One of the many challenges facing physicians this year is the transition from volume-based to value-based payment. The CHIP and Medicare Access Reauthorization Act, also known as MACRA, replaces Medicare’s current fee-for-service reimbursement program with a new value-based care framework that focuses on quality, value and convenience. responsibility. This transformation is the largest effort in the entire industry that will affect millions of healthcare providers across the country.
MACRA offers two repayment path models, Alternative Advance Payment Models (APM) or Merit Based Incentive Payment System (MIPS). The MIPS model is an incentive model that consolidated three existing Medicare quality programs into one. Many independent medical practices will opt for MIPS because of its incentivized benefits and its potential to increase net income through payment adjustments, which in some cases reward value in primary care rather than volume.
With such a dramatic change, independent medical practices are asking: What can we do to thrive under this new values-based equation of care?
In this article, I present some tips to help individual and small healthcare practices on how to best use information technology tools in a values-based care setting. In addition, we discuss how to improve financial results, while reducing overall costs.
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1. Solid investment in analytics to predict readmissions.
Understanding patterns in your data allows you to act on trends before they become cost-reducing issues.
For example, analyzing data information about patients being treated. Small practices can more easily identify patients who are likely to be candidates for readmission. Then tailor specific patient engagements and interactions for these patients. From there, make the quality improvements that can lead to better clinical outcomes. The cost of investing in a population health management solution can help generate greater savings over time.
Remember, the only way to report on those results, and get paid for the service you provide, is through quality data. Look for an IT solution, such as a population health management system, to help you provide the quality data you need.
2. Empower patients to take control of their own health
Independent health practices must focus on the specific attributes of their communities to move towards a quality-driven model. Strategies that personalize labor and empower patients to better control their own health are the ones most likely to be successful.
For example, a physician serving a predominantly Hispanic population may consider developing diabetes prevention programs. These programs could focus on helping limit the spread of the disease.
The development of such programs can help small independent practices to better define information technology tools. For example, data-driven tools. These tools provide information on cost and quality metrics and provide the data necessary to make care decisions that are consistent with effective clinical practice.
3. Offer continuous access to mission-critical data and systems
No matter the size of your organization, no organization can afford downtime. In the healthcare sector, system failures cost more than money. They can cost lives. When the flow of data is disrupted, the effect is viral, impacting patient health and safety, internal processes, and revenue.
High availability is no longer a pleasant thing, it is a must. Across all industries, high availability (HA) is measured in nines. “One nine” refers to 90% uptime of systems, “five nines”, a standard benchmark, refers to 99.999% uptime. Downtime that occurs during peak patient care hours will have a greater impact on your organization than downtime that occurs during off-peak hours.
For high availability configurations, your IT must ensure that there are no interruptions in the flow of data and that administrative and patient functions are performed according to standards. High availability for healthcare should:
- Allow scheduled system maintenance and updates without interrupting service
- Respond to unplanned system outages
- Scale to meet your volume requirements
- Reduce the load on your internal IT resources
- Employ fault tolerance and automatic fault detection
- Provide 99.999% uptime
Small, individual healthcare practices that previously viewed downtime as unavoidable or a necessary evil must be adapted to increase availability requirements. As the volume of information sharing increases, so will the amount of revenue lost per second of downtime.
4. Form alliances to help meet requirements and maximize payouts.
A great method to help maximize payments under the CMS payment policy is to forge an alliance with another healthcare organization. The right alliance can help meet the requirements of payers and patients to deliver quality.
Given the central role that technology plays in today’s healthcare environment, carefully consider the IT implications of any new alliance before committing to the association. Considerations that can help ensure a successful clinical association include:
Emphasize sharing – many organizations will have different technologies that must work together. Invest in integration platforms that make connections near seamless, which can simplify and simplify information sharing.
Insist on interoperability. Many organizations have invested in EHR or EMR technology. Forcing alliance partners to change technologies for the sake of consistency only creates more confusion and disruption. Implementing an integration model that allows information to be used meaningfully across different clinical systems will increase interoperability.
5. Secure your data
Healthcare data is the new frontier for aggressive hackers looking for an easier and more lucrative way to perform identity theft. The estimated cost of a health care violation is quantified as $ 200 per patient record. This does not include the loss of commercial and financial resources. Keeping your applications, patient data, and system safe will help you maximize your payments under CMS.
When it comes to healthcare data, you can never be too safe considering the facts. Here are the steps you can take now to help you better practice protecting your data:
- Recognize that policy changes must come from the higher levels of an organization.
- Evaluate the 5 Rs in your security strategy: risk, redundancy, replication, recovery, and accountability.
- Review and update your HIPAA compliance regularly. By achieving HIPAA compliance, you will also increase your cybersecurity posture.
Between declining reimbursements and the transition to value-based care, single, independent healthcare providers face increasing pressure to lower the cost of healthcare delivery. To protect margins, business operations must be managed more efficiently.
Value-based care equation
The Holy Grail for achieving optimal value-based care is finding less expensive ways to provide optimal care in a lower-cost setting that is also accessible. More specifically, to thrive in the era of value-based reimbursement, small independent healthcare organizations will need tools that allow them to measure their results.
