Posted by: adelvecchio
Accountable Care Organizations, ACO, EHR incentives program, Meaningful use, Medicare reimbursement, Shared Savings Program
Guest post by Richard Royer, CEO of Primaris
The Centers for Medicare and Medicaid Services (CMS) is trying to make the accountable care model a more compelling option for healthcare providers. The Affordable Care Act established the Medicare Shared Savings Program to improve care coordination and to incentivize providers and other healthcare institutions to participate in an accountable care organization (ACO).
By opting into the one-sided ACO track, an ACO can earn up to 50% percent of its shared savings, achieved by meeting quality performance standards. To entice providers to enroll in its two-sided ACO model, CMS sweetened the pot by offering as much as 60% percent of shared savings — the catch being the ACO is also responsible to repay a portion of any losses, based in part on its quality scores.
Participation in each of these programs is currently voluntary. But there is no denying the value-based and accountable care model they exemplify is the future, in both the public and private payer realms. Indeed, commercial insurers such as Cigna Corp. and Aetna Inc. have already launched their own versions of ACOs.
The adoption and meaningful use of certified EHRs underpins the whole concept of accountable care. These systems should serve as the source of data for dozens of clinical quality measures that ACOs must annually report to CMS. That data runs the gamut from recording preventive health measures, such as immunizations and mammography screenings, to tracking populations at risk for diabetes, hypertension and other chronic conditions.
But even if your institution isn’t participating in a public or private ACO, it’s important to consider ramping up your meaningful use of certified EHR technology. After all, any healthcare provider that wants to receive Medicare and Medicaid EHR incentives also needs to meet value-based care measurement thresholds.
Bring meaning to meaningful use
All that said, it appears there is still a ways to go to make the meaningful use of EHRs truly meaningful. Consider, for example, that according to a 2014 report by KLAS Research, based on a survey of 46 physician-led ACOs, EHR vendors earned an average 6.3 rating out of 9.0 for meeting ACO needs.
Fortunately, it is possible to improve EHR systems so healthcare providers in ACOs can more efficiently gather data to meet CMS reporting requirements and so any provider can be better positioned to receive payments from the Medicare and Medicaid EHR Incentive Programs, while avoiding possible penalties.
EHR systems can be optimized to help providers get ahead of healthcare quality issues, whether these practices are involved in ACOs or simply prepping for a future in which value-based and collaborative care models rule. That’s because EHR technology can be leveraged to give providers a better understanding of critical care points and associated risks, and give them an improved method of communicating required data to other partners in the medical chain.
Realize the value of the accountable care model
To get real value out of EHR systems, support meaningful use requirements, and position your organization for a future where accountable care is everywhere, it’s important to take the following steps:
- Don’t just capture data. Capture it appropriately and accurately. EHR systems are only as smart as they are set up to be. And they won’t be very smart if you don’t correctly document what medical options you propose to patients, the education you share with them and the information you learn from them in an easily removable, communicable and reportable data format. That could translate into loading new templates or input forms into the EHR to ensure critical information is captured in a structured format, rather than simply in the notes field. That way, it can be easily and automatically reflected in a practice’s quality improvement efforts, such as screenings for flu vaccinations or smoking cessation.
- Bring in the data reports and take action on them. One of the great things about EHRs is they potentially give healthcare organizations an improved capacity to plug gaps in treatment that can lead to accountable care gaffes, such as overlooking signals in patient data that wind up hurting the quality score related to hospital readmissions.
- That capacity is easier to leverage if your practice has regular access to comprehensive and comprehensible data reports, making it simpler to spot problems affecting a fraction of the patients within a large population. Otherwise, that is no easy task, especially now that practices’ data volumes are exploding as samples and test results from external sources — such as labs or information from patients’ mobile healthcare devices — can directly import into EHR systems. But when the information is culled together so you can quickly spot a week-to-week roller coaster ride in a diabetic patient’s blood sugar levels, you can move quickly to correct the problem before the patient lapses into an acute condition.
- Customize only where necessary. There are some situations where customizing your EHR system is unavoidable. Those are the only times where you should indulge in the practice. In other words, deploy customizations only for reasons of functionality, not aesthetics. For instance, many EHR systems don’t automatically include an interface to transmit immunization data to a state immunization registry, but adding one to your system is worth the investment given that providers must show they have performed at least one test of their certified EHR technology’s capacity to electronically submit such data.
- When it comes to changing things like the location of a menu bar, though, skip it. That won’t be accounted for in the next general release of your vendor’s product, nor will the vendor have prepared it as an optional add-on that can be purchased for a reasonable fee. That means when upgrade time comes around, you’ll be undertaking the whole process again, and that can cost you thousands of dollars and increase the time it takes your practice to move onto the next version.
- Consider where your expertise really lies. While the healthcare profession is changing and many physicians’ practices are being acquired by larger health systems, the industry still has more than its fair share of small practices. And most of them — perhaps your own — are without staff that is well-versed in technology or adept in the processes that optimize an EHR system for meaningful use. In those cases, it’s not a good idea to take the do-it-yourself approach to deploying EHR systems, and certainly not wise to follow that route to satisfy stage 1 or 2 criteria.
- While trying on your own may seem reasonable, there’s a lot at risk if you hit significant stumbling blocks, including your cash flow. You may experience a decrease in returns from the Medicare Shared Savings Program or in meaningful use incentive payments. Many EHR systems also are responsible for triggering bills to patients or insurance companies. So, if issues arise with the system as you attempt to increase its meaningful use functionality — and those issues affect your ability to use the technology for other purposes — core revenue may be put in jeopardy. Under those circumstances, the old saying about asking for help when you need it could not be truer.
Are you ready to reap the value that comes from the meaningful use of an EHR system in a world moving to the accountable care model? Things are changing fast in the healthcare industry and the more prepared you are to meet those changes, the better off you’ll be.
About the author:
Richard A. Royer has served as the chief executive officer of Primaris since 2001. He has extensive administrative healthcare experience and is actively involved in a number of statewide healthcare initiatives. In 2006 he was appointed by the Missouri governor to the Missouri Healthcare Information Technology Task Force and chaired the resources workgroup. He also serves on the board of directors as treasurer for the Excellence in Missouri Foundation.
In his more than 35 years of medical business experience he has held positions as CEO at Cuyahoga Falls, Ohio, General Hospital; executive director of Columbia Regional Hospital in Missouri; and founder and president of Avalon Enterprises, a medical financial consulting firm.