Dr. Thomas Barber Shares How Providers Can Impact Policy

From DOCSF17

Dr. Thomas Barber sits with Breanna – to talk more about what it’s like working on health policy in Washington, D.C., the importance of registries, and the app he can’t live without!

A transcription of the entire interview is below:

Breanna Cunningham: Hi there. Bre Cunningham here live with the Dr. Barber, a practice orthopedic surgeon specializing in total joints and a heavy hitter down Washington on Capitol Hill. Lots of experience with that. Very actively involved in AAOS, remember their advocacy program. Dr. Barber, you just gave an amazing presentation on where things are headed with the new administration and also kind of gleaming on your past experience and then kind of projecting to what you know is going to be happening in the future. One of the things that I’m really interested in hearing, and that we talked about offline, was the curriculum for residence. In residency programs, which you’re very active and involved in as well, there isn’t really much of an emphasis on how do you change policy and what is your role as a physician in that? I’d love to hear your thoughts on that.

Dr. Thomas Barber: Absolutely. There are a bunch of ways the residents could get involved. I think we have the political action committee, which really solicits resident involvement, as far as not just giving money but just being active and actively participating in the process on Capitol Hill and also with regulators. We define advocacy in a very broad way, meaning that it’s not just political advocacy on Capitol Hill, but also looking at the regulators behind the scenes. That can be Medicare, Medicaid, FDA. We often have to influence all the major policy makers in the government and we really encourage younger physicians to get involved in that process.

Now, I understand that not all residency programs have professors within them that can teach all these skills, but where it does exist we often encourage people to teach the residence about what’s happening on the hill, what’s happening in the regulatory space, and how that might impact their patients and their practices later on.

There are so many resources to turn to to allow residence to actually learn more both on the academy website, as well as some of the subspecialty websites. Really encourage some of those residence to get involved and contact the academy to learn more.

Cunningham: Tell me about your personal journey as an orthopedic surgeon into this role that you’ve developed and being well known as the person who is the go to for what’s going on on the Hill.

Barber: I’ll tell you, it really started awhile ago when I joined the board of counselors. That was probably about twelve, thirteen years ago now. I was elected to the board of counselors from the state of California and I started getting really engaged. The board of counselors for the academy is really our House of Representatives. It has representatives from every state and it is a very active group that really looks at the changes and what’s happening in orthopedic surgery and how it impacts the world of orthopedics throughout the nation.

I think that when I got involved there I became very engaged and interested on all the differences between the states and what was happening on a federal level. I became the chair of the board of counselors. While I was chair was the whole time when they were considering Obamacare. I got to be in the middle of that whole change where there were multiple bills being brought forward about changes in healthcare on Capitol Hill. I obviously had to be very engaged. I went to a lot of healthcare policy conferences and I also stay involved with legislators to try to understand the changes.

What I learned, amazingly, is that we actually have a lot of say and we can make changes in how things role forward. I can think of three or four things that were actually included in the final bills that we actually brought forward.

Cunningham: The surgeons.

Barber: The surgeons brought forward and said, “We need something different. Yes, we understand you’re moving in this direction but we need some tweaks to this and can you make these changes?” I said, “Those changes were made.” Which is exciting even if the overall change wasn’t positive, we could make changes that were more positive within in.

Cunningham: What I’m hearing is that Medicare has been receptive of the opinion of the end user, or the provider in the situation.

Barber: Yeah. In fact, they are amazingly enough. When I started as a chair of advocacy we started having quarterly meetings with Medicare

Cunningham: Okay.

Barber: Particularly with those …

Cunningham: Was that new?

Barber: That was new.

Cunningham: Okay.

Barber: They were not so willing to do it initially, but we tried to make the point that we’re really trying to work with them to develop the best quality measures and to really understand how we manage healthcare and partner with them rather than be just adversaries. While we don’t agree with all of their positions, we’re at least in the door and able to talk to them and that makes a really big difference. I think being able to sit down and really debate which quality measures will work, which ones won’t …

Cunningham: Sure.

Barber: That was fun. It was interesting, fun, and they were listening. It’s amazing how many changes have been put into place because of the steps that we’ve done. In fact, just on the 20th of December we had an interesting teleconference with Slavet who was talking to us about the changes that they are putting forward in some of the programs. A lot of the changes which we had asked for. It was really nice to hear that they had listened and made the changes. They don’t do that all the time, but in a lot of the things that we were very concerned about they were listening and willing to make those changes.

Cunningham: What I find really nice is that it makes sense that you guys have had some a heavy role in that. A lot of the measures, like with CJR, really do make sense. The HOOS & KOOS are great tools. PROMIS is a great global tool. The intervals are … You can tell that that was well thought out, caregiver derived. That’s very exciting.

Another area that you’re passionate about is data registries?

Barber: Correct. Yep.

Cunningham: I would love to hear how you think these data registries, what they’re going to evolve into and what their role will be in the future of Medicare.

Barber: Sure. It’s interesting you say the future of Medicare. I would say the future of healthcare because I don’t want to find it just in Medicare. Registries are so critical because all of the implants that we put in in the United States need to be tracked for their quality. We have seen a number if instances where implants have been put in that don’t function well in the long term. DePuy, metal on metal ASR hip was probably the one that was most famous or infamous depending on your perspective. I think that we need to be able to track how things work and whether they work well for our patients. Registries do a really good job of that.

They also do a really good job of being able to track quality. I think that’s one thing where we haven’t had as much exposure and as much success as we need to have because we can really look from our registry and look at the data that they have and see how many infections you get, how many pulmonary emboli and DVTs and what the length of stay is. Some of the more complex issues. When we first started out in our registry, we were looking at one single outcome. That was whether the surgery was revised or not. It was looking particularly at the implant. As time went on, after about five years, we were able to incorporate other outcomes. That would include infection, readmission rates, re-operation, and things like that that are really more critical to the quality of what we do.

I think as we move for a value based payment program, registries will be critical because they capture all of the information about our patients and how they’re doing in a way that surgeons can understand. I really would encourage us all to get involved with registries and do the things that are necessary to make them happen essentially.

Cunningham: Excellent. Well, as we wrap up here I’d love to ask you what application or piece of technology do you use in your personal life that is something that you can’t live without?

Barber: The one I can’t live without the most is Waze because I’ve got to be able to get somewhere quickly.

Cunningham: There you go. Sure.

Barber: Especially in the Bay area where there’s a lot of traffic. I’ve got to figure out what the best way to get someplace is. What I’m looking for is the Waze application for healthcare and so I can navigate and see what the best thing is for my patient at all times and at some point we’ll get there.

Cunningham: We will. You know what? We can be having this discussion next year at this exact conference about the new Waze in healthcare.

Barber: Exactly.

Cunningham: Dr. Barber, it was a pleasure talking with you.

Barber: Alright. Nice to see you.

Cunningham: Thank you very much for your time and we’re out.

Barber: Alright. Terrific. Okay, thank you.

Cunningham: Thank you.