IDSA response: Guest post by Dr. Dan McQuillen

The following is a guest post from Dr. Daniel McQuillen, IDSA Chair for the IDWeek 2016 Program Committee, and President of the Massachusetts Infectious Diseases Society.

With the acknowledgement that IDSA needs to expand communication/marketing efforts in this area, I wanted to offer some information on ongoing activities our society has been engaged in for several years, beginning with IDSA’s leadership level membership in the Cognitive Care Alliance, an organization that has evolved from a loose coalition to a more formal structure last January. The Alliance hopes to take advantage of the collective power and footprint of cognitive specialties to advance the agenda that the current payment system seriously undervalues cognitive services. Change is slow and incremental in this area, but some of the reforms in payment delivery coming along offer opportunities for ID to improve our reimbursement position in the clinical arena and more importantly in the non-clinical arena (antibiotic stewardship programs (ASP), infection prevention (IP), overall system quality). You'll note that the Alliance member who signed this letter to the Senate Finance Committee (John Goodson from SGIM) is also the author of the recent NEJM article regarding fixing the Medicare Fee Schedule.

IDSA representatives to the AMA CPT/RUC committees have been involved in development and valuation of codes for physician supervision of OPAT infusion, RVU revaluation (upwards) of Evaluation & Management codes and transitional/continuing care codes. In addition, the IDSA Board approved a partnership between the Valuation Workgroup that I lead and The Advisory Board, a consulting group with a healthcare focus, to formally develop the concept of an ID Hospital Efficiency Improvement Program. Such a program will contain ID service lines that are threads throughout healthcare systems, and can serve as templates for members to use when they are proposing new or expanded ASP, IP and OPAT programs to their hospitals or systems. The IDSA Board of Directors previously funded our work with an external expert valuation firm to establish that the benchmarks for “fair market value (FMV)” for ID executive compensation should be higher than the FMV numbers usually thrown out by hospital executives at ID docs. The compensation survey just published by the IDSA Clinical Affairs Committee (CAC) complements this and represents an effort to generate accurate data to counter the inaccurate data promulgated by MGMA and Medscape, not a ‘spin’ that everything is fine. It is just one piece of a broad effort to bolster the value of ID specialists to the systems they work in and support. I note that SHEA has recently surveyed its membership on compensation and await a report on the findings in hopes that it serves as another more accurate benchmark reference. The FMV data along with examples of medical executive co-management agreements for non-clinical activities with sample contracts can be found in the “Value of ID Specialists Toolkit” on the IDSA website (membership login required).

A major thrust of what the IDSA Clinical Affairs Committee, Value Task Force, and Valuation Workgroup have been doing for several years is to establish a robust set of tools with supporting evidence that will serve to increase the benchmarks for what we get paid for our non-patient care activities. New trainees coming out of fellowship have little idea how to establish the value of and negotiate for fair compensation for those activities (I know I had no clue). Success in these efforts will go a long way to increasing overall compensation and have potential to yield far more reward than increasing payments for E&M services would. Our specialty’s inherent altruistic nature, especially in academic settings but still in many clinical practice settings, gives our expertise away with too much ease. We have to change that.

Finally, two IDWeek plugs: the IDSA CAC has organized a session for several years that explores the issues of Health Care Reform as they affect our specialty. This year will feature talks on Health Care Reform trends by a speaker from The Advisory Board, ID-led ASP, and how ID specialists fit in a bundled payment environment. Second, in lieu of their annual Business Meetings, the Presidents of IDSA and HIVMA will be hosting an ID “State of the Specialty” Town Hall Meeting Friday evening at IDWeek. Please attend with suggestions in hand.