An Executive Q&A with Paul McGann

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Paul McGann, MD is the Chief Medical Officer (CMO) for Quality Improvement at the Centers for Medicare & Medicaid Services (CMS). His position is located in the Center for Clinical Standards and Quality in the Quality Improvement and Innovation Group. Dr. McGann also serves as the Co-Director of CMS Partnership for Patients (PfP), launched by U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius in April 2011. He is also the Co-Director of the Transforming Clinical Practices Initiative (TCPI). In 2002, he joined the full-time staff of CMS and in July 2007 was promoted to Deputy CMO. He has contributed to the ongoing re-design of the End Stage Renal Disease (ESRD) Network Program, identification and reduction of health care disparities, and introduction of the principles of geriatric medicine into numerous CMS programs, including the development of two entirely new divisions within CCSQ. From February to May 2011, Dr. McGann served as the Acting CMO for CMS, reporting to the CMS Administrator. He received a bachelor’s degree in chemistry and a master’s degree in biology from the Massachusetts Institute of Technology. He graduated from the McGill Faculty of Medicine in Montreal and completed both internal medicine and geriatric medicine training in Canada, where he practiced geriatric medicine for 14 years. Dr. McGann is board-certified in both internal medicine and geriatric medicine in both the United States and in Canada. He returned to the United States in 1995 to become the founding Clinical Director of the J. Paul Sticht Center on Aging at Wake Forest University in North Carolina. He was named the first American Geriatrics Society-Health Care Financing Administration (AGS-HCFA) Health Policy Scholar in 1999 and contributed to the development of the active Health and Aging Policy Fellowship Program. Dr. McGann received the prestigious Nascher-Manning Award from the American Geriatrics Society and the CMS Lifetime Achievement Award in 2014.

Q. What are your goals and priorities in your new role as CMO for Quality Improvement at CMS?

I have a number of goals and priorities. To cite just a few: improving our ability to define and generate measureable improvement in outcome goals; improving hospital safety nationwide; improving care coordination, including by closely examining hospital admission rates; implementing the National Quality Strategy; improving the total cost of care, including all-payer cost of care; reducing overutilization; catalyzing, through TCPI and the Quality Improvement Organization (QIO) Program, major clinical practice transformation at national scale; improving patient and family engagement; linking high performance in patient and family engagement to better outcomes; and working very hard to achieve alignment of all health quality programs within HHS, including those at CMS and at non-CMS operating divisions.

Q. CMS has been taking steps to align its various quality improvement initiatives and programs, including the QIO Program. What are the benefits of this alignment to providers and patients, and what are the next steps in this process?

The benefits are many. Greater alignment of quality programs and initiatives leads to better clarity for both patients and providers. It also leads to greater efficiency in the use of scarce resources. Increased alignment toward definable aims improves and accelerates progress toward achieving those aims. As far as next steps are concerned, CMS is in the process of announcing some very large, national quality improvement collaboratives, including the second round of Hospital Engagement Networks (HENs) under the Partnership for Patients, and the Transforming Clinical Practices Initiative." This development will enable us to bring together all HHS forces for quality in the last quarter of 2015 and align them toward achieving common goals. This will be a major focus of our CMS Quality Conference in December.

Q. Data transparency is an increasingly important focus for CMS. What are the QIO Program – and individual QIOs – doing to support the agency’s efforts to make more data available to the public?

The QIO Program has begun to model internally the data sharing and transparency that is necessary to rapidly identify opportunities to accelerate improvement in health care. By agreeing to do this, the entire Beneficiary and Family-Centered Care-QIO (BFCC-QIO) and Quality Innovation Network-QIO (QIN-QIO) community will more effectively spread what is working across the country in order to maximize our collective use of performance data. We see this as the first step to spreading a culture of data transparency within the Program and provider communities, and in preparation for our ultimate goal to publically share more data, more often. The Partnership for Patients is also committed to data transparency. As part of the Leading Edge Advance Practice Topics (LEAPT) program from 2013 to 2014, six HENs committed to data transparency as they worked on advanced practice topics like severe sepsis and hospital culture of safety. For a great example of this work, you can visit the Washington State Hospital Association’s hospital quality website.

Q. How will CMS use the data they are sourcing from the QIO Program to move the Program forward?

The data that we extrapolate from the QIO Program and other sources enables us to track our progress toward achieving national aims such as the National Quality Strategy Aims of better care, healthy people, healthy communities and affordable care. Examples of how we use the data include to measure and improve hospital safety, hospital admission and readmission rates, emergency department visits, and – with the advent of the TCPI Program – to measure and improve overutilization. These data inform our ability to set national aims and to align systems to achieve these aims over the next four to five years. Additionally, the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) legislation this year is enabling us to align our quality metrics, quality goals and programs with the new payment direction that the agency is pursuing under MACRA. 

Q. How can the QIO Program best maximize the national impact of quality improvement initiatives conducted at the local level?

In short - only in coordination with others. When we contemplate and discuss national aims, we realize that it is hard to achieve them when local initiatives are not fully aligned with each other and with other projects. Full coordination and alignment is the key to maximizing national impact. We are seeking strong synergy, not duplication of effort. But you can’t achieve any synergy at all, let alone strong synergy, if different programs do not talk and interact with each other — on a frequent and powerful basis — all aligned with bold aims to generate national results.

Q. Outside of the office, what are your favorite hobbies or activities?

My favorite activity is to spend time with my wife and family. I am very much into the restaurant scene, especially spicy ethnic and regional cuisines like Indian, Thai, Malaysian, Chinese and Mexican. I also study wines and have a small vineyard in my backyard. I play and study chess frequently.

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

Our health care quality improvement work has always been rewarding, but in the last three to five years, it has become even more high profile and exciting. President Barack Obama’s involvement in the launch of HHS’ Health Care Payment Learning and Action Network (LAN) was significant. Our work is getting seen, recognized and acknowledged now more than ever in my lifetime. There has never been a better time to be involved in health care quality improvement. Thank you all for the energy and enthusiasm you bring to this work on behalf of patients — every day.