The 21st century has seen a massive change in the way people live their lives. It is now the digital era, and almost everything is online or made available in electronic form. There are now jobs online. Elections are now run in many countries so that people can submit votes electronically. Hotel bookings and other travel accommodations can be done online. Even bank transactions are done over the web.
One of the most consequential manual-to-digital revolutions is the US government’s drive to create electronic health records (EHRs) from the mountains of filed information for patients. The main aim is to make medical information available to all concerned parties whenever needed. The long term goal is making healthcare significantly more effective.
This policy direction delivered a jolt to the medical IT industry, inspiring hospitals all over the US to start looking for digitalization partners. It has also pushed clinics and hospitals to standardize their functions, especially those that relate to drug formulas.
Because of the scale and promise of these standardization efforts, health and pharmaceutical leaders and administrators are wondering how to best respond and take advantage of the EHR frenzy. Here are some of the ways that pharma companies can plan for the future…
Intensify efforts to get empirical support for product effectiveness.
The digitization of almost everything has bestowed on people the power of more effective insight. The mountains of data that is being digitized can be searched for trends, such as the effectiveness of one prescription over another. Informative resources that allow anyone to immediately refer to them for help in making crucial decisions regarding health are now on the horizon.
To make their products appealing to doctors and patients, pharmaceutical companies can focus on getting empirical support for their claims. They can conduct many forms of scientific analysis on the use and effectiveness of their drugs.
However, be careful not to interpret with the results just so they project only a positive image. Bear in mind that the main purpose of testing is to understand the actual mechanisms at play and eventually get ideas on how to improve. Tests should never be aimed at getting marketing support points, though those are going to be very welcome bonuses if that is what the study uncovers.
By Zachary Blunt, manager of product management population health, Greenway Health
Electronic health records (EHRs) were expected to revolutionize healthcare practices, making them more efficient, reducing costs and enabling them to provide more coordinated care.
But ask healthcare providers about the EHRs they’ve deployed, and the results are far from what was expected.
In fact, more than 60 percent of healthcare professionals rank their return on investment (ROI) for EHR systems as “terrible” or “poor,” according to a recent survey from Health Catalyst. Another study, published in the Journal of the American Medical Association, estimated the costs of billing and insurance-related activities using EHRs ranged from $20 for each primary care visit to $215 for inpatient surgery, totaling 3 percent to 25 percent of professional revenue.
So, why aren’t EHRs living up to the hype and delivering the promised investment? In many cases, it has to do with these systems not being used to their highest potential.
Here’s a look at five steps healthcare practices can take to address challenges resulting from EHR implementation and maximize their ROI.
Get Buy-In Across the Board — from IT to Finance to Front Office Staff
Adopting EHRs to manage clinical activities impacts many revenue cycle-related functions, such as patient registration, insurance eligibility, scheduling and the services/treatments a patient received during each clinical encounter. To achieve ROI, EHRs must be able to improve several operations of a practice and streamline the workflows of different departments. It’s best practice for all clinicians and staff to weigh in before installing new systems or technologies.
Provide Strong Leadership, Communication and Training
Changes in common practices during EHR implementation can result in significant resistance from users or a longer learning curve that hampers efficiency and adds to the cost of the system. To achieve results, healthcare leaders should clearly articulate the EHR implementation plan, prepare themselves for a transition period and develop a training protocol so all users understand their roles in using the system. In addition, users should have a solid background and understanding on how their roles factor into the overall success of the system and the practice at large.
Improve Staffing Efficiency While Improving Operating Margins
Labor costs can account for nearly half of a healthcare provider’s operating costs. But providers often fail to take a strategic look at how adjusting staffing can improve the bottom line. Often, providers use historical averages to determine staffing levels at their practices, resulting in an outlay of overtime pay outside the planned budget when unexpected staffing demands occur. Data from EHR solutions, as well as enterprise resource planning (ERP) sources, can be analyzed to gain a better understanding of historical staffing trends. Accenture estimates that by getting insights from EHR and ERP data, U.S. healthcare providers could save more than $77 billion over the next five years by reducing overtime and overall labor costs.
By Richard A. Royer, chief executive officer, Primaris.
Back in the day – the late 1960s, when social norms and the face of America was rapidly changing – a familiar public service announcement began preceding the nightly news cast. “It’s 10 p.m. Do you know where your children are?”
Today, as the healthcare landscape changes rapidly with a seismic shift from the fee-for-service payment model to value-based care models, there’s a similar but new clarion call for quality healthcare: “It’s 2018. Do you know where your data is?”
Compliance with the increasingly complex alphabet soup of quality reporting and reimbursement rules – indeed, the fuel for the engine driving value-based car – is strongly dependent on data. The promising benefits of the age of digital health, from electronic health records (EHRs) to wearable technology and other bells and whistles, will occur only as the result of accurate, reliable, actionable data. Providers and healthcare systems that master the data and then use it to improve quality of care for better population health and at less cost will benefit from financial incentives. Those who do not connect their data to quality improvement will suffer the consequences.
As for the alphabet soup? For starters, we’re as familiar now with these acronyms as we are with our own birth dates: MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), which created the QPP (Quality Payment Program), which birthed MIPS (Merit-based Incentive Payment System).
The colorful acronyms are deeply rooted in data. As a result, understanding the data life cycle of quality reporting for MACRA and MIPS, along with myriad registries, core measures, and others, is crucial for both compliance and optimal reimbursement. There is a lot at stake. For example, the Hospital Readmissions Reduction Program (HRRP) is an example of a program that has changed how hospitals manage their patients. For the 2017 fiscal year, around half of the hospitals in the United States were dinged with readmission penalties. Those penalties resulted in hospitals losing an estimated $528 million for fiscal year 2017.
The key to achieving new financial incentives (with red-ink consequences increasingly in play) is data that is reliable, accurate and actionable. Now, more than ever, it is crucial to understand the data life cycle and how it affects healthcare organizations. The list below varies slightly in order and emphasis compared with other data life cycle charts.
Find the data
Capture the data
Normalize the data
Aggregate the data
Report the data
Understand the data
Act upon the data
One additional stage, which is a combination of several, is secure, manage and maintain the data.
Find the data. Where is it located? Paper charts? Electronic health records (EHRs)? Claims systems? Revenue cycle systems? And how many different EHRs are used by providers — from radiology to labs to primary care or specialists’ offices to others providing care? This step is even more crucial now as providers locate the sources of data required for quality and other reporting.
Capture the data. Some data will be available electronically, some can be acquired electronically, but some will require manual abstraction. If a provider, health system or accountable care organization (ACO) outsources that important work, it is imperative that the abstraction partner understand how to get into each EHR or paper-recording system.
And there is structured and unstructured data. A structured item in the EHR like a check box or treatment/diagnosis code can be captured electronically, but a qualitative clinician note must be abstracted manually. A patient presenting with frequent headaches will have details noted on a chart that might be digitally extracted, but the clinician’s note, “Patient was tense because of job situation,” requires manual retrieval.
Normalize the data. Normalization ensures the data can be more than a number or a note but meaningful data that can form the basis for action. One simple example of normalizing data is reconciling formats of the data. For example, a reconciling a form that lists patients’ last names first with a chart that lists the patients’ first name first. Are we abstracting data for “Doe, John O.” or “John O. Doe?” Different EHR and other systems will have different ways of recording that information.
Normalization ensures that information is used in the same way. The accuracy and reliability that results from normalization is of paramount importance. Normalization makes the information unambiguous.
Aggregate the data. This step is crucial for value-based care because it consolidates the data from individual patients to groups or pools of patients. For example, if there is a pool of 100,000 lives, we can list ages, diagnosis, tests, clinical protocols and outcomes for each patient. Aggregating the data is necessary before healthcare providers can analyze the overall impact and performance of the whole pool.
If a healthcare organization has quality and cost responsibilities for a pool of patients, they must be able to closely identify the patients that will affect the patient pool’s risks. Aggregation and analyzing provides that opportunity.
Medical innovators can’t come up with ways to implement 3D printing into categories of healthcare fast enough. With so many practical applications, 3D printing is quickly becoming a technology realized for its untapped potential and seemingly limitless possibility to transform healthcare.
3D printing alone has many applications across a wide range of industries — for one example, advancements in health data are benefiting nursing and patient care. As 3D printing continues to be combined with the innovations in health data, it will further revolutionize patient care, lower healthcare costs, expand the field of nursing, and improve modern medicine as we know it. How will 3D printing and health data do this?
Below is an extensive look at how innovations in health data are changing healthcare fields, and how 3D printing will further reform these sectors, allowing for advancements in both medical practice and patient care.
Home healthcare benefits patients who would like personal care in the comfort of their own home. Elderly and disabled patients don’t have to travel to have minor care done, and patients who have such diseases as HIV and are worried about discrimination or bias can have their privacy. Home-based care allows for specialized care for the patient, rehabilitation, and the close monitoring of vital signs for health and wellness, without the trouble of an in-person office visit. This convenient transfer of data through new technology makes it increasingly easier for caregivers, whether it be family members or professionals, to care for patients on their terms.
ASU reports, “75.2 percent of nurses agree that telemedicine makes their job easier.” Telemedicine is another sector of healthcare made possible by the accessibility of telecommunication technologies such as videoconferencing. Through videoconferencing, a professional is able to listen to a patient’s concerns and diagnose illness or injury from a remote location. This gives the patient another level of privacy and both parties freedom and independence. Telemedicine cuts healthcare costs, as a physician doesn’t need to physically travel to a patient every time a minor checkup is needed.
EHRs and CPOEs
Electronic health records, or EHRs, are just that: electronic patient health documents that provide real-time information. Medical history, treatments, and diagnoses can be constantly updated along with other details such as allergies and current medications. An infographic by Duquesne University highlights the increased reliance on EHRs while illustrating patient data in the age of technology.
CPOEs, or computerized provider/physician order entries, are a better way to order medication and control the dosage and frequency at which the medication is administered. This efficient method of ordering pharmaceuticals reduces error and abuse, and therefore diminishes illness and injury. As Scott Rupp writes, CPOEs are “foundational for meaningful use. Make sure it’s easy to use and intuitive.”
Involvement of 3D Printing
In its infant stages, 3D printing is being utilized to make hearing aids, prosthesis, skin for burn victim patients, heart and airway splints, and much more. Showing potential for almost every aspect of healthcare, 3D printing, combined with the innovations in health data above, will transform these fields for even more accessible, affordable, and convenient healthcare.
3D printing can be applied to home health care, telecommunications, EHRs and CPOE in a number of ways. A professional can diagnose the atrophy of a leg, order the rehabilitation of walking, 3D print a prosthetic, and monitor the progress all while a patient is at home. In another instance, home healthcare and telemedicine can diagnose that a patient is ill, EHRs and CPOEs will allow for a better determination of what medication to order, and 3D printing can be used to print the medication for a patient
More accessible healthcare means more easily affordable healthcare, and with the involvement of 3D printing home-based care, telemedicine, EHRs, and CPOEs, healthcare will be transformed and turned on its ear. Patients who desire privacy, or are not mobile, will be able to get the care they need at home, while professionals will be able to stay in the office to help people with more immediate and urgent matters.
As mentioned above, 3D printing is in its infancy stages for many of these processes. An argument can be made that 3D printing will make home care, telemedicine, EHRs, and CPOEs more expensive — and that’s true, but only for now. As 3D printing becomes more of a norm in the medical field, and it will with its promising applications, the cost will decrease. As 3D printing becomes a normal process in these fields, it will increase patient care and make healthcare more accessible and more easily affordable.
Many hospitals and healthcare organizations say they’re committed to moving to a paperless or paper-light environment. Greater document digitization is key to a more seamless flow of information within the healthcare enterprise, increasing worker productivity and reducing costs while also enhancing patient data security and ultimately improving quality of care.
Electronic health records (EHRs) are viewed as a foundational component of this strategy. In 2016, more than 95 percent of all eligible and critical access hospitals demonstrated meaningful use of certified health IT including EHRs, according to Health IT Dashboard. The conventional wisdom would lead some to expect subsequent decline in paper usage, but quite the opposite is happening.
Studies have shown that despite the growing adoption of EHRs and other digital technologies, paper in the healthcare enterprise remains prevalent – and is even growing. Experts say hospitals are seeing as much as an 11 percent increase in their annual print volumes driven by the Meaningful Use program, the Affordable Care Act, ICD-10, and the adoption of electronic record-keeping.
Why is this happening? Sometimes we find that physicians to not yet fully trust EHRs. Approximately 27 percent of a doctor’s time is spent with patients, the rest being spent on office work, documentation and EHRs – a common source of physician frustration. Also, disjointed processes of gathering paper-based information from a variety of points within a facility lead to delays in uploading this information to the EHR – leading to physicians keeping copies of patient files on hand.
EHRs alone are not enough to decrease the mountains of paper in hospitals and healthcare facilities. Organizations should consider augmenting EHRs with the following capabilities:
Integrated Document Workflows
Even healthcare organizations that have achieved late-stage meaningful use continue to print and process high volumes of paper for assorted reasons – from patient admissions and discharge, to belongings and consent forms, to prescriptions and pharmacy records. The benefits of EHRs can only be achieved insofar as they are integrated with digitally-based document workflows – the series of electronic steps by which a process is executed.
Consider physicians submitting prescriptions to pharmacies. When the EHR is directly integrated into this process, it can be automatically flagged if the patient is on another medication or has an existing condition which could cause an adverse reaction. If the EHR is not integrated, the entire process is disjointed and not as seamless and safe as possible. Or, consider the discharge process – when the EHR is integrated, discharging physicians have immediate access to patient files and charts – negating the need to print this information. Furthermore, studies show that “hybrid” paper-electronic workflows are ripe for error.
Now that at least 96 percent of hospitals have implemented an electronic health record (EHR) most organizations are facing the reality that the technology has not truly helped them achieve their clinical quality and financial goals.
Electronic, enterprise-wide data is essential to manage highly complex, high-cost patients that providers care for every day. However, EHRs typically do not deliver the insight or tools providers need to manage these high-risk or the near high-risk patients when they are not in the hospital.
If the EHR does offer such population health management (PHM) capabilities, it typically requires an excessive amount of manual data access and manipulation, leading to even greater costs. That means patients who require more intensive care support at home, or who could highly benefit from timely and targeted intervention, face care delays simply due to lack of provider resources.
The Medicare Access and CHIP Re-authorization Act (MACRA) of 2015’s Merit-based Payment System (MIPS) brings this challenge into clear focus, highlighting how individual providers and healthcare organizations need automated patient interventions to efficiently deliver care throughout the continuum. Automation and more precise outreach not only helps care managers work more efficiently, but it also forges stronger engagement between providers and patients for long-term clinical quality and financial gains.
Gaps In Technology Capabilities
According to a recent survey conducted by our company of more than 800 healthcare professionals, most organizations seem to understand how crucial PHM technology is to MIPS success. Few professionals, however, are apparently taking full advantage of available opportunities to better their organization. For example, 80 percent of healthcare professionals reported they have the necessary technology for PHM or to manage MIPS performance, but only 30 percent reported they are able to automate interventions across populations.
Automating interventions is becoming a critical piece of PHM to reduce the significant resources required to analyze data and conduct outreach. Currently, a care manager can spend approximately 40 percent of their time just searching for patient data, while PCMHs require 59 percent more staff per provider to fulfill care management requirements.
Streamlining the data aggregation combined with technology that continuously analyzes data and initiates communication with the patient will eliminate the manual efforts that burden the care managers and providers assigned to PHM today. More importantly, such technology delivers consistency and predictability for patient interventions, an essential component to modify patient behavior and yield successful outcomes.
Yielding More Precise Guidance
Guidance to deliver precise and effective interventions and outreach is possible, yet very limited if confined to single-practice EHR data alone. By only utilizing a provider’s own patient data, organizations will be limited to a partial view of a designated population and the accuracy of patient care-gaps will be substantially degraded. Numerous other data sets, including EHR data captured from unaffiliated providers as well as non-clinical sources, must be included for more accurate outcome predictions and targeted interventions.
For example, by including data from community providers that co-manage patients, data from regional and national HIEs (Carequality/Commonwell), as well as other key data points concerning social determinants of health will yield much more accurate risk scoring and prioritize patients for interventions. Information such as patients’ nearby relatives, home address, and car ownership can change frequently and be incorporated into sophisticated algorithms that help predict behaviors and outcomes.
A care manager can then use those analytic capabilities to stratify these patients into risk categories for more frequent interventions that can be initiated automatically based on pre-defined rules. Patients at varying risk levels for acquiring Type-2 diabetes, for instance, may need different levels of support from the provider to help them make the healthcare and lifestyle choices to better manage their health and improve their outcomes.
Guest post by Fizzah Iqbal, content writer, Incubasys.
After a number of initial coin offerings being launched in the cryptocurrency market, blockchain development companies plan to introduce blockchain technology to the health records (EHR) industry. The Electronic Health Record (EHR) is a digitised version of patient’s medical history maintained by their doctors over a period of time. It includes information on demographics, diagnosis, vital signs, past medical history, progress over time, lab tests and more.
Owing to the de-centralised nature of blockchain system, it securely stores health records and maintains a single version of the truth that cannot be tampered with. This is of significant importance to different medical organisations and individuals like doctors, hospitals, labs, and insurers who can request permission to access a certain patient’s record from the blockchain without involving an intermediary. It offers two-way benefits; first, doctors and medical organisations get access to patients’ details and history without losing any precious time waiting for approvals from any intermediary and provide better patient care based on more accurate data, second, patients have more control over who sees their data.
The biggest challenge faced by healthcare systems throughout the world is how to share medical data with known and unknown parties for different reasons without violating patients’ rights and ensuring data security. Creating a trusted environment for decision-making regarding EHRs is challenging for medical community since each EHR stores data using different workflows which makes tracking data recording rather ambiguous. The growing focus on care coordination and EHR access across the care continuum has raised questions about ways to ensure that multiple providers can view, edit and share patient’s data without violating their rights and privacy in any way.
It’s not only about the problem of data sharing logistics in HER instead every solution that requires serious contemplation in a national healthcare system needs to put patient’s privacy and rights first in their list of priorities. And although laws have made health care data more accessible, vast majority of hospitals and doctors still cannot share data safely and securely. The time has arrived where solutions are needed in which patients themselves control whom to share their data with and where to remain pseudonymous.
Healthcare data is inherently sensitive in nature. Besides that the constant challenges of interoperability, patient record matching, and health information exchange have created opportunities for blockchain development companies to come up with a blockchain-based solution.
Once a blockchain solution is deployed to manage EHRs, it becomes a unified and common backbone for digital health. The biggest advantage of using this backbone is that each hospital or care provider no longer needs a specific version of databases or software to access patient data. Any information presented by EHR on the distributed ledger of a permissioned blockchain would be perfectly reconciled community-wide with the assured integrity throughout without any human intervention.
The use of blockchain technology to manage EHRs reduces the time it takes any medical representative to access patient’s information, enhance system interoperability and improve data quality. It also enables a reduction in overhead costs especially for development and maintenance of legacy health record systems. What blockchain does for everyone in healthcare system is that instead of relying on a designated intermediary for information exchange the de-centralised nature of blockchain allows any approved party to join in and either access information, share or exchange without the need to build data exchange channels between certain organisations.
There is an ample amount of evidence to back-up the notion that electronic health records (EHRs) help improve medical practice management, by ultimately increasing overall price efficiencies and cost savings within a practice. In fact, a national survey done in August of 2012 rendered the following statistics as evidence to back up this claim:
– 79 percent of providers’ report that with an EHR, their practice functions more efficiently
– 82 percent report that sending prescriptions electronically (e-prescribing) saves time
– 68 percent of providers see their EHR as an asset with recruiting physicians
– 75 percent receive lab results faster
– 70 percent report enhances in data confidentiality
These results offer an abundance of proof towards the fact that there is an obvious correlation between EHRs and overall practice efficiency, as well as general cost savings.
Now that we can provide plenty of evidence towards the notion that EHR software can result in a more effective practice, let’s look into what specific items are actually being reported by individuals. More specifically, what particular results of EHR solutions are providing them with fewer headaches in managing patient records.
In a study completed for the Journal of Revenue and Pricing Management, these are the main reductions and overall time-savers that stem from these profound digital records:
– Reduced transcription costs
– Reduced chart pull, storage, and re-filing costs
– Improved and more accurate reimbursement coding with improved documentation for highly compensated codes
– Reduced medical errors through better access to patient data and error prevention alerts
– Improved patent health/quality of care through better disease management and patient education
These points can, of course, be quite apparent once you implement EHR solutions into your practice. However, there is another huge benefit that is often reported by members of practices that initialize EHR solutions. That being the resulted drop in paperwork, which is often the biggest strain on office managers and administrative office workers for practices of any size. However, EHRs can streamline these tasks and create a practice that can largely benefit from this move towards a digital platform.
Guest post by Justin Rockman, vice president of sales and business development, Surgimate.
Since the late ’80s, the inflexible and cumbersome Health Level 7 (HL7) protocol has been the standard form of sending messages between healthcare applications. However, HL7 integration is timely to implement, technically limited and costly. It is not uncommon for a medical practice to face upwards of $10,000 in expenditure for one simple message.
Application programming interfaces (APIs) have recently become a fashionable alternative. The term API sounds complicated, but it’s really just a way in which software applications (like your EHR) can talk to other systems, and exchange large amounts of data rapidly and securely. In short – they support better, faster, cheaper interoperability.
In addition to transmitting data between systems, APIs offer the ability to plug in chunks of functionality to another system, in a clean and predictable manner. Instantaneous and seamless interaction between systems is the leanest and trendiest way to design software in 2018. New applications should not “reinvent the functionality wheel” but provide unique integratable services.
As the EHR market estimated to reach $28 billion in 2016, it is no surprise that tech titans like Amazon, and Apple are looking for ways to get a slice of the pie. With top of the line products sure to come from those companies and others, here are 4 reasons why healthcare IT vendors must offer their clients a way to integrate using APIs.
Physicians need easy access to data supported by EHRs, but hate the time it takes to manually enter patient information. It’s no wonder – doctors typically spend 50 percent of their day working with an EHR. If a physician isn’t happy with the usability or efficiency of their system, they’ll drop it and choose another. While the annual EHR adoption rate among providers is 67 percent, the EHR vendor switch rate is about 15 percent.
APIs offer cheaper and deeper integration options. For EHR vendors to provide better value for their customers they must embrace the API and ditch the expensive, outdated and rigid HL7 protocol.
Using an EHR that is integrated with other programs will make switching systems even more inconvenient. EHR vendors who give customers the additional functionality offered by their partners will be rewarded with brand loyalty, and lower churn.
An Additional Revenue Stream
Innovative EHR vendors are partnering with upstart technology companies to generate additional revenue. Greenway and athenahealth advertise an array of solutions in their marketplace, and provide partners with utilization of their APIs. In exchange, they receive monthly or recurring payment for each license sold. Since most practices already have purchased an EHR, finding new revenue streams is crucial for a company’s growth.
The healthcare API market is predicted to exceed $200 million in the next few years. Former engineers from Epic Systems saw the industry’s need for interoperability and raised $15 million in venture capital to found Redox – a company solely focussed on building bridges between healthcare applications. Creating platforms that deliver easy integrations at reasonable costs will greatly benefit the healthcare industry.
Jeff Lew, vice president of product management, Nextech.
The dawn of a new year brings anticipation for things to come—and this certainly holds true regarding health information technology. Electronic health records (EHRs) continue to evolve, and the next 12 months should provide some excitement as new developments emerge. In particular, there are three trends worth watching.
The inescapable shift to the cloud
More and more healthcare organizations are seeking cloud-based EHR and practice management systems, and it appears this trend will continue throughout the coming year. One of the primary reasons for moving to the cloud is the economics of these solutions. An organization does not have to maintain costly hardware and software or allocate resources for upgrades and other technology management functions. Instead, the system is housed remotely and kept constantly up-to-date by the vendor. Users can access the software with any device that has an internet connection, including laptops, tablets and, in some cases, smartphones. A cloud solution is especially cost effective for those organizations that have multiple facilities. Gone are the days of a server in each site—users can bring their laptops or tablets with them as they travel from location to location, logging in to the system from anywhere. Not only can this keep costs in check, it can also promote greater user satisfaction because the tool offers the flexibility to work from anyplace at any time.
Security and protecting an organization’s IT from threats will continue to make headlines like it has in the past year. It is a real and present risk that organizations must be acutely aware of and ensure relevant preventative measures are established and continuously maintained. This requires not just the relevant knowledge and skills, but also focus and resources, that many organizations may not have.
Ultimately, most—if not all healthcare providers—will shift to cloud-based solutions at some point. Although the move may not occur immediately for every organization, 2018 will see many healthcare entities take steps in that direction.
Complying with MACRA
This past November, the Centers for Medicare & Medicaid Services (CMS) released the final rule governing 2018 MACRA participation. The rule introduced several changes that stand to impact physician practices and other healthcare organizations. Here are a few key aspects of the rule of which to be aware for the coming year:
The exclusion thresholds have changed, and this may allow more specialty practices and other smaller organizations to exempt themselves. Note that CMS is now including Medicare Part B drug reimbursement in the calculations for exclusions, which may skew applicability for certain entities. If a physician practice uses a lot of Part B medications, for example, it may increase its revenue amounts and thus preclude the practice from exclusion.
For the first time, practices must submit cost measures, and these will represent 10 percent of an organization’s MIPS score. That percentage will rise to 30 percent in 2019. Since organizations will need to demonstrate cost performance, they may want to review that performance and see how it relates to their peers as well as the quality of care they deliver. Even if cost numbers are high, if they can be tied to good quality, then they are likely justifiable.
Organizations must start submitting cost and quality measures on January 1 and submit for the entire calendar year. They also must achieve a composite score of at least 15 out of 100, which is up from last year’s three out of 100.