Joseph Fifer came aboard as president and CEO of the Healthcare Financial Management Association in June, succeeding Richard Clarke, who retired after 26 years. Fifer is no stranger to the HFMA, having served as board chairman in 2006 and 2007.
Interviewed by Marty Stempniak
What tools will hospitals need to evaluate whether they'll succeed in value-oriented models?
I think of this question as there's a tangible side and maybe a less tangible or human side. On the tangible side, data are going to be critically important. One of the buzzwords we use is business intelligence — access to that information, understanding that information. And I'm not even talking about just in a hospital setting. The difficult part and the interesting part about business intelligence today is it spans across the entire episode of care, outside of the hospital walls. And getting that data, understanding it and working with it is the only way that we're going to be able to shift the cost curve in this country. For example, looking at business intelligence across chronic care conditions and using that data to think differently about care models is one thing that's pretty important. On the human side, we've had lots of data for years. So what needs to go along with that is more of a human behavior, and that is having a deep sense of curiosity and trying to really penetrate through the data to either develop new streams of information or the meaning behind it. We're in such a complex industry and there's so much variation that it really takes a curious mind to understand that data. And I think that curiosity is going to be a huge need going forward. And finally, just a willingness to experiment, a willingness to try new and different things is critically important as the industry moves as quickly as it is.
How do HFMA members believe the Affordable Care Act might impact them?
The market is changing rapidly, with or without the Accountable Care Act. It's not waiting until 2014 when all these provisions kick in; it's happening as we speak. I don't know that I would characterize it as a fear, but one of the many, many questions that we can't answer yet is how the exchanges are going to work. That will dictate how the whole industry is going to have to react and think differently about things. We don't know yet how those are going to work, specifically for hospitals, doctors and health plans; we don't know how the payment rates are going to shake out or the methodology of payments within those exchange models and the various partnerships or deals or mergers or acquisitions or whatever is going on in the marketplace to react to those exchanges.
What are the greatest challenges for HFMA?
The biggest challenge is the fact that the industry is moving so quickly. And if you think about health care, it's kind of been a three-legged stool. There's the traditional hospital component, the traditional physician practice or office component, and a health plan component. What's happening now is those circles are coming together. In fact, we had this conversation with our board and I drew those circles up on a flip chart, just talking about how we look at where the industry is changing, and one board member stood up and said, "You almost got it right," and he took the pen and drew one circle around the whole thing, saying, "This is perhaps how we need to look at health care today." The challenge that we have is to develop our thoughts that go across all three of those traditional environments, because that's where providers' and health plans' thinking is today. With all the deals happening and risk arrangements taking place, you'll see a lot of overlap in those circles.
What capabilities should health care providers develop?
This is really captured in our Value Project reports, and we've focused on four key capabilities that we believe providers and others in the industry need to have: business intelligence; performance improvement in looking at disciplined ways to evaluate and improve their processes and workflows; people and culture, which are huge you can't do much if you don't have people and the culture within which to make change; and capabilities in risk management or contract management. That's the whole realm of looking at ways outside of the traditional fee-for-service reimbursement, and that's the context in which we are encouraging people to experiment.
Do finance people have the right skills going forward?
Absolutely, I think they do. And the reason I say that is that financial people are analytical, they're data-driven and they're curious. And I think those are traits that are incredibly important in this environment, are enabling them today to understand more than just the numbers. What's the story behind the numbers?
Are there too many quality metrics now?
Before I address the quality side, think about what happens in financial reporting. We would have in a hospital thousands of accounts and, depending on the size of the hospital, either hundreds or more than a thousand cost centers. There are data spread out all over the place. But in financial reporting there is this cascading process in which we accumulate all of these accounts and all of these cost centers into understandable buckets. First, it's at a cost center level, and then we group those cost centers into responsibilities by director, and then by VP and by entity, and then, ultimately, those are reported with a standard set of reporting rules, Generally Accepted Accounting Principles, that enable them to be published with some consistency from entity to entity. The question is: Can we develop a similar thought process with quality data?
Now, on the financial side, we're able to categorize in common form very different organizations. And the results of all those metrics are very different, but it's within a common set of rules. Why can't we have a similar environment for quality? Maybe the issue is not that there are too many quality metrics. Maybe we need thousands of quality metrics just like we have thousands of accounts and thousands of cost centers. But maybe it's developing a methodology whereby those thousands of metrics are gathered and analyzed in a cascading manner down to a common set of understandable metrics that would be used to compare organization to organization. And just as in financial reporting, you can't draw complete conclusions by looking at those summarized financial statements. To really understand an entity compared with another, you need to dig underneath the financial statement covers to find out what's going on. I think the same argument would be the case for quality data. You can't draw total conclusions, but at least it's a framework that is consistently generated and consistently reported that gives … a comparative starting point.