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.

National Health IT Week and the Ways We Help Patients

i_heart_hitNational Health IT Week is a proud time for all of us at SRS Health. Though we all took different paths to get here, the same overarching urge drove us: to help people. Despite our divergent skillsets and backgrounds, we share a lot in common with the specialists our IT solutions support. We are two halves of the same brain, and the betterment of clinical care is always at the forefront of our minds.

“We can harness data and technology to remove obstacles from the daily work of the people who keep us healthy,” believes Abraham Sanders, Principle Software Engineer at SRS Health. “There is amazing potential to consider. How can medical data be used to improve clinical outcomes for patients? How can the same data be used to help simplify the documentation of a patient visit, freeing clinicians up to focus on what matters most—the patient?”

These questions aren’t just food for thought, they drive every improvement and decision that goes into our HIT solutions. Where others see constraints and barriers, we see opportunities to lend a hand. Not the steady hand of a surgeon, or the gentle hands of nurse, but assistance that alleviates the pressure of paperwork and postage, remembers dates down to the millisecond, and notices the nuances that become patterns. As Hector Martinez, Sr. Implementation Specialist at SRS Health, puts it, “I enjoy the gratification that comes with enabling healthcare professionals to focus on practicing medicine and engaging with their patients. Seeing the clinical and nonclinical staff establish a level of confidence and comfort in their everyday roles is what I strive for.”

“When we suffer from a sickness or injury, we depend on healthcare professionals to get us back into shape,” says Ganesan Solaiappan, Software Development Manager at SRS Health. “Those professionals, in turn, depend on healthcare information technology to be able to do their work. In that way, I think I am helping to improve the quality of life by building and maintaining the systems that clinicians need.” Solaiappan adds, “Healthcare providers look to their IT systems to provide the information they need to make effective clinical decisions, to increase their awareness of innovations in the medical field, and to document and identify patterns. When doctors are able to provide complete and fully informed patient care, it may help to save a life. I’m thankful to be a part of that.”

“I am most proud of the way SRS comes together, cross functionally, to support our clients, even at the most inopportune times,” believes Michael Arbunzo, Technical Support Manager at SRS Health. “Emergency requests never take a holiday, and neither will physicians or the IT staff backing them up.”

To all our colleagues celebrating Health IT Week, especially the SRS Health Family, thank you for your unyielding dedication, hospitality, and warmth.

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.

Is Healthcare Hi-Tech Enough?

Barbara Mullarky

Barbara Mullarky

Director, Product Management at SRS Health
Barbara has had a successful career in the healthcare industry, working for both vendors and healthcare provider organizations. She has held roles in sales, marketing, product management and professional services, working with EMR and department-focused solutions for the laboratory and imaging.

Prior to becoming the Director of Product Management at SRS, Barbara was with GE Healthcare (now GE Digital), where she held the positions of Senior Product Marketing Manager for Centricity imaging products, Product Marketing Manager and Customer Collaboration Leader for what is now Caradigm, and Upstream Marketing Manager for Centricity Laboratory. Barbara also worked at the University of Arizona Medical Center, where she managed a team that was responsible for implementing and maintaining 27 departmental IT solutions, the ambulatory EMR and the patient safety initiatives; Wyndgate Technologies (now Haemonetics); Sunquest Information Systems and Community Medical Center.

Originally from New Jersey, Barbara now lives in Tucson, AZ. She is a graduate of the West Virginia University College of Medicine and is a registered Medical Technologist. When not at work, she loves traveling, taking photographs, watching football and spending time with her two Brittanys.
Barbara Mullarky

Latest posts by Barbara Mullarky (see all)

315x236-Devices-med-iconsThe answer to that question depends on what part of the healthcare continuum you look at. When it comes to the actual treatment of disease, few fields can compare with medicine in terms of developing and incorporating new technology. Think of cyber knives, genetically guided cancer therapies, complex new drugs for autoimmune diseases, and the way that surgery has become increasingly less invasive through its reliance on computer imaging and magnification for micro-, laparoscopic, and robot assisted surgery.

On the other hand, when it comes to the use of information technology, healthcare hasn’t been nearly as forward looking as, say, banking, or travel, or even the food industry. How often have you visited a highly respected doctor, located in state-of-the-art facilities, and had to spend half an hour filling out pages of badly xeroxed forms, asking redundant and often irrelevant questions about your personal health history? How often has a member of your doctor’s staff had to spend the time to call you to remind you of an appointment? How often have you wasted time trying to reach your doctor by phone to ask a simple question about your treatment?

Fortunately, the landscape is changing. The industry is starting to engage patients in new ways, using text messaging, video conferencing, and wearable devices to keep patients actively in the therapeutic loop rather than simply at the passive, receiving end. And it’s about time.

According to Pew research:

  • 88% of Americans use the Internet
  • 73% have broadband service at home
  • 95% of us carry a cell phone of some type
  • 62% of those have used their phone in the past year to look up information about a health condition.

Those numbers don’t surprise me. As I write this, I am sitting in O’Hare Airport and almost everyone in the departure lounge has a smart phone in his or her hand. Urban legend has it that people under 55 like to text while people over 60 prefer to make phone calls, but if O’Hare is any indication, the over-60 crowd is just as tech savvy as the younger generation. They’re checking the airline app—this happens to be a really bad travel day fraught with weather delays—so that they can text their families and friends with updates. In 2013, Exerpian Marketing found that adults over 55 send almost 500 text messages a month. I’m sure that number is much higher today.

So why not take advantage of this in your practice? Phones and texting allow you to engage with your patients in a whole new way. You can text them appointment reminders (my hair dresser has been doing it for years), let them know if your office is closed due to inclement weather, or notify them that it’s time to make an appointment to have their eyes checked.

Mobile devices can also be used as an electronic physician’s assistant, with apps to guide care and improve outcomes. Imagine if patients could log onto an app on their phones that reminded them of exercises they had to do that day, showed a video of how to do those exercises, recorded that the exercises had been done as well as the patient pain level and other progress indicators . . . and then automatically transmitted all of this information to the physician to become part of their charts. And that all this happened without the time and expense of the doctor’s staff having to make personal calls.

Even better, imagine that you, as the patient, could see your doctor without leaving your home or office. While video technology has been around for a long time, traditional physician practices have been slow to adopt teleservices. This is partly because state regulations and reimbursement policies have not encouraged it, outside of the few online physician services offering quick and relatively easy consults on a “pay now for service” basis. However, more and more states are passing legislation that allow doctors to establish provider-patient relationships through face-to-face interactive, two-way, real-time communication, or through store-and-forward technologies. In addition, some of the laws call out payment policies, and require that care provided via teleservices be billed the same as an in-office visit. I’d personally love it if my doctor adopted teleservices—it would save me the 30-minute drive to her office, the 10 minutes spent parking, the 20-minute delay because she is usually running late, and the 30-minute drive home. Instead, her office could text me when she’s ready and we could engage for 15 minutes via a telemedicine system. A lot better than the minimum 90+ minutes to do an in-person visit.

The final frontier is when healthcare manages to combine information technology with its existing drive for advanced treatment technology. One university research team is developing a tracking device that could be embedded in a pill; the device would activate when the patient took the medication, sending a message to a receiver app, which in turn would create a record for family members or physicians to review. This may initially sound a little too invasive, but think of the boon for families caring for an elder relative—they could verify that the correct meds were taken without having to hire an on-site care-giver or to make daily trips to ensure compliance.

What’s common to all these new technologies is that they recognize that the patient is at the center of the care team, and the information the patient provides must be incorporated into the therapeutic process in real time. The sooner we engage patients in their own care, the better outcomes we will all experience—and the technology that we are already using every day can help us get there. Is the healthcare you are providing hi-tech enough? What technology are you using now to advance your patient engagement?

We Must Enable Patients to Become Better Stewards of Their Own Care

Conventional wisdom says that people perform better if they have a vested interest in the outcome of a given situation. From experience, employers know this to be true: Employees who are given an ownership stake in their company historically perform better, and enjoy a higher degree of satisfaction from their respective jobs than do their non-stake-holding counterparts.

Recent research has shown that a similar premise holds true in healthcare as well. The Healthcare Information and Management Systems Society (HIMSS), which has expanded its focus on patient engagement each year states, “Patients want to be engaged in their healthcare decision-making process, and those who are engaged as decision-makers in their care tend to be healthier and have better outcomes.” The most commonly cited technologies hospitals plan to add involve patient-generated health data solutions (2016 HIMSS Connected Health Survey). Generally speaking, the greater the engagement of the patient, the better the results, and information technology (IT) can support improved engagement platforms, such as patient portals, secure messaging, social media and other technologies.Graph

Data underscores importance of patient engagement
According to a 2016 New England Journal of Medicine survey of 340 U.S. healthcare executives, clinician leaders and clinicians at organizations directly involved in healthcare delivery:

  • 42% of respondents indicated that less than a quarter of their patients were highly engaged.
  • More than 70% reported having less than half of their patients highly engaged.
  • And to underscore the importance of this result, 47% of those surveyed revealed that low patient engagement was the biggest challenge they faced in improving patient health outcomes.

In addition, a 2017 U.S. Government Accountability Office (GAO) report recommends that the U.S. Department of Health and Human Services (HHS) “should assess the effectiveness of its efforts to enhance patient access to and use of electronic health information.”

This is not only true for hospitals, but also for specialty care practices, such as orthopaedists, ophthalmologists, dermatologists, gastroenterologists and other high-performance specialists. In these environments, it is imperative that practices understand the very specific needs of their patients, and how to best conduct outreach that will increase patient portal access and engagement.

How has your practice encouraged more patient engagement?

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?

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.