“It’s Not About Me”

St. Joseph’s College

Health Administration Blog Post

October 2019

“It’s Not About Me”

Delivering the desired outcomes to stakeholder is one leader’s definition of effectiveness.  While debriefing her 360-leadership assessment and helping her identify a developmental area for the coming year she described herself as driven, bold, likes to take risks and gets things done.

I asked if she had an idea of what might be an area for her to develop as a leader in the coming year. She commented, “This is not related to my effectiveness, but something I struggle with is getting buy-in from my staff.” She elaborated, “sometimes their questions and comments I’ve already thought through and know won’t work so I move the conversation forward explaining what needs to be accomplished.  I sense a negative response from them and lack of buy-in which slows us down.” 

Curious about her definition of effectiveness I asked if we could do an exercise called mapping a polarity. Although you may never have mapped a polarity, you know intrinsically what a polarity is.  A polarity is a duality that exists as contradictory interrelated elements that persist over time.  Alone each element is logical but juxtaposed may seem irrational, like flexibility and control for example.  An either/or mindset used in decision making creates a dilemma that makes us want to choose one over the other to reach our goals. However, when the elements are interrelated any choice between them is a false choice and will only be a temporary solution.  A natural tension exists in a polarity and learning how to navigate and leverage the tension with a both/and mindset ultimately leads to effectiveness.  Examples of leadership polarities include candor and diplomacy, hold accountable and give freedom, self-assured and humble to name a few. 

The leader agreed to mapping the polarity of task and relationships.  We drew a diagram with four quadrants adding plus signs to the top two quadrants and negative signs to the bottom two quadrants.  On the left side of the horizontal line we wrote task, on the right-side relationships.  She identified the positive outcomes she has experienced by focusing her energy on tasks. The list came easy for her.  She reiterated her story of being an effective leader because she delivers desired performance outcomes for stakeholders, meets her organization’s goals and feels valued by her leaders.

Identifying the positive outcomes when focusing on relationships required more contemplation. The tone in her voice added a question mark with each thought; “there is more collaboration and idea sharing? The work environment is healthier? People feel valued for their contribution?” (pause) I asked whether she thought these outcomes contribute to effective leadership.   

Noticing her take a deep breath, I sensed her sinking into her body connecting to a new awareness as she shook her head yes.  “We’re not done yet though” I said. Now we need to look at what happens to the energy when we over focus on one to the neglect of the other.  What happens when we over focus on task to the neglect of relationships?  “I DON’T GET BUY-IN!” (pause) There’s not an opportunity for my staff to develop and they don’t feel valued.  This can create a negative work environment.  (a longer pause)

 “IT’S NOT ABOUT ME” she declared. This was the new awareness she was connecting to within. She put her head in her hands and again stated, “IT’S NOT ABOUT ME.”  A moment later and with an energetic tone in her voice she stated, “I’m a leader; I need to help my staff grow, contribute, and also become leaders.”  We took a moment to savor this awareness and then completed the map.

What happens when we over focus on relationships to the neglect of task?  “I don’t deliver the outcomes the stakeholders need and want from me.” “My supervisor may not see me as a valuable contributor.” “The organization’s goals are not being met.”  She expressed that these are her fears and that is in part why she is so driven and gets things done. She continued, “But what I’m experiencing right now is really the downside of an over focus on tasks.”  “If I’m really honest, my team is stuck right now in not having buy-in and not feeling valued.” (another ah-ha moment)

The infinity loop is used in a Polarity Map to illustrate how energy oscillates between the elements of a polarity.  Creating action steps helps ensure that when the energy dips into the downside of a polarity we have a plan to leverage the positive outcomes of both elements and can move the energy toward our greater purpose.  This leader decided her development plan for the coming year would include learning to leverage task and relationships.  

Illustration of Task and Relationship Polarity Map

(Adapted from Dr. Barry Johnson Polarity Mapping)

              This illustration of a Polarity Map demonstrates the dynamic experience of leaning toward one element we value most in an interrelated duality. Understanding how we lean has the potential to reveal our biases. (1. Above) We work hard to achieve these positive outcomes and mitigate the fears that exist if we don’t. (2.) Because of this, we miss out on the values of the interrelated elements (3) and as this leader is experiencing, eventually end up in the downside (fears and negative outcomes) (4) of the element we over focus on.

In the process of mapping the task and relationship polarity this leader demonstrated what Dr. Robert Kegan, professor at Harvard University describes as a subject – object move.  He explains that when we are subject to an idea, thought or belief, “It has us.”  It drives our behaviors and decision making. In this case, the leader was subject to the belief that effective leadership was dependent on delivering performance outcomes which requires focusing on tasks.  When subject becomes object, “We have it.” We can see it, reflect on it and discern our decisions from broader perspectives.

“IT’S NOT ABOUT ME” awareness for this leader demonstrates the shift from subject to object and the potential growth in one’s inner capacity to hold space that allows energy to flow naturally between two opposing and contradictory elements that need each other over time.  Leadership effectiveness is about delivering desired outcomes to stakeholders AND it is about creating caring connections, providing mentoring, support and collaboration.

Danine Casper, MHA

Instructor, HA511 Leadership in Health Administration

Certified in Polarity Mastery – Polarity Partnerships

Leadership Coach – Transitions Coaching llc

Quality Payment Program (Part 2 of 2)

How does the Quality Payment Program work?   (Part 2 of 2)

Merit-based Incentive Payment System (MIPS) rewards exceptional performers by giving them a positive adjustment in their payment from Medicare. If the practice is a low performer then they will receive a lower payment, or a penalty. For exceptional performance a practice can receive additional payments from 4% in 2019 to 9% in 2022 and forward. For a poor performing practice they can be penalized anywhere from 4% in 2019 to 9% in 2022 and forward. Each practice can choose how much they wish to participate. They can go from a “Test Pace” where they submit some data after January 1, 2017 and receive a neutral adjustment to a small pay adjustment. They can choose a “Partial Year” option where they can report for a 90 day period after January 1, 2017 and before October 2, 2017 and they can receive a small positive payment adjustment. Keep in mind that whenever a practice chooses to start, they will need to send in their performance data by March 31, 2018. Lastly, they can choose a “Full Year” option where they can fully participate starting January 1, 2017 and receive a modest positive payment adjustment. The best way for a practice to realize the positive impact from the Full Participation option is to submit data on all the MIPS performance categories. 

Now to avoid any downward payment adjustment a practice can submit a minimum amount of data in 2017 to Medicare that can be one quality measure or one improvement activity, and they can avoid any downward payment adjustment. A key factor for positive adjustments is that these are based on the performance data on the performance information submitted, and not the total amount of information submitted or the length of time that the practice is reporting on during the year.

The Bonus Payments and Reporting Periods are as follows. To receive the MIPS payment adjustment it will be based on the data submitted. The best way to get the most out of the program is to participate for a full year. This type of participation gives the practice the most measures to pick from. CMS is encouraging clinicians to pick the option that best fits their practice needs and abilities. The categories are Quality, Cost, Improvement Activities, and Advancing Care Information. The default weights for each category are Quality (60%), Cost (0%), Improvement Activities (15%), and Advancing Information (25%). These default weights can be adjusted in certain circumstances. Quality has approximately 300 different quality measures and the practice needs only to select about 6. For Advancing Care Information there are 2 measure sets for EHR. The nice thing here is that if a clinician faces a significant hardship and are unable to report on the Advancing Care Information measures, they can apply to have their performance category reduced to a weight of 0%. If this category is not applicable to the clinician, then the 25% weight will be added to a different category.

CMS Quality Payment Program Part 1 of 2

Medicare and the Quality Payment Program- What is it and who can participate. (Part 1 of 2)

Many physicians and their staff ask what a Quality Payment Program is and who can or should participate. Currently the Centers for Medicare and Medicaid Services (CMS) is looking to move to a more beneficial Quality Payment Program (QPP), but knowing the past would be helpful. Way back physicians were reimbursed in a Fee-for-Service (FFS) model where it was volume, not quality that drove the payment. As this payment model was slowly getting out of hand, Congress passed temporary fixes called “doc fixes” to avoid cuts in reimbursement. If they did not do this it would have resulted in a 21% cut in Medicare payments to clinicians.

In comes a great idea, a Quality Payment Program (QPP) that can help to reform Medicare Part B payments for more than 600,000 clinicians across the country. This is a huge step in the direction of improving care and controlling costs across an entire healthcare delivery system. There are two tracks that a clinician can choose from which are Advanced Alternative Payment Models (APMs) that require the clinician to participate in an innovative payment model. The second option is the Merit-based Incentive Payment System (MIPS) which works with clinicians that choose to remain in a more traditional Medicare payment model and possibly earn a performance-based payment adjustment.

Now the question is who can participate? The Quality Payment Program is available to all Medicare Part B clinicians billing more than $30,000 a year to Medicare and providing care for more than 100 Medicare patients per year. The clinicians include Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists. Those clinicians who are excluded from the QPP are ones that enroll in Medicare for the first time during a performance period as they are exempt from reporting on any measures and activities for MIPS until the next performance year. Also, clinicians that are below the low-volume threshold of $30,000 per year in billing to Medicare or they see less than 100 Medicare patients per year. In addition, clinicians significantly participating in Advance Payment Models (APMs) are excluded.

Overall, this program is designed for small practices to be able to successfully participate in the Quality Payment Program by reducing the time and cost to participate, allowing the small practices to “Pick Your Pace”, increasing the opportunities to participate in an APM, including a practice-based option for participation in an Advanced APM as an alternative to total cost-based, and by conducting support and outreach to small practices through various programs such as Transforming Clinical Practice Initiative.  For the Rural and Health Professional Shortage Areas (HPSAs) they can have less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients served. They only need to report on one high-weighted activity or two medium-weighted activities. These are all designed to have ease of access to the program, regardless of the size of the practice or the location that they serve Medicare patients.