Guest post by Richard A. Royer, MBA, chief executive officer, Primaris.
It has been several years since Medicare began introducing payment changes aimed at driving the healthcare industry away from volume-based payments and toward value-based reimbursements. One of the main purposes of the payment system’s overhaul is to improve the quality of care that healthcare providers deliver to patients. Of course, the other main goal is to keep costs in check. In simple terms, the shift to value-based incentives rewards providers that deliver on cost, quality and patient outcome measures. What many providers have learned along the way is that technology plays an important role in the transition to value-based care, and meaningful use of electronic health records is necessary for success under value-based incentive programs.
Value-Based Payment Basics
For healthcare providers that are working to adapt to new payment models and are just beginning to make adjustments, understanding the basics of value-based care is the first step to success. Some of the key points healthcare providers need to recognize about value-based reimbursements are:
- The value model rewards performance. That can mean a number of different things, for example, achieving high quality and patient satisfaction scores or making improvements to care over time. The point is, providers must focus on meeting certain standards for care and cost in order to be eligible to earn financial incentives and to avoid penalties.
- Value-based care models are extremely data driven. Providers need to measure and report performance outcomes in order to assess their efforts internally, and also so they can earn reimbursements from external payers. As a result, healthcare providers need to continuously measure and analyze patient data, not just collect it.
- Collaboration is an important success factor under value. Patients – particularly those with chronic health conditions – receive care from multiple providers as they move across the care continuum. To ensure that treatments, medications, and care plans are safe and effective, and that patient outcomes (which impact reimbursements) are the best they can be, providers need to communicate with each other and work to coordinate care. Value-based programs demand coordinated care.
The Role Of EHRs
Adopting new processes, training staff on new procedures and implementing other quality improvements takes a lot of effort. One of the things provider organizations should do as they undergo these changes and work to improve quality, measure performance, and coordinate care is examine their use of electronic health records and work to optimize their EHR technology.
A majority of hospitals and a large number of physician practices now use electronic medical records. Nursing homes have been slower to adopt EHRs, mainly because of cost barriers. The degree of EHR success varies from one organization to the next. Some providers are using more advanced features while others are still in the early stages of use.
Getting to a point where EHRs increase efficiency rather than detract from it is something a lot of providers struggle with. However, providers need to stick with EHRs and strive to take full advantage of the capabilities of their technology. Why? Because EHRs give providers a better understanding of critical care points and associated risks, which means more opportunity to manage patient populations and health outcomes. Also, EHRs help improve data sharing with other partners in the medical chain so care can be better coordinated.
Speaking of data sharing, a hot topic surrounding EHRs right now is interoperability. Healthcare providers know that they need to communicate with external providers in their community and coordinate patient care. Coordinated care helps prevent medical errors, it leads to better patient experiences, it can reduce duplicate tests and cut medical costs – it is a big part of value-based care. But as of now there are several barriers that make data sharing difficult. Luckily, interoperability breakthroughs are on the way, and new requirements will soon force EHR systems to be interoperable. In the future, EHRs truly will be the best way to completely and efficiently share essential patient information with other providers so that care can be coordinated.
Besides improving communication between providers, EHR systems can strengthen the connection between providers and patients. EMR systems can receive patient data directly from home monitoring devices. This is significant because it gives physicians a way to monitor patients and intervene as needed so that dangerous and costly complications can be avoided. Many of Medicare’s value-based programs offer incentives to reduce hospital re-admissions. Preventing re-admissions is much easier with the help of real-time data captured by EHRs.
EHRs are the key to getting ahead of quality issues that can lead to financial penalties under value-based care. Healthcare providers that are without staff well-versed in technology or adept in the process improvement expertise that makes it possible to optimize an EHR system may need to work with a consultant. Partnering with a consultant experienced in helping healthcare practices and facilities take full advantage of EHR systems is a good way for care providers to get the support they need to improve care coordination and clinical outcomes.
For healthcare providers there are both opportunities and challenges tied to value-based care programs. Recognizing those opportunities becomes easier with optimized EHR technology.