Body Language

In what I think is one of the most fascinating pieces of work in the field of psychology, a team of family counselors found they could predict, with a very high degree of accuracy, the likelihood of a married couple getting a divorce just by reviewing a few seconds of video footage of the two of them talking to each other in a counseling session, even without hearing the actual words that were said. 

It turns out the mind can’t fully keep the body from sending out involuntary signals through micro tics, facial expressions, and changes to the voice inflection.  We all work with people whose filter here is so broken that we don’t need any training or slow-motion video to read the micro signs because, well, they aren’t really micro, are they? 

After studying hundreds of couples, the researchers were able to isolate the signs that pointed to ‘contempt for the other,’ the tell-tale sign that a split was imminent.  With that and a little video, the trained therapists could accurately predict outcomes without ever talking to the couple.

So, it was interesting a month or so ago as I sit in on a panel discussion about bundled payments when I noticed a micro tic from the payer representative on the panel.

‘She’s getting a divorce,’ I thought, but then realized I was correct in my observation, but sort of missed the application.

Actually, what she signaled, and then later confessed directly in response to a question, is that while they – the payers – and their employer clients really like bundled payments as part of the move to value-based care, the practical administration of these deals is pretty complex.  And we were talking about total joint replacements, the bundle that most people think is the easiest to administer and clearly the one with which we have the most collective experience.

So it was not a surprise when CMS issued an ‘interim final rule’ (oh, I love government-speak) last week delaying by three months the expansion of its bundled payment program.  A slight delay by a government bureaucracy is a slight tic in that world, but don’t miss the signal of contempt.

HHS Secretary Price has made it clear that, like his boss, he is generally averse to overly aggressive government regulators and has put his finger on this very program as one example.  Voluntary programs to encourage innovation are one thing, but making mandatory things the law does not is frowned upon by the Trumpsters.  Do you wonder if they get gold stars (in this case, real and gaudy gold stars) in the cabinet meetings every time they kill one of these deals?

Add to the philosophical position feedback from the market, both payers and providers, that even with all parties onboard and cooperating on a bundled payment contract, figure out how to do the day to day work takes time.

Don’t be surprised if what comes out of this 90 day delay is a significant pull-back on the ‘required’ elements of this deal.  The Secretary and mandatory bundled payments may be splitsville.


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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