Power of the Patient Interface

patient-powerHealthcare providers have long known that engaging patients leads to improved health outcomes; in a value-based payment world, engaged patients also provide a stronger framework for increased revenues. For this to happen, however, practices need the right patient engagement platform—one that not only empowers patients to become partners in their own healthcare, but that also documents that engagement.

A reliable, cutting-edge patient portal, for example, can enlist patients to provide extensive personal health data outside of the actual healthcare encounter, freeing up caregivers to spend more time with patients. Further, as population health becomes of increasing concern, practices whose patient engagement platform offers the ability to aggregate and analyze these individual health histories will have a head start. Patient engagement is where relevant data on population health begins.

It is equally important that the patient portal supports compliance with MIPS (Merit-based Incentive Payment Systems), enabling practices to comply with government requirements under Meaningful Use and MACRA (Medicare Access and CHIP [Children’s Health Insurance Program] Reauthorization Act) regulations—this will increase Medicare payments and minimize takebacks.

Finally, the patient portal needs to integrate seamlessly with the organization’s electronic health record, health information exchange, and accountable care organization, if any. The right solution will be flexible enough to adapt to the healthcare facility’s IT system, not the other way around.

ACOs and Triple Aim’s interest in patient engagement

Patient engagement was not initially a concern of accountable care organizations (ACOs), which were born of healthcare reform as a way to redefine the shared responsibility of doctors and hospital staff for coordinating care, improving quality, and lowering costs. That changed when the Affordable Care Act officially codified them into law, and recognized that ACOs could not succeed without patient engagement.

Patient engagement has also been deemed essential for the success of the Triple Aim, a framework developed by the Institute for Healthcare Improvement for optimizing health system performance by:

  • improving the patient experience (including quality and satisfaction);
  • improving population health; and
  • reducing the per capita cost of healthcare.

According to the IHI, “quality” is defined from the perspective of an individual member of a given population which leads logically to a focus on patient-centric care and patient engagement.

The ideal patient portal should be easy-to-use, responsive, and allow your patients to communicate with your practice on their terms. Practices need to communicate and connect with their patients to improve healthcare.

Do you have the right platform to engage your patients?

Achieving Value-Based Care – Making the Right Partnership for Success

Christine Schiff

Christine Schiff

Government Affairs Specialist at SRS Health
Christine has been with SRS for over 5 years, working in Government Affairs and serving as the HIPAA Privacy Officer. She is devoted to providing excellent customer service, and she translates this passion into the work she does to support government program compliance. She has an expert understanding of MU and PQRS and serves as a valuable client resource.

Prior to joining SRS, Christine worked at NYU for 11 years where she also obtained her Bachelor of Science in Healthcare Management.
Christine Schiff

There are many factors that contribute to achieving “value-based care,” some of which your practice may already be targeting—patient engagement, interoperability, outcomes, and efficiency, just to name a few! The reality is that the shift to value-based care has been underway for some time, but the change-over is accelerating with the implementation of MACRA. Whether through Alternative Payment Models or the Merit-Based Incentive Payment System (MIPS), the emphasis is now on improving quality and reducing cost.

For most doctors, of course, delivering quality care has always been a priority, so the question really is how to document that while maintaining practice efficiency, containing costs, and continuing to provide excellent patient care. Let’s look at some of the components of Value-Based Care:value-based-care-infographic

 

Whether you focus on all or some of these components, there will likely be a shift in how you use your EHR. To be effective in your pursuit of value-based care, you need your HIT vendor to be a true partner. Here are some questions to consider as you determine your goals and your technology needs:

  • What am I doing to drive value-based care, and how are my partners supporting me?
  • Where do I need more assistance?

And more specifically:

  • Do I have the capability to effectively engage and maintain communication with my patients—both pre- and post-visit—to better manage their care?
  • Can I track outcomes and set standards of care/protocols?
  • Can my current technology improve my practice efficiency?

Don’t settle for only what is imposed by regulatory requirements—decide what is truly valuable for the care of your patients and then implement it. The right technology partners will help you to develop a strategy for achieving your patient-care goals. Remember: How to efficiently deliver the highest quality patient care is an ongoing conversation—make sure your technology partners are holding up their end of it.

Let’s continue the conversation – tell us what you are doing to drive value-based care.

Enterprise Growth in the Ambulatory Space – The Benefits & Challenges

Diane Beatini

Diane Beatini

Vice President, Sales at SRS Health
Diane Beatini is the Vice President of Sales. She oversees the Sales, Account Management, and Sales Operations teams. She works to promote the complete SRS product suite of HCIT solutions to medical practices of varied sizes and specialties. Diane’s background includes an MBA in marketing and finance with 15 years of executive sales and customer service management experience in the radiology, medical device, and pharmaceutical industries.
Diane Beatini

“Leadership is the challenge to be something more than average.” Jim Rohn

trees-growth-39281207_sEnterprise growth is an emerging trend in the ambulatory specialty space. The shift to a value-based market with an emphasis on quality rather than volume, together with associated pressures in the healthcare landscape, has fueled the consolidation of individual practices into super groups.

This trend was a predictive model and growth strategy for hospital systems as the shift to value-based care loomed on the horizon. Hospitals understood the need to grow by becoming better—leveraging cost, quality, and service advantages to attract key decision-makers as opposed to pursuing prior, price-extractive growth strategies that were driven purely by increasing size through acquisitions and expanded market share. (Advisory Board: Health System Growth Strategy for the Value-Based Market)

A similar shift is occurring with ambulatory specialty practices, which face challenges from declining reimbursement, increased costs, changes in government regulatory requirements with the advent of MACRA/MIPs, hospital system pressure and competition, and the shift from a fee-for-service model to value-based care. Physicians have realized that, in order to remain independent and profitable, they need to come together and create regional—and in some cases statewide—groups united under a common brand name and/or the formation of clinically integrated networks (CINs).

Enterprise growth empowers physicians to practice independently and compete with area hospitals and health systems. Enterprise specialty groups are a strong sustainable alternative to hospital employment and they support ancillary growth opportunities like ambulatory surgery centers (ASCs), urgent care, imaging, and physical therapy locations. They provide a platform from which to negotiate local/state/national contracts inclusive of malpractice premiums, and to direct employer opportunities. This bargaining power allows for a reduction in overhead together with an improved revenue stream. Enterprise groups also have the advantage of scale to tackle infrastructure and HCIT investments, improvements, customizations, and maintenance.

In any industry, growth through acquisition and consolidation brings challenges. It’s not easy to merge management, staff, locations, and office cultures—it requires strong leadership and governance. A unified community-facing brand, a shared growth strategy /approach, and the development of KPIs are key determinants of success. Performance metrics may include market share, geographic reach, patient growth vs. physician density, annual revenue by specialty, total cost of care, and outcomes quality. Other important considerations are developing an integrated approach for human resources, employment contracts, health and malpractice plans, purchasing/procurement, and Bundled Payments for Care Improvements (BPCI).

The emerging organization must keep the community it serves as its top priority as it transitions and the pieces come together. The main driver of enterprise growth—the need to demonstrate quality outcomes and low-cost episodic care—also serves as the attraction for referral sources within the surrounding medical community and their consumers, the patients.

Done well, the demonstration of quality outcomes will support a strong brand reputation, providing the necessary bargaining power needed with payers and employers. To accomplish this, many groups seek a common HCIT platform for patient engagement, regulatory compliance, and outcomes reporting. While this represents yet another change during a time of transition, the right HCIT partner is an integral part of the success of the organization. Other key considerations are the ability to integrate these solutions to drive a seamless experience for both the clinician and the patient. Equally important is that the HCIT solution participates in a collaborative dialogue regarding ongoing needs, and supports each individual specialist’s clinical workflow preferences and patient volume while providing reliable, dedicated, hands-on support.

The Top 5 Challenges for Orthopaedists

In a recent article featured on Becker’s Healthcare, 19,200 physicians representing over 27 unique specialties were surveyed on what the most challenging parts of their careers were.

Here are the top 5 challenges for orthopaedists:

The Top 6 Challenges for Orthopaedists

It is also interesting to note that “Despite challenges, 79 percent of orthopedists would choose a medical career again, and 95 percent would choose orthopedics again.”

Would you?

Patient-Reported Data Collection and Return on Investment

ROI-300x300-screenDetermining ROI Metrics

The determination of when an investment recoups its costs is in many instances a fairly straightforward matter. In other instances however, it isn’t quite that simple. As the transition to value-based healthcare advances, providers are keenly looking for ways to assess the impact of patient-reported outcomes data on their bottom line.

The identification of a specific ROI metric to the cost of deploying a patient-reported outcomes data platform deployment is dependent on a number of factors that are not always easily quantifiable. Much depends upon what kind of data is being collected, the purposes for which it is being collected and both the qualitative and quantitative nature of the data.

To ensure a credible and reliable calculation of the ROI of patient-reported outcomes data collection, providers should rely upon a rigorous systematic approach for evaluation. One such methodology can be found in the work of the ROI Institute, through their “evaluation framework,”1 which categorizes results in a prescribed, logical order. This recommended sequence represents a chain of impact that can attribute and account for benefits realized. This framework consists of 5 levels of information to consider:

  1. Reaction to the program, particularly the perceived value of the program.
  2. The extent of learning such as skills, competencies, knowledge, and insights in the program.
  3. The extent of application and use of knowledge, skill, and insights acquired during the process.
  4. The program’s effect on the data such as, sales, productivity, quality, time, and costs.
  5. The ROI, the net monetary benefits compared to the cost of the program.

Patient-reported outcomes data collection offers its users a myriad of ways to generate value. For researchers, the data analysis tools provide powerful opportunities to analyze deep data sets. Practice managers are enabled to follow physician members to uncover best practices. And of course physicians can optimize their CMS reimbursement adjustment amounts by monitoring their performance scores throughout a performance year. The point is each user has a unique basis from which to evaluate and determine the overall benefit Patient-reported outcomes data collection contributes to a provider’s practice. Any valid assessment of an ROI must be tailored to the specifics of each user. Any generalized metric is clumsy at best and more than likely misleading.

Value Return to Physicians

The value of any patient-reported data collection platform to a physician must be measured by an array of considerations requiring objective and deliberate analysis. Each aspect of a physician’s practice that is impacted, whether directly or indirectly, necessarily needs to be factored into the equation. Failure to pursue such diligence in the assessment process will more than likely produce an incomplete and misleading result.

Application of the ROI Institute’s evolution framework offers a substantive foundation on which to assemble a meaningful appraisal. The framework is flexible enough to enable application to each unique practice configuration, yet establishes cumulative benchmarks that result in a succinct and useful metric. The sequential nature of the framework reinforces an approach that captures seemingly disparate variables and leverages them collectively to reveal a deeper and more nuanced valuation of deploying a patient-reported outcomes measurement system.

Data mining technology, such as OBERD’s “Mountain,” can factor prominently in generating value out of the data being collected. With it, physicians have the power to slice and dice information in a myriad of ways for infinite uses. For example, providers may measure effectiveness of care, by specific procedure as well as in aggregate. These insights, which can be generated on-demand, can empower physicians with invaluable and actionable information. No longer is a physician constrained to wait for an annual, boilerplate report.

The capacity to robustly leverage data enables insightful benchmarking for both patient and practice analysis can fortify operational best practices. By incorporating efficiencies and successful procedures revealed through tools such as Mountain, new competitive and productive gains can be realized.

A byproduct of this ability to mine data is to provide physicians the opportunity to license newly uncovered knowledge to manufacturers for research and development by the medical and pharmaceutical industries.

Patient Engagement

Patient portals and other technologies that identify and fortify patient touch-points provide opportunities to encourage patient participation in their own care. Heightened patient engagement can lead to better healthcare outcomes at a lower cost by increasing the efficiency of the healthcare system/care offered. In addition, the deployment of patient defined outcomes instruments offers to maximize clinician-patient communication by facilitating an environment that involves patients in their care leading to a better understanding of their conditions and quality outcomes.

Tracking patient reported outcomes for research purposes provides an exceptional marketing tool to showcase your advancement in medical treatments/surgical practices. OBERD’s powerful analytic tool, Mountain, offers providers a platform to analyze and mine the data you collect, and to benchmark against other data sets, global or local.

MIPS Compliance

The determination of any unambiguous ROI regarding MIPS compliance relies upon several factors that presently are premature to firmly assess and are simply not available. No reliable computations can be made until CMS has aggregated Composite Performance Scores (CPS) of all physicians participating in MIPS performance year one, 2017. All scores achieved during this initial year will be used to determine a “CPS Threshold” against which providers will be compared in order to assign reimbursement adjustments that will affect payment year one amounts in 2019. Until that threshold is published, it is simply impossible to identify express ROI expectations.

That said, close monitoring of CMS communications are beginning to reveal benefits through the thoughtful and strategic usage of patient-reported data measurement for the collection, analysis and reporting of patient-reported outcomes data.

CMS has published guidelines to demonstrate how reimbursement will work through the Quality Payment Program (QPP) but has yet to provide specific monetary values. The program has allocated $833 million dollars yearly for the next 5 years that will be distributed based on eligible clinician merit with a focus on quality outcomes, which is reflected in one’s CPS.  The better one’s CPS, the higher the probability that positive reimbursement adjustment will follow. Beyond the funding set aside to incentivize performance merit, here is an additional $500 million dollars available annually for the next 5 years reserved for those with an overall composite score of 70 points or above.

OBERD continues to closely monitor CMS announcements and regulatory developments. As each iteration of QPP rules are revealed, OBERD will continue to refine its products to optimize results for its customers.

Reinforcing a Practice’s Marketing Message

The publication of CMS’s Physician Compare website, by publishing clinician measure scores, allows patient to embody the role of a consumer in shopping around for the best healthcare and for providers that demonstrate higher quality outcomes. CMS has further advanced the promotion of provider score transparency by empowering qualified clinical data registries (QCDR) to supplement Physician Compare website information with enriched content that will further empower patients to see additional information about providers and their practice. OBERD, as a CMS-approved QCDR, is developing multi-modality scorecards to showcase a provider’s best qualities, identify top performers, identify best practices and establish additional practice marketing opportunities.

Summary

As the transition from a fee-for-service to a value-based care system continues to evolve and accelerate, the ability to efficiently and economically collect, analyze and communicate patient-outcomes data will be foundational to a provider’s success. Evidence-based healthcare decisions will rely on leveraging a patient’s involvement in their own healthcare. By increasing the role of a patient to communicate on their own individual situation and progress, that patient is afforded a more active role, which promotes better patient experience and satisfaction. Better performance scores directly impact reimbursement computation.

Of the ROI Institute’s five point evaluation framework mentioned earlier, it needs to be underscored that the first three elements address subjects that do not lend themselves to quantifiable measurement. The perceived value derived from acquired knowledge, skills and insights precludes the value received in the application of those newly realized observations. Application of the new knowledge in turn can directly impact and drive a provider’s best practice.

The ROI evaluation framework begins to address quantifiable activities in step four only after the first three steps of the process are accomplished. These activities, such as sales, productivity and costs can only be accurately assessed in the context of framework steps 1-3. The ROI Institute’s framework requires that all four steps are necessary, a condition precedent, before any actual ROI, the net monetary benefit compared to cost, can be accurately assembled.

OBERD understands that providers desire to be free from the routine task of data collection. Providers can now harness exceptional new methods to gather information from their patients, learn from them and to apply those insights towards that patient’s care. A healthcare provider should be able to practice medicine, and not have to monitor every single regulatory change. OBERD is set up to do just that. Be assured that OBERD will continue to advance solutions that address the latest in compensation strategies that generate optimized benefit to its customers.

As seen in OBERD’s Insights Blog.

Learn how you can take your value-based care to new levels with our new outcomes solution in partnership with OBERD.

2018 MACRA (MIPS) Proposed Rule: The Abridged Version

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

lynns-notesThe proposed rule is here, and it’s another long one! So for those who don’t have the patience (or the time) to read through the 1,000+ pages, here are some highlights from what CMS is suggesting for the second year of MIPS. Bear in mind that these are proposals; they must be confirmed in the Final Rule, which will be released by November. (What had already been set in stone within the MACRA legislation itself is the maximum penalty and related incentive: 5% in 2020 based on performance in 2018, up from 4% in 2019 based on performance in 2017.)

  • CMS would allow clinicians to use either 2014- or 2015-Certified EHR technology to report for 2018. Acknowledging the slower-than-anticipated pace at which EHRs are achieving the next required certification, this accommodation will facilitate more successful, non-rushed upgrades and provide sufficient time for training on the new capabilities and associated requirements. To encourage the move to 2015 CEHRT, 10 ACI bonus points would be awarded for its exclusive use. (Finalized as proposed)
  • The Quality reporting period returns to full year, but ACI (Advancing Care Information) and Improvement Activities remain at a minimum of 90 days. Cost is still unscored, but performance in this category will be evaluated by CMS and feedback will be provided to clinicians to prepare them for 2019 when, by law, the cost category must account for 30% of the MIPS score. (Finalized as proposed)
  • The proposed performance threshold separating “the winners” from “the losers”, (i.e., recipients of positive vs. negative payment adjustments), would increase from 3 points out of 100 in 2017 to 15 MIPS points in 2018—still an eminently achievable bar. (Finalized as proposed)
  • CMS would implement increased protection for small groups (≤15 eligible clinicians)—these are the practices that had been predicted to be the most vulnerable to penalties. (Finalized as proposed)
  • Many more clinicians would be exempt from MIPS altogether because the eligibility threshold would increase from $30,000 to $90,000 in annual Medicare revenue and from at least 100 to at least 200 Medicare patients.
  • Small groups that do participate in MIPS would receive 5 bonus points toward their score, in an attempt to level the playing field.
  • And my favorite proposal (Unfortunately, not finalized as proposed) is one that specialists, in particular, will appreciate: the elimination of the restriction that all 6 quality measures had to be reported by the same submission method. In 2018, clinicians would be able to mix and match submission methods within a category. Specialists, who have typically been faced with an insufficient number of relevant eCQMs, would be able to continue reporting those measures which are available by EHR submission, but could supplement them with registry or claims measures that are also specialty specific. The result would be more meaningful reporting and more equitable scoring. This is a request that SRS has included in its comments to each of the previous proposed and final MACRA rules, so we were very happy to see this change.

MIPS is only one of the two MACRA participation options, and CMS has also proposed some changes designed to accelerate the shift from MIPS to Alternate Payment Models. More on that topic in a future post.

CMS Overpaid $729MM in MU Payments: What Does That Mean for You?

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

overpaid-blogIt’s been all over the press for the past week—CMS paid a lot of money in the form of EHR incentives (Meaningful Use) to providers who did not truly earn them. These inappropriate payments were revealed in a report by the OIG (Office of the Inspector General) that reviewed CMS’s compliance with Federal requirements in the Medicare EHR Incentive Program for eligible professionals from 2011-2014. Although the subject of the OIG’s audit was CMS—in contrast to the audits of providers (pre- and post-payment) that have been conducted by Figliozzi and Company—there are some important implications for providers.

Here are two of the OIG’s major conclusions:

  • 14 EPs (Eligible Professionals), out of a sample of 100 who attested to having met MU one or more times did not actually meet the MU requirements. They either could not support their attestation with sufficient evidence or had errors in their attestation. Affected payments to these providers totaled $291,222. Extrapolating on this data, the auditors estimated that CMS inappropriately paid over $729 million.
  • In addition, 471 payments to EPs who switched between the Medicare and Medicaid incentive programs were incorrectly calculated, accounting for another $2.3 million.

The report recommended that CMS:

  • recover the $291,222 from the EPs who had the unfortunate luck to have been sampled [editorial comment is mine, not the OIGs!] and found to be non-compliant;
  • recover the $2.3 million in overpayments to EPs who switched programs; and
  • try to recover some of the estimated inappropriate payments made to other providers.

It’s likely that CMS will pursue the first two recommendations, but yet to be determined what—if anything—they will do about the third. That said, however, one thing is certain: CMS will intensify its oversight going forward. (This was another of the OIG’s recommendations.) Does this mean you should abandon your plans to participate in MIPS and/or MU (Medicaid program)? Absolutely not! It does, however, imply that it will now be more important than ever to keep full documentation to support everything you submit. And, make sure to keep it somewhere that will survive any future changes in software, hardware, and/or practice staff.