CMS Executive Q&A with Kate Goodrich

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Kate Goodrich, CMS
Kate Goodrich, CMS

Kate Goodrich, MD, MHS, joined the Centers for Medicare and Medicaid Services (CMS) in September 2011 and presently serves as Director of the Center for Clinical Standards and Quality (CCSQ). The Center is responsible for over 20 quality measurement and value-based purchasing programs; implementation of the new Merit-based Incentive Payment System and the Improving Medicare Post-Acute Care Transformation Act; quality improvement programs in all 50 states; clinical standards and survey and certification of all providers across the nation; and all coverage decisions for treatments and services for CMS. The Center budget exceeds $1.3 billion annually. 

Previously, Dr. Goodrich served as the Director of the Quality Measurement and Value-based Incentives Group in CCSQ where she oversaw the implementation of over 20 quality, value-based purchasing and public reporting programs across multiple settings. She also co-led a U.S. Department of Health and Human Services (HHS)-wide group to align quality measures across programs, and more recently has worked with numerous private payers to align measures across the public and private sectors. From 2010 to 2011, she served as a Medical Officer in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at HHS where she managed a portfolio of work on comparative effectiveness research and quality measurement and improvement.

Dr. Goodrich is a graduate of the Robert Wood Johnson Clinical Scholars Program at Yale University where she received training in health services research and health policy from 2008-2010. From 1998 to 2008, Dr. Goodrich was on faculty at the George Washington University Medical Center (GWUMC), where she served as Division Director for Hospital Medicine from 2005-2008 and was chair of the Institutional Review Board from 2004-2008. She went to medical school at Louisiana State University in Shreveport, Louisiana, and completed her internal medicine residency and chief medical resident year at GWUMC. She continues to practice clinical medicine as a hospitalist and Associate Professor of Medicine at GWUMC.

Q. Tell us your thoughts about the recent CMS Quality Conference. What were your chief takeaways?

I think it was an incredibly energetic conference. What particularly impressed me was the ability of many different groups involved with quality improvement to interact with and learn from each other. Every day, we heard how energizing, exciting and useful it was for participants to engage in knowledge sharing and collaboration… for the Hospital Engagement Networks (HENs), Practice Transformation Networks, Support and Alignment Networks, Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and others to be interacting and learning best practices from each other. We know that some new collaborative relationships were established at the conference and that they will continue to be nurtured in the coming year. While the CMS Quality Conference always has involved a lot of sharing, we felt that the number of connections and degree of collaboration and openness this year were greater than ever before. To me that’s the big takeaway.

Q. As the new leader of CMS’ Center for Clinical Standards and Quality, what are your priorities for 2016

We have a number of priorities, but I’ll focus on three of our main ones. First, we plan to issue a regulation in the Spring and are developing the operations and information technology (IT) systems for the new Merit-Based Incentive Payment System (MIPS), which changes how we pay physicians and clinicians for the care they provide. We will pay based on their performance on quality and cost measures, while also emphasizing the use of electronic health record technology and quality improvement activities. We’ve engaged with various stakeholders, including our IT colleagues, on how to stand up the program, so that the clinician experience with it will be a seamless and positive one. We want to reduce their burden and make it easy for them to succeed.

Another priority is the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. We have finalized the initial wave of standardized quality measures and will be proposing additional measures that are standardized across care settings. We also will begin our national training program this year.

Finally, we’ve been doing a lot of work in the past few years to update or modernize quality and safety standards for facility-based providers. In the last few years, we have developed a number of regulations for hospitals and soon will have them for home health and long-term care as well. We’ll publish several final rules in 2016 and begin implementation, working with survey agencies to train surveyors and working with providers on how to meet the regulations. As with our other activities, we will aim to do this in a way that minimizes the burden on providers.

Q. How has your current role as a caretaker to your mother influenced your work at CMS?

It has influenced my work greatly. As a caretaker, I’ve been able to see how the system works and doesn’t work through the eyes of a beneficiary. I’ve see firsthand how my mother has received tremendous care from her geriatrician and other providers. I’ve also seen instances where health systems fail patients. Whenever things fall through the cracks – such as lab tests not being followed up on or prescriptions not being refilled – I see it as a system issue rather than as an individual’s error. I’ve been able to see how health systems are really trying hard to make things better for patients, such as by increasing shared decision making and improving communications.

Q. You played a significant role in the development of the CMS Quality Strategy. Could you tell us a bit about the updated 2016 strategy – what’s new and what’s next?

Fundamentally, the updated strategy isn’t very different from the original one; it has the same six goals with objectives and the four foundational principles. But the passage of some significant legislation and the setting of clear goals and timelines by the Secretary of Health and Human Services made us feel that the CMS Quality Strategy should reflect these developments. Under the Make Care Affordable” section, we added some goals with specific targets, and mentioned our activities involving the Medicare Access and CHIP Reauthorization Act (MACRA) and IMPACT Act. We also updated some of the home and community-based services language to reflect our work in that area. Another new development is the establishment of affinity groups at CMS in order to accelerate implementation of the Quality Strategy, and that's reflected in the 2016 update. Moving forward, we will continue the work of these affinity groups, creating new ones based on staff requests and determination of need.

Q. What advice would you give to those who might be encountering barriers in collaborating with other health quality stakeholders to improve provider care?

It depends on what type of barrier we’re talking about. Anyone working for a CMS quality program or initiative should feel free to reach out to us when barriers are encountered, so we can help troubleshoot and resolve them. Whatever barriers exist are less likely to involve a general unwillingness to collaborate so much as a lack of understanding of what’s being asked or a time/​schedule conflict. One thing we’ve found is that the ability to connect in person accelerates the generation of ideas, the sharing of knowledge and the making of commitments. If you’re a QIN-QIO trying to connect with your local ESRD Network, you can offer up a particular commitment – such as providing a best practice or data – when making your ask of them.

Q. Anything else you would like QIO News readers to know?

I want to emphasize that it’s become very natural now for patients to be at the center of care in quality of care discussions. This wasn’t always the case. It’s important for the general public to know that person-centered care is a priority for CMS. We think that it’s made our work better. For the provider community, we’ve heard how important it is to make clear connections between the improvement work they’re doing and the payment systems under which they’re being held accountable. Under MIPS, we’ll want to hear from providers about how programs like the Transforming Clinical Practices Initiative are helping make them successful and transition towards participation in Alternative Payment Models.