Electronic health records (EHR) play a critical role in tracking patient-recorded outcomes and demonstrating improvement over time. These benchmarks are first and foremost important for use as Clinical Quality Measures (CQMs) under the Medicare Access and CHIP Reauthorization Act's (MACRA) Merit-Based Incentive Payment System (MIPS). Practices that qualify for MACRA/MIPS are obligated to identify and track six CQMs. These quality measures are used to evaluate a practice's eligibility for value-based incentive reimbursements. Practices that demonstrate value to patients receive incentives in the form of higher Medicare reimbursement rates.
In other words, any practice that currently qualifies for MACRA/MIPS is, in essence, a VBC healthcare provider. These practices need an EHR system that simplifies quality tracking – for example, by storing Patient Health Questionnaires (PHQ-9) and other patient health improvement measures . This information, along with other data that demonstrates better healthcare outcomes, will be pivotal for practices as they shift toward value-based reimbursement models.
Ultimately, value-based reimbursement isn't just about tracking the quality of healthcare; it's about identifying opportunities to improve that quality.
A best-in-class practice management solution enables more than one way to contact patients about scheduling, appointment reminders and other forms of outreach, by using multiple channels such as secure messaging, texts and automated phone calls. It will also provide an online patient portal that makes it easy for patients to become more involved in their healthcare without ever leaving the house. For instance, patients should have the means to update critical information, such as symptoms, insurance information, demographic data, and past medical, family and social history. They should also be able to submit appointment requests, keep credit card data on file to simplify payments and receive electronic statements.
The combined effect of these practice-manager functions is better overall engagement and, in that same vein, better patient care.
Revenue cycle management (RCM) is a crucial element of transforming to a value-based reimbursement model, as payments are increasingly dependent upon demonstrable clinical outcomes and not just services rendered. This presents a critical challenge to independent practices and further underscores the need to accurately track quality measures. What's more, practices don't simply treat patients in a VBC mode - they manage those patients' healthcare. This distinction invariably influences coding for services rendered, which introduces yet another layer of RCM complexity; practices now need to be exceptionally precise as they document CPT and ICD codes. They don't want to miss reimbursement opportunities, but they also don't want to introduce financial risk in the form of more denied claims.
It's also worth noting that value-based care requires strong coordination. Billing and coding teams need to be well-aligned with providers as well as the operational elements of practice management to ensure that quality measures are properly correlated with reimbursement opportunities. This requires strong data management resources such as those referenced above (e.g., practice management solutions and EHR), and streamlined cross-department coordination.
At the end of the day, every component of a practice is influenced by the transition to VBC. Many processes will need to be fine-tuned or even re-engineered. That said, most of these processes in some way fall into one of more of the above four categories. At a high level, dividing VBC transformation into four core components can make the undertaking much more manageable.
Learn more about how AllMeds' can help your practice's transition to VBC, click here to contact us today.