The buzzword of the day is “Value-Based Payment”, and everyone is talking about the transition from volume to value. Recently, Becker’s—the leading source of cutting-edge business and legal information for healthcare industry leaders—interviewed SRS’ Lynn Scheps and Lester Parada as part of an article exploring this very important subject. The article discusses what “value-based” means, how the recently proposed regulations supporting the implementation of the MACRA legislation will impact orthopaedists, and how EHRs must evolve to facilitate practice success in the future. Read Value-based payments are coming for orthopedics: Are you ready?
“Being flooded with information doesn’t mean we have the right information or that we’re in touch with the right people” – Bill Gates
We are able to collect a wealth of information today, thanks to technological improvements over the last couple of years. For a long time, specialists struggled to get the most out of earlier EHR solutions due to the limited data available. This was not so much the fault of EHR vendors but rather of the inherent limitations of the technology at the time. Additionally, the first “templated” EHR systems were specifically designed for primary care and family practice doctors. These systems were not suitable to meet specialists’ different data needs and handle a much higher volume. I did a post recently on the evolution of data capture (read it here).
When it comes to submitting meaningful use data to CMS, however, with all this data available, identifying and collecting it generally takes a long time. There are studies that show an increase in the number of physicians who spend more than one day a week on paperwork, and that indicate many physicians still feel that EHRs do not save time. Although this technology is allowing practices to comply with meaningful use requirements, the cost seems to be too high.
What are we seeing here? Physicians are spending more time capturing data due to regulations, and this is taking up the time available to see patients. How did we get to a point where the physician is spending more time staring at the screen than looking at the patient? I’m not a doctor, but I can imagine that they went into the profession to actually help people as much as they can, so more face-to-face time with the patient is the end goal here.
What is the solution to handling this volume of data? Certainly not reducing the amount of data—it would be hard and time-consuming to distinguish which data to get rid of. The solution must focus on making it quicker to handle this data. This is where free-flow workflow comes into play. Rather than having to go through the laborious process of submitting the data to each application, it essentially reduced the repetitive steps involved, thereby streamlining the submission of data.
This big time saver helps to alleviate the pain, but there are still limitations. Fortunately, we are now at a point where we can get a workflow that isn’t just free-flow, but also adaptive. To find out more about this development and other future trends, you can read our white paper.
The proposed MACRA rule is here. With the goal of changing the way physicians are paid, this rule proposes how CMS intends to move toward increasingly rewarding value—meaning high quality care at a cost-effective price—over volume.
CMS claims that MACRA will simplify life for providers, (although I’m a little suspicious since it took 962 pages to explain the “simplification”). However, there is no question that the world is about to change. These proposed regs are scheduled to be finalized in November and then be effective on January 1, 2017—a rather ambitious schedule which leaves little time for planning your approach to compliance.
While I haven’t read the entire rule yet, MACRA—Medicare Access and Chip Reauthorization Act—provides two paths for physicians and other clinicians. In the long-term, APMs (Alternate Payment Models, like ACOs) will be a popular route—higher risk/higher reward—but for now, most physicians will participate in the MIPS (Merit-Based Incentive Program) option. So let me provide a few teasers about MIPS, as currently proposed:
- If you expected an end to Meaningful Use, PQRS, and the Value-Based Payment Program, you will be disappointed for certain. MIPS just changes the names, rolls them up into one program, and adds (yet another) set of required activities.
- Providers will be scored on a 100-point scale and compared to other providers—this year’s weighting would be 25% MU-type measures, 50% quality measures, a la PQRS, 10% cost, and 15% Clinical Practice Improvement Activities. (The rule spells out how a provider’s score is calculated and the payment adjustment is determined, but you might need an advanced math degree to follow that discussion!)
- MU is now “Advancing Care Information”. It will have fewer required measures (proposing to eliminate CPOE, CDS, and multiple Public Health reporting requirements), no longer be all or nothing, and will provide some choices to clinicians for how they demonstrate success. CQM reporting will not be part of this component.
- Quality measure reporting (like PQRS) will be the bulk of the score, but only 6 measures will be required. Like under the Value-Based Payment Program, performance will count, i.e., impact the provider’s score.
- Assessment of cost will be done by CMS—providers won’t have to report anything. This is similar to how CMS currently attributes a cost factor to providers in calculating the V-BPM.
- The new category, Clinical Practice Improvement Activities, offers providers a choice of approximately 90 activities from which to choose to earn points in that category.
- MIPS would be reportable as an individual provider or as a group.
Stay tuned to EMR StraightTalk for more in-depth analysis of MACRA in upcoming posts. We welcome your initial comments.
We have had a lot of fun here at SRS over the last couple of weeks; don’t worry, we have still been working hard! To clarify, we have been focused on our second annual Hackathon, a collaborative forum designed to innovate meaningful HCIT solutions for specialists.
We brought together our enthusiastic employees throughout the organization as well as select clients to come up with ideas for new and useful innovations. We didn’t simply see this as a side-project; our staff was fully committed to this project, and was working around the clock over the last couple of weeks bringing these great ideas to fruition.
This year’s theme was “Problem Solved”. Cross-functional teams were created and tasked to come up with breakthrough solutions to problems that would affect the patient and/or clinical experience.
Teams were also asked to think from the point of view of a new start-up healthcare IT company and encourage to invent a solution that really responded to a need in the market today from a fresh perspective.
Each team presented their solution’s business case, along with a prototype, video, and supportive marketing campaigns. Judges selected winners, and SRS will be funding development of the innovations that they believe will have the biggest impact on providing better healthcare through technology.
Several of the ideas selected will be showcased in the Innovation Expo at SRS’ annual User Summit. Clients can see future innovations in action and add their feedback at the event. Last year’s expo was one of the highlights of the conference.
We are always looking to hear great ideas, and get very excited during the Hackathon period which allows us to bring together our creative staff and client partners. That is the thing about great ideas; you just never know where the next one will come from! This is the way to come up with solutions that are truly user-centric in design.
Click here to learn more about how we do things.
We all know how increasingly important the patient experience is becoming in clinical trials and healthcare. With more emphasis being placed on quality care and patients’ active participation in their own treatment, it follows that this will have an effect on what solutions and services are required to satisfy consumers in this market. Consumers nowadays have a flood of information available at their fingertips—an amount unimaginable even just 15 years ago. And while the ability to look up symptoms online in the middle of the night has undoubtedly increased the number of hypochondriacs, it has also led to a higher number of truly educated patients, and an accompanying need for specialists to respect and involve them in the diagnosis and treatment process.
But what does it mean to be patient-centric? Our good friend Wikipedia defines it as “support[ing] active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment.” Not much help, is it really?
The Institute of Medicine defines it as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” The difference in definitions seems to come down to how involved the patient gets in their healthcare. The first definition suggests that the specialist is at the center of decision making, but supports the patient involvement as well. The latter, at least in my opinion, implies that the specialist actively collaborates with the patient by empowering them with the necessary data to make their own treatment decisions.
By either definition, however, data capture is currently falling short of what it takes to be truly patient-centric, despite how far it has come over the last decade. Electronic Health Record (EHR) solutions have been widely adopted in a variety of healthcare specializations, and although the way they collect data can create friction and inefficiencies with specialists’ workflow, they still provide enormous benefits. They streamline access for the specialists to vast quantities of patient data more quickly than traditional paper-based systems, and they eliminate need for patients to fill out the same forms again and again at each specialist’s office.
With the power of technology growing at an exponential rate, new technology solutions are coming out every day, but the challenge is to figure out how to use these technologies to address the real problems that medical practices are facing. In other words, to provide the right technology solution, one that really works for practices. At the moment, more often than not, EHR software interferes with and takes time away from the doctor-patient interaction. However, by giving specialists data-capture tools that allow them to focus on their traditional role of caregivers and that reduce the time and energy that is diverted away from patients, everyone benefits: specialists win, and therefore so do their patients.
There are already good vendors out there who are designing solutions with specialists’ requirements in mind, and some of these certainly help to give specialists more time with patients. However, to achieve a truly patient-centric solution, data capture will need to both predict and adapt to the data being fed into it in real-time. This would give specialists relevant, up-to-date information right at their fingertips, which they could use both to inform their own decision-making process and to educate the patient on their particular condition. The result would be a collaborative, evidence-based plan of care that—because the patient had participated in creating it—would lead to an increased patient commitment to the plan and a better outcome overall.
That’s what providing a truly patient-centric solution looks like.
To find out more about the evolution of data capture and what to expect in the future, you can read our recent white paper on this topic.
To learn more, check out our full white paper on the Evolution of Data Capture.
Do you remember the days when cell phones were brand new? I am not referring to the Nokia 3310 (back when all we needed was a single game, Snake – simpler times . . .). I am talking about when they were first launched and introduced. Those were the days when cell phones were only purchased by business people and you could only make calls near a transmitter tower (oh how mobile!). They used to come with big cases, but these were not for the phone itself; their real purpose was to hold the phone’s huge battery! Despite that, the purpose of original cell phones was clear—to make phone calls on the move. Well, so long as you were going past at least one transmitter tower on the way . . .
Fast-forward to today—the cell phone we once knew has completely changed, and along with it, we see a transformation in how people see and use their phones. What used to be their original purpose (making phone calls) has now been virtually replaced by activities such as Internet browsing, checking social networks, shopping, listening to music, and playing games (you can still download Snake, but it’s no longer pre-installed!).
It would probably be more fitting to call them powerful mini-computers; the average smartphone today is millions of times more powerful than all of NASA’s combined computing power in 1969. Smartphones today are even powerful enough to run old Windows operating systems such as Windows 95. Good to know for all those old-operating-system enthusiasts who want a bit of nostalgia on the go.
The evolution of cell phones eventually led to a revolution in the market. The pace at which technology was developing eventually led to the creation of the first iPhone—the rest is history!
So how does the evolution and revolution in cell phones relate to data-capture technology? Just as the first cell phones had only one purpose—talking—data capture nowadays means simply sharing or collecting information. While 1990s-era electronic data capture focused almost exclusively on big data associated with clinical trials such as EDC and electronic patient reported outcomes (ePRO), it was eventually adapted for private medical practice. Over the years, the opportunities afforded by electronic data capture have grown, partly because of healthcare costs.
However, although these first digital data-capture systems offered some relief to physicians and other users, they were still time-consuming and cumbersome, creating more productivity issues than they solved. What was meant to save time actually had the opposite effect; while the new systems were being introduced, they actually resulted in physicians seeing fewer patients.
Back then, these solutions were designed for primary-care physicians. Specialists, who needed to maintain smaller sets of data, found that these first digital systems did not take their specific needs into account. What specialists required was a solution that would allow them to see many patients without sacrificing data quality and regulatory compliance. Fortunately, there were a few vendors who had the insight to rise up to the challenge and help to solve these specialty-specific problems.
To find out more about the evolution of data capture and how EHR solutions are becoming revolutionary—like smartphones—read our recent whitepaper on this topic.