Value based care is doing more than change the way healthcare is reimbursed; it’s transforming how physicians use technology. Can your EHR solution handle what’s coming?
For years, the traditional reimbursement model has focused on how many procedures were performed and patients were seen.
Value based care is going to change this incentive system. It’s a reimbursement model that rewards medical professionals who improve patient outcomes and lower medical costs. The transition from a volume-based, fee-for-service payment model to a data-driven value-based care solution will affect more than the way physicians get compensated. It will impact the way medicine is practiced and the technology that doctors rely on to treat patients.
For those of you making IT purchasing decisions in your practice, it’s important to understand the demands that value based care places on your EHR system. You also need to know whether your solution can meet both present requirements and future needs.
In the transition toward value based reimbursement, Congress passed MACRA (Medicare Access and CHIP Reauthorization Act). Among its provisions, MACRA establishes new ways to pay physicians who successfully demonstrate quality and effectiveness over volume in treating Medicare beneficiaries. And while MACRA only applies to Medicare patients, it’s a likely indication of what’s to come for the broader patient population.
Both EHR vendors and providers alike will be impacted.
Physicians are feeling the pressure to implement these reimbursement mandates and avoid unnecessary care, waste and duplication of services. This requires a careful evaluation of your practice’s solution and whether your EHR partner is making the necessary investments in their technology to replace legacy systems with next-generation tools.
Vendors are looking — some may say scrambling — to upgrade their software’s capabilities to extend beyond the scope of traditional EHRs.
Let’s look at some ways that value based care is redefining the capabilities and functionality of your EHR system:
A 2016 HIMSS Cost Accounting Survey looking at the transition from fee-for-service to pay-for-value concluded that “[E]ffectively navigat[ing] the challenges posed by a payment model requires sharing and analyzing of data in ways that fee-for-service and its legacy revenue cycle management systems and business processes never contemplated.”
Value based care is much more data driven than traditional fee-for-service models. It places new demands on the revenue cycle management process, from what patient information is collected and billed to how it’s formatted and reported.
First and foremost, you need to determine how your billing software handles the additional data requirements for this new financial incentive system along with the traditional fee for service model. Will it require add-ons and upgrades, and what is the cost to do so? Is it customized to handle the specialty and subspecialty needs of your practice?
Integrating the necessary EHR functionality with your billing software enables your practice to manage updates. Your staff can then track procedures, process payments and ensure billing code compliance. This aids with meeting quality care information requirements necessary to determine reimbursement amounts and avoid denials, penalties and lost revenue.
Evaluating your EHR system goes beyond the revenue management cycle and the capacity to meet the reporting and reimbursement requirements of value based care. You need to assess its data management capabilities and how your EHR can help you reduce costs and improve outcomes. This is especially crucial for older patients with multiple chronic conditions.
Value based care emphasizes quality of care metrics. That puts greater pressure on tracking and reporting adverse events, patient engagement, treatment and patient health to demonstrate your improvement.
It’s no longer enough for providers to look at what’s on a patient’s chart. A wide array of factors will come into play from social determinants (e.g. demographics, level of education and employment status) to data that’s recorded on personal medical devices.
All of this involves larger sets of meaningful and actionable data to drive decisions by all members of the care team. The next generation of EHR systems will do more than collect and store data. They will help providers share data, interpret results and predict more accurate outcomes.
Providers will need better access to data visualization tools that help analyze patient data over months and years. A greater reliance on and access to data will also require robust encryption tools that better safeguard against hacking, ransomware and other breaches.
With value based care, wellness and preventive care are critical to improving outcomes and keeping patients healthier. This requires more collaboration between caregivers and their patients to ensure care is more coordinated, appropriate and effective.
Part of the challenge will be overcoming the obstacles of interoperability and the costly and time-consuming tasks of sharing information among different providers, health organizations and health information exchanges.
Systems will need to facilitate engagement between providers and patients through more user-friendly interfaces that improve access and self-management, including patient portals and medical devices.
Demand for more data will also increase the reliance on HIPAA-compliant, cloud-based EHR solutions that can interoperate with larger repositories of available data on a community or public basis.
The ability to access and share large pools of data will fuel the demand for advanced analytics necessary to drive patient insights. Physician practices can turn these insights into more accurate, more targeted treatment planning. Ultimately, this will turn into better outcomes and higher reimbursement rates.
The transition to a value based care reimbursement model has the potential to lower costs and improve outcomes. Turning this promise into reality rests on several contributing factors.
First and foremost, providers will need to embrace new ways of treating patients and new incentives for getting paid. It also requires behavioral shifts in patients themselves to accept greater involvement in the treatment and maintenance of their healthcare.
The success of value based care won’t solely rely on greater collaboration between doctors, patients and caregivers. It will require partnerships between providers, IT professionals and EHR vendors. Together, they can help advance the capabilities of EHR systems to help providers deliver better care at a lower cost with higher rates of return on their technology investments.