The healthcare industry is undergoing significant transformation. The federal government and commercial payers are focused on reducing costs by shifting to a “value-based” reimbursement system in which the highest quality outcomes delivered at the lowest possible cost is the standard. As a result of the Affordable Care Act, patients will be changing their healthcare usage patterns based upon new insurance models being introduced.
In addition to these shifts in reimbursement, digitization of the healthcare industry is accelerating within hospitals, as well as in primary care and specialty practices. The transformation is fueled by requirements for safe medication management practices, quality reporting, information sharing within the continuum of care, and patient engagement. Simultaneously, an overhaul of the diagnosis coding system is underway.
With all of these changes occurring simultaneously, 2014 will be a turbulent time for the practice of medicine. How can practices navigate this perfect storm and succeed?
What are the most important things a practice should do to be prepared for this transformation? Preparatory steps should focus on the following elements: electronic medical records (EMR), health information exchanges (HIE), and personal health records (PHR).
- Acquire, implement, or upgrade EMR systems before July 1, 2014, to ensure that they will meet meaningful use stage 2 and ICD-10 requirements. This will help minimize or avoid Medicare payment penalties and reimbursement delays.
- Embrace e-prescribing and submit those prescriptions that you can electronically from your EMR.
- Interface your EMR to reference laboratories and make sure the results you receive are placed into your EMR in LOINC® (Logical Observation Identifiers Names and Codes) format.
- Define the quality measures that you need to collect and report and work with your EMR vendor to ensure that these measures are naturally derived from the information already being entered into the EMR. This may require you to change or increase the amount of documentation being entered into the system but will save time on the backend. Connect to a clearinghouse that can electronically submit these quality measures for you. In many areas, regional extension centers or local Accountable Care Organizations (ACOs) are beginning to offer these services in addition to EMR vendors.
Not to be confused with the health insurance exchanges (where consumers purchase health insurance under the Affordable Care Act), HIEs are intended to share summary patient treatment information across the continuum of care. Participating in an HIE will be part of succeeding within an ACO or bundled payment system, because patient registries and performance metrics will most likely be derived from the HIE.
In many areas, HIEs are funded by the federal government and managed by Health Information Organizations (HIOs). Contact your local hospital or physician organization to find out how you can participate.
- Work with the HIO or HIE and your EMR vendor to be able to send and receive information from the exchange.
- Identify funding sources to help offset the cost of joining an HIE by tapping into local grant funding or seeing if your hospital will help with a subsidy.
- Push the HIEs to add medical images to the information.
Many experts believe that patient engagement is key to reducing costs across the care continuum because engaged patients may more carefully manage their healthcare needs. Aspects of patient engagement include electronic access to their PHR, the ability to maintain a personal health maintenance record, the ability to maintain an over-the-counter and prescribed medication list, and the ability to send messages to care providers.
Meaningful Use stage 2 requirements mandate that a patient be able to send messages to their healthcare provider and to view, download, or transmit their health information. Many EMR and HIE vendors provide this functionality within their product offerings.
- Look at what others in your area are doing and determine the solution that works best for your practice.
- Make sure that you are compliant with meaningful use stage 2 requirements.
Taking these steps will not be easy. The greatest challenges a practice will face will be in the areas of cost, learning and education, and privacy and security.
- Cost—Some estimates indicate that the total cost of ownership over a 5-year period for an EMR, HIE, and PHR can exceed $50,000 per doctor. Practices will need to look for ways to eliminate costs by automating services such as transcription and record storage fees. Additionally, some relief can be provided by hospitals, labs, and ACOs that supply subsidies.
- Learning and education—Software products and work flow processes continue to evolve over time. Practices will need to budget time for this on an annual basis to keep up with the latest changes, regulatory requirements, and upgrades. The more educated users are, the more facile and productive they will become.
- Privacy and security—Under the Health Insurance Portability and Accountability Act, if a breach of privacy occurs, the practice is liable (guilty) until proven innocent. Large penalties and damage to reputation are occurring at an alarming rate.
Practices should ensure that systems have proper security logging and tracking features and review those logs periodically to spot problems early. Install technical safeguards such as virus and malware protection and encryption software on servers and devices. Investigate incidents and report them properly. To survive an audit, practices should keep a binder of policies and procedures, notices, risk assessments, remediation activities, and on-going monitoring controls.
To succeed in the new healthcare normal, practices must embrace the new technologies offered: EMR, HIE, and PHR. In addition, affiliated hospital systems are transitioning through the same transformation and will require the use of Computerized Provider Order Entry, medication reconciliation, e-prescribing, electronic notes, and scripts provided for outpatient services with ICD-10 codes. Engage with them, for everyone is in this together.
David P. Dyer is vice president of planning and chief information officer at Somerset Medical Center, Somerville, N.J. He can be reached at 908-685-2823 or email@example.com