Basic Flow Of Information Within A Healthcare Organization Using Ehrs Medicare Reimbursement Declined – 5 Essentials for Success In The New Healthcare World

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Medicare Reimbursement Declined – 5 Essentials for Success In The New Healthcare World

One of the many challenges facing physicians this year is the transition from volume-based payment to value-based payment. The Medicare Access and CHIP Reauthorization Act also known as MACRA replaces the current Medicare reimbursement schedule, fee-for-service, with a new value-based care framework that focuses on quality, value and accountability. This transformation is the most important industry-wide effort that will impact millions of healthcare providers across the country.

MACRA offers two cost recovery models, Advance Alternative Payment Models (APMs) or the Merit-Based Incentive 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 incentive benefits and potential to increase net income through payment adjustments, which in some cases reward value in primary care rather than volume.

With such dramatic changes, independent medical practices are asking: What can we do to thrive under this new value-based care equation?

In this article, I present some tips to help independent and small healthcare facilities on how to better utilize information technology tools as part of value-based care. In addition, we look at how to improve financial results while reducing overall costs.

5 small solo practice tips for success

1. Strong investment in analytics to predict readmissions.

Understanding patterns in your data allows you to act on trends before they become cost-cutting problems.

For example, by analyzing data on patients being treated. Small practices can more easily flag patients who are likely readmission candidates. Then customize patient engagements and interactions specific to those patients. From there, make quality improvements that can lead to better clinical outcomes. The cost of investing in a population health management solution can help generate greater savings overtime.

Remember, the only way to report those outcomes—and get paid for the service you provide—is through quality data. Look to IT solutions like a population health management system to provide the quality data you need.

2. Empower patients to take control of their own health

Independent health practices should focus on the specific characteristics of their communities to move toward a quality-driven model. Strategies that personalize delivery and empower patients to take better control of their own health are most likely to succeed.

For example, a physician serving a predominantly Hispanic population might consider developing a diabetes prevention program. These programs could focus on helping to limit the spread of the disease.

Developing such programs can help small independent practices better define information technology tools. For example, data-driven tools. These tools provide insight into cost and quality metrics and provide the data needed to make care decisions consistent with effective clinical practice. This can improve service delivery and increase value-based outcomes.

3. Provide continuous access to critical systems and data

Regardless of the size of your organization, no organization can afford downtime. In healthcare, system failures cost more than money. They can cost lives. When the flow of data is disrupted, the effect is viral, affecting patient health and safety, internal processes and revenue.

High availability is no longer a nice to have, it’s a must have. Across industries, high availability (HA) is measured in the nines. “One nine” refers to 90% system uptime, “five nine”, the standard reference point, refers to 99.999% uptime. An outage that occurs during peak patient hours will have a greater impact on your organization than an outage that occurs outside of peak hours.

For high-availability configurations, your IT should ensure that there are no interruptions in data flow and that patient and administrative functions are performed according to standards. High availability of health care should:

  • Enable planned maintenance and system upgrades without interruption

  • Respond to unplanned system outages

  • Scale to meet your volume requirements

  • Reduce the burden on your internal IT resources

  • Use fault tolerance and automated error detection

  • Ensure 99.999% uptime

Independent and small health practices that previously considered downtime an inevitable or necessary evil must adapt to increased availability requirements. As the volume of information exchange increases – so will the amount of lost revenue per second of downtime.

4. Form alliances to help fulfill claims and maximize payouts

A great method to help increase payment under CMS payment policy is to form an alliance with another healthcare organization. The right alliance can help meet payer and patient demands for quality delivery.

Given the central role technology plays in today’s healthcare environment, carefully consider the IT implications of any new alliance before committing to a partnership. Considerations that can help ensure a successful clinical partnership include:

Put a premium on sharing – Many organizations will have different technologies that need to work together. Invest in integration platforms that make connections nearly seamless, that can streamline and easily share information.

Insist on interoperability. Many organizations have invested in EHR or EMR technology. Forcing alliance partners to change technologies for the sake of uniformity only creates more confusion and disruption. Implementing an integration model that enables meaningful use of information in different clinical systems will increase interoperability.

5. Protect your data

Health data is the new frontier for aggressive hackers looking for an easier and more lucrative way to steal identities. The estimated cost of a healthcare breach was quantified as $200 per patient record. This does not include lost business and financial resources. Keeping your applications, patient data and systems secure will help maximize your CMS payments.

When it comes to health information, you can never be too sure about the facts. Here are the steps you can take now to better protect your data:

  • Realize that policy changes must come from the highest levels of the organization

  • Consider the 5 R’s in your security strategy: risk, redundancy, replication, recovery and accountability.

  • Regularly review and update your HIPAA compliance. By achieving HIPAA compliance, you will also improve your cybersecurity posture.

Between declining reimbursements and the shift to value-based care, sole and independent health care providers are facing increasing pressure to reduce the cost of providing health care. In order to protect margins, it is necessary to manage the business more efficiently

The value-based care equation

The holy grail of achieving optimal value-based care is to find less expensive ways to deliver optimal care in a less expensive setting that is also accessible. Specifically, to thrive in the era of value-based reimbursement, small independent health care organizations will need tools that allow them to measure their results.

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