Though many Medicare and private payer reimbursement programs that require practices to begin moving to value-based compensation already have set sail, most small practices are still treading water near the shore when it comes to this new wave of payment models.
While admirable in their care goals, these quality care-based reimbursement programs can pose some insurmountable challenges for small providers. In fact, they require a whole new way of providing care for some practices, as well as creating new documentation of integrated data analysis, development of care coordination with other providers, payer reporting applications, and often times new technologies that can support these new provisions.
What’s more, all this change also can be quite expensive for small practices and wreak havoc on current business practices.
Set the course
No doubt about it, though, the move to value-based care is on. According to the 2015 Physician Compensation Survey, conducted by Physicians Practice magazine, 63 percent of physician compensation is currently tied to productivity; 37 percent to value metrics and 29 percent to patient satisfaction scores.
The Centers for Medicare and Medicaid Services (CMS), however, has expressed its goals of having more providers participating in value-based plans each year, with a goal of 50 percent by 2018. And it has further incentivized physician participation by specifying increasing reductions in payments for non-participation that began in 2013.
So unless they want to start leaving money on the table, practices have no choice but to take the plunge into such new compensation programs.
Lift the Anchor
Before diving in and potentially draining money and resources to participate in such programs, physicians need to look around and assess their current situation to determine how the new reimbursement model might work in their practice. For example, they need to evaluate current technology, vendors, resources and physician support to determine what changes they need to make, as well as what internal infrastructure they can use.
The long awaited road to true healthcare IT system interoperability is being implemented at Good Samaritan in Indiana, enabling the 232-bed community healthcare facility to better deliver on its commitment to delivering exceptional patient care. The system will also enable the hospital to substantially increase their practice’s revenue while containing healthcare system integration costs.
“We strive to be the first choice for healthcare in the communities that we serve and to be the regional center of excellence for health and wellness,” said Rob McLin, president and CEO of Good Samaritan. “We are proud to be the first hospital in the country to implement this great integrated health record system that will allow us to provide a much higher level of continuity of care for our patients, as they are our top priority.”
The integration is being made possible with Zoeticx’s Patient-Clarity interoperability platform that will integrate WellTrackONE’s Annual Wellness Visit (AWV) patient reports with Indiana’s Health Information Exchange (IHIE) and the hospital’s Allscripts EHR. IHIE is the largest HIE in the US, serving 30,000 physicians in 90 hospitals serving six million patients in 17 states.
Revenue Generator for the Hospital
WellTrackONE and Zoeticx will enable patient’s AWV data to flow from the application to Allscripts EHR and the IHIE system. With Zoeticx’s Patient-Clarity platform and WellTrackONE’s software, the healthcare IT integration passes on increased revenue from the Centers of Medicare & Medicaid Services (CMS) and decreased IT costs for medical facilities.
Medicare pays medical facilities $164.84 for each initial patient visit under the AWV program and $116.16 for each additional yearly visit. With the AWV integration in place, the hospital is now able to meet CMS’s stringent requirements for patient reimbursements.
It is estimated that the Good Samaritan will be able to generate $500 to $1,200 per AWV patient from follow up appointments for additional testing and referrals for approximately 80 percent of the Medicare patients that are flagged by the AWV for testing, imaging and specialty referrals within the hospital.
This subscriber number is expected to trend upwards into 2050 and will create billions in new healthcare revenue through the US as the population ages. The hospital is not charged any costs for the system until it is reimbursed by CMS.
Overcoming Healthcare System Limitations
The hospital began offering Medicare’s AWV’s a few years ago, but had to develop its own tracking protocols, which impacted its budget and staff resources. The system it had created also operated poorly, allowing hospital staff to only view about 10 percent to 15 percent of patient data.
Good Samaritan medical teams were also constrained by interoperability, having to enter new illness findings and other medical info manually and fax PDFs to other facilities where they would have to again be entered into a different system. The hospital also had all of the data contained in WellTrackONE and Allscripts’ system, but no way to integrate the two, let alone achieve that integration with IHIE. Providers were also spending valuable patient face time trying to find specific patient data buried in the EHR system.
“Our systems were working fine, independently of each other,” said Traci French, director of business development and revenue integrity. “But we could not achieve true interoperability between the two systems. The best we could do was basically reshuffling PDF documents. The next challenge was to integrate that data with the exchange. We needed to get data to providers where they needed it, when they needed it.”
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
Facilitating more than five million patient visits every month, Practice Fusion’s platform is the new gold standard for ambulatory EHR technology. We can support your organization’s goals for risk adjustment, accurate coding and coordinated care management—in real time and at scale. We also partner to support clinical programs in collaboration with our physicians to improve outcomes for patients at the population level. Finally, our connectivity services provide a single point of connection to our ecosystem of over 112,000 health care professionals nationwide.
Practice Fusion is the #1 cloud-based electronic health record (EHR) platform for doctors and patients, with a mission of connecting doctors, patients and data to drive better health and save lives. A driving force in modernizing American health care, Practice Fusion is used by a community of more than 112,000 active medical professionals with over 100 million patient records under management. In 2014, Practice Fusion’s EHR facilitated more than 56 million patient visits (approximately 6% of all ambulatory visits in the US) and is the fastest growing EHR in the US.
Founded in San Francisco in 2005 and bootstrapped in a Starbucks, Practice Fusion has grown dramatically, building the largest physician-patient community in the U.S.
Services and Products Offered
Clinical data exchange, HCC code assist, digital care management
In the first real-world trial of the impact of patient-controlled access to electronic health records, almost half of the patients who participated withheld clinically sensitive information in their medical record from some or all of their health care providers.
Should patients control who can see specific information in their electronic medical records? How much control should they have? Can doctors and other clinicians provide safe, high-quality care when a patient’s preference may deny members of the medical team from seeing portions of the electronic medical record? What is the appropriate balance between individual privacy concerns and health care providers’ need for relevant data?
The Regenstrief Institute, Indiana University School of Medicine and Eskenazi Health (formerly Wishard Health Services) partnered to design and conduct the first real-world trial intended to help answer these and related questions. During the six-month trial, 105 patients in an Eskenazi Health primary care clinic were able to indicate preferences for which clinicians could access sensitive information, in their electronic medical records, such as information on sexually transmitted diseases, substance abuse or mental health, and designating what the clinicians could see.
Regenstrief informatics developers then created a system where those preferences guided what information doctors, nurses and other clinic staff could see. Patients were able to hide some or all of their data from some or all providers. Importantly, the healthcare providers were able to override patients’ preferences and view any hidden data, if they felt the patient’s healthcare required it, by hitting a “break the glass” button on their computer screens. When providers hit this button, the program recorded the time, the patient whose electronic chart was being viewed and the data displayed.
Guest post by Brian White, founder of Competitive Solutions.
Should every physician practice adopt electronic health records? Maybe not. When evaluating the transition to an EHR system, it is critical to consider the long-term efficiency of the practice. Simply put, EHR adoption will not yield operational improvements for every practice.
While many practices using EHRs increase the overall throughput of the business and enhance profitability, others struggle with adoption of the new technology – slowing operations and creating significant financial losses. Many practices repeatedly change vendors or abandon the EHR entirely after significant investment. Making the right decision for your individual practice and navigating the pitfalls of EHR implementation can be difficult and time-consuming. Maximize your potential for success by undertaking a strategic evaluation that includes the following considerations.
If your practice has not adopted EHR, is now the time to do so?
1. What are the operational benefits/detriments of adoption?
a. Will EHR allow the practice to see more patients? Or, will it cause the practice to see fewer patients?
b. Will EHR require additional labor in the day-to-day function of treating patients? (In most cases, the answer to this question will be yes.)
c. Will EHR provide the ability to track trends in patient status, statistical data or ease of access that will be more efficient and/or clinically beneficial?
Guest post by Mike Hoaglin, a fourth-year medical student at the University of Pennsylvania School of Medicine.
“Patient engagement” is a phrase that reinvigorates the doctor-patient relationship and prioritizes the patient experience. With many designers scrambling to “engage” patients in their healthcare journeys, it is easy to get lost in the chaos. But what lies at its core is simple: healthcare leaders need to find easy methods that better connect people with the environment and the technology.
One way this is already proving effective is with the smartphone physical. Led by medical students from John Hopkins and University of Pennsylvania, quick diagnostic tests using devices connected to a smartphone are changing the face of the traditional physical and begging the question as to why modern medicine struggles to become more patient-centric.
The smartphone physical uses a series of peripheral devices attached to a smartphone to measure and analyze patient data ranging from weight to blood pressure to even heart activity. Patients are then able to receive an overall health picture and potentially electronic health record (EHR)-ready results from the smartphone physical immediately after the experience. Essentially these robust handheld digital devices are re-engaging patients because they promote more personalized, data-driven decision-making at the point of care.
The Hill Country Health and Wellness Center is a small clinic located in the rural community of Round Mountain in Northern California. The Center, which opened in a trailer in the 1980s, continues to reflect its founder’s passion for helping the area’s rural, largely underserved population. From that humble beginning, with one doctor and one nurse working without pay, the clinic today is housed in a modern building, with 90 employees.
The Center’s provider staff, consisting of two MDs, three mid-levels and three dentists sees about 3,700 patients per year — most of whom drive 30 miles or more for care.
All of the Center’s providers are in different stages of earning meaningful use incentive payments. The physician and nurse practitioners have each attested to Medi-Cal’s Adopt, Implement, Upgrade (AIU) incentive program.
The Center, which has been live on its EHR since June 2012, uses GE Centricity.
According to Epocrates’ annual mobile trends survey physicians and other providers have an urgent need for tools and resources that can assist them in meeting more stringent and complex requirements around administrative tracking, economic trajectories of different therapies, and ultimately, patient outcomes. Clinicians clearly endorse the viability of mobile technology to enable rapid access to clinical information and communication among a growing roster of caregivers.
Industry stakeholders, such as EHR providers, pharmaceutical companies, technology firms and content owners, must now determine how best to leverage this groundswell of behavioral input to inform product development and marketing programs that support providers in successfully embracing these rapidly evolving models of healthcare.
Guest post Ruby Raley is director of healthcare solutions at Axway.
One little-discussed but widely recognized aim of the HITECH Act’s meaningful use Stage 2 requirements is to stem rising costs and improve outcomes by engaging the consumer to take control of their healthcare. But how is the consumer supposed to take control of anything when their health plan determines which clinicians and hospitals they can visit, and their doctor controls their health record?
That’s an issue the Department of Health and Human Services (HHS) recognized as they developed the incentives for the HITECH Act. To address it, they adopted the electronic health record (EHR), a tool that (1) helps clinicians and hospitals reap incentives and avoid penalties by proving they’ve achieved meaningful use, and (2) puts the certification burden on EHR vendors instead of clinicians and hospitals.
Introducing an electronic medical records system into the practice helps the physicians and staff provide more efficient health care by making medical records more accessible to all health care team members. It also brings some risks. In this two-part article, CAP Risk Management and Patient Safety identifies 10 areas of risk exposure and provides some brief recommendations in each area.
Tracking of laboratory and diagnostic orders and results is more efficient and timely when all orders are processed through the EMR with a bi-directional interface. If possible, also set up to receive all results back through the system. If fax or paper reports are received, scan and index reports into the system the same day. The EHR system may also be used as a “tickler file” for verification of orders and paper reports. Physicians should see all diagnostic testing whether normal or abnormal.