practices and is not available to the public.
- Huddle. WordNet Dictionary definition. Online Dictionary. www.webster-dictionary.org/definition/huddle. Accessed January 15, 2017.