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Revenue cycle data analytics helps with value-based reimbursement, MACRA

It's important to understand how technology can help a healthcare organization achieve value-based reimbursement. A health IT expert discusses the role of revenue cycle data analytics.

Rosh Plugge, executive director of revenue cycle at Brookwood Baptist Health in Birmingham, Ala., discusses how...

data analytics tools can help healthcare organizations be successful in transitioning over to value-based reimbursement and the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), or MACRA.

How will revenue cycle data analytics tools help healthcare organizations when it comes to MACRA?

Rosh Plugge: We handle the billing and collections in the system in our EHR and in [our data analytics platform] for just the hospital, so I think MACRA is going to have probably the biggest impact on the physician-clinics side, so that's not as directly going to have an impact on us on the hospital side. But I think, just like with any other major changes that we see in the industry and in our organization, these analytic tools will enable us to monitor our performance on a trended basis very quickly after those changes are made. Just like … the ICD-10 implementation or the merger that we went through in the fourth quarter of last year; we met daily when those changes took place to monitor trends and get on top of any abnormalities we saw right away [or that] we could expect. … It's kind of hard to really pinpoint what kinds of adaptations we'll have to make with MACRA, but any changes in the fundamental way we do business will be easily tracked in the same way using the analytics tool.

MACRA seems to be pushing healthcare organizations to transition over to value-based reimbursement. Will revenue cycle data analytics tools help healthcare organizations do this?

Plugge: I think it definitely will. … We haven't really gotten into the bundle payments [and] some of the things that are being piloted in different parts of the country. So, we dabbled a little bit into value-based care with some of the pay-for-performance-type bonuses we have with a couple of payers that are typically done at the end of the year. So, we kind of bill on a normal basis and then get to the end of the year and do a look back. And just again, the analytics really give us the ability to pull whatever type of information is relevant to demonstrating that we've met the requirements to achieve those bonuses [and] payments from the payer.

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This was last published in August 2016

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