Guest post by Steve Tolle, chief strategy officer and president of iConnect Network Services, Merge Healthcare.
Sooner than later, payers will demand meaningful interoperability to determine the true cost of quality healthcare outcomes. While they may not have a preference for which electronic health record (EHR) platform a doctor or health system uses, they will understand that a platform’s ability to communicate with other EHR platforms will affect the cost and quality of the care provided.
Payers are already implementing bundled payments for some types of costly care, such as full hip replacements. Conventional assumptions aside, physician fees and facility charges are not the leading drivers of joint replacement cost variability. Instead, wide cost disparities frequently seen between Joint Replacement Procedure A and Joint Replacement Procedure B are the product of unpredictable charges for supplies, anesthesia, and medical imaging. When payers start bundling reimbursements for common procedures, risk will shift to providers who will be challenged to closely manage cost fluctuations. In preparation for this transition, healthcare organizations must proactively assess their imaging strategies to keep their business running smoothly, continue providing quality patient care, and ensure they maximize revenue for the services they deliver.
What Providers Must Evaluate
Medical imaging is a $100 billion industry that drives $300 billion in healthcare spending. It accounts for nearly eight percent of U.S. healthcare spending, according to the Journal of the American College of Radiology — a costly component of care that must be effectively addressed as the industry readies itself for the shift from volume to value-based reimbursement.
The U.S. Department of Health and Human Services recently set an ambitious goal that by 2016, 85 percent of healthcare payments will be tied to quality and value of care. Successful healthcare organizations will need to manage two key factors closely — appropriateness and efficiency.
CMS and private payers will increase their vigilance around quality measures such as readmission rates and unnecessary diagnostic imaging. Medically unnecessary or redundant imaging is already on Medicare’s radar, showing up in legislation that mandated decision support for imaging and extended the deadline for ICD-10 conversion. If providers begin to correct course now, downstream risk of lost revenue and decreased patient satisfaction can be mitigated, if not avoided.
Take Stock of Current Assets
To stay ahead of the curve, providers should evaluate all aspects of their image management programs. Many are looking for new solutions that simplify and digitize outdated, paper-based procedures for patient orders, automate insurance payment authorization, and move images from point A to point B in real time, regardless of file format.
Managing storage costs while establishing the ability to efficiently and securely share patient data with multiple, authorized users will become paramount. Vendor neutral archives (VNA) offer one solution. VNAs have been critical to the success of teleradiology where image management is well ahead of many other specialties.
Other clinical departments will need to evaluate the efficacy of their EHRs. Enterprise EHRs are as important to the healthcare system as VNAs are to imaging. The Digital Imaging and Communications in Medicine (DICOM) global standard enables electronic image management, making it easier to implement technological change in imaging.
Comparatively few mature and widely adopted standards exist to efficiently move health data between disparate EHRs. Implementation of a closed-loop referral and imaging management process concurrently with a VNA can provide the seamless transfer of data that is needed, and establish a model for all healthcare organizations to emulate in preparation for value-based reimbursement.
Shifting From “Sick Care” to “Health Care”
There are real consequences if an organization does not properly prepare for value-based reimbursement. Population health management approaches will forge professional relationships between providers and patients that span decades, and may face new cost drivers as a result.
Take a diabetic patient, for example. Most health plans will manage a patient’s A1C levels but don’t monitor retinal screening exams, even though such screenings play an important role in preventing blindness related to the disease. If that same patient is part of a single health information exchange (HIE) set up by a health system for 10 years or more, the system’s costs will spike if the patient goes blind. As a result, providers will have incentives to manage chronically ill patients more effectively to keep patients healthy in the first place.
Providers must pay closer attention to appropriateness of their orders and may need to consider alternative approaches to diagnosis and treatment, recognizing it is to the benefit of their patients and their practice to uncover health issues before they spiral out of control and drive unsustainable costs. This new approach requires more data transparency, which in turn requires enhanced interoperability among different EHR platforms. More efficient processes are likely to emerge around order entry and transmission to ensure patients receive only the tests they need.
Look to the Imaging Industry for Guidance
Technology that supports the shift to value-based reimbursement is available now. Healthcare organizations can take note of the imaging industry’s progress in better preparing themselves for success as changes continue to take hold.
Health systems that invest in core image management and connectivity capabilities now will be best positioned to successfully transition to value-based reimbursement, and in turn focus on what matters most – providing efficient, quality patient care.