Healthcare Reform & Technology:

Positioning Your Practicefor the Future

Presented By:

Maureen West McCarthy, CPA

Snyder Cohn, PC

Jonathan KrasnerBEI (Business Engineering,

Inc.)February 28,

2012

The Reform Landscape Improved Outcomes

Reduced Cost (ACOs, Shared Savings)

Readily available (and usable) information Health Information Exchange (HIE)

Provider to Provider Patient to Provider

The Reform Landscape Engage patients in their treatment Patients responsible for their own

health More direct costs borne by patients Emphasis on preventative medicine

and wellness Patient Centered Medical Home

(PCMH)

Ultimately…. Change in the Way Providers are Reimbursed

Fee for Service Quality Based Payments?

Capitation for a full range of services?

Hybrid? (i.e., fee for service with quality based incentive)

Models are still being worked out and tested;

however FFS will not continue indefinitely.

What is an ACO? Accountable Care Organization Payments based on outcomes For larger organizations, but

small practices can participate. Outcomes adjusted for patient

panel Every major carrier has an ACO

model

* The American Recovery and Reinvestment Act (ARRA), and specifically the Health Information Technology for Economic and Clinical Health Act (HITECH) provisions have resulted in an intense focus on the use of technology in the healthcare setting.

* EHRs are the “foundation” for outcomes measurements.

The ‘carrot’ = Stimulus $$ for Meaningful Use of Certified EHR Technology

The ‘stick’ = Medicare penalties starting in 2015 for

NON-adoption and Meaningful Use of EHR

Medicare Meaningful UsePhysician payments are 75% of Medicare allowed chargesPenalties – reduction in physician fee schedule10% increase in incentives if physician practices in a designated health professional shortage areaAt the Secretary’s discretion, Medicare payments can go down as much as 5% in 2019 and beyond

CMS has reported that over 176,000 eligible professionals and

hospitals have registered to receive stimulus money. $2.5 billion was

awarded in 2011.

‘the train has left the station’

We believe ……

THE PRIVATE CARRIERS WILL FOLLOW SUIT.

Outcomes-based payments can’t realistically be measured and

determined using paper records.

What Can Physicians (Ideally) Expect with EHR Use?

Improved Efficiencies (i.e., ‘real time’ info sharing and updating of patient charts)

Fewer Medical and Rx Errors

Improved care coordination and ability to make quick, informed decisions (emergencies)

What Can Physicians (Ideally) Expect with EHR Use?

A more automated, streamlined practice.

EHR and Billing System Integration:

Complete charge capture (services and tests performed)

Coding documentation

Reduction in staff time for data entry

Increase in speed of payments

Cost Benefits of EHR: Less storage costs (medical records)

Reduction in number of staff (after full implementation and training – might take a few years)

Reduction/elimination of transcription costs

Using an EHR: Data vs. Information

Data is information in raw form.

Information is processed data that is usable in decision making.

With EHRs, we often have too much data BUT want and need information.

Using an EHR: Data vs. Information

Make sure your EHR is providing

you with information and not just data.

Evidence-Based Care: Ability to report system data for specific

population/illnesses/conditions

Use of shared data to determine optimal treatment (i.e., what has worked and what has not for patient populations)

Disease Management & Care Coordination

Evidence-Based Care: Reporting of quality metrics (generated

by EHR) to CMS and carriers

Higher utilization of ‘best practices’ (i.e., a patient with a given condition receives the same treatment, regardless of the setting)

Engaging Patients:

Assisting patients in becoming more knowledgeable and informed about their care.

Patient portals Automated phone and text reminders Customized patient education Personal Health Records (PHRs)

Transitioning to EHR: Design processes around new technology and

continually build on them (not a ‘one-time’ event)

Staff training and implementation plan

Define and put ‘rules’ in place

Need ‘buy-in’ from all users (especially physicians) in order to be successful

Why Else Purchase an EHR?

Attract new physicians

Makes a practice more marketable

Makes a practice more valuable

Attract patients

Beware…… Choose the right system for your practice

and specialty

Fully understand the system Software capabilities Maintenance and support agreements (additional

training included?)

Beware…… Compliance with privacy requirements

Use templates carefully (do not over-rely on them)

Increase in payor audits

Other Technologies to be Adopted in 3 – 5 Years:

Remote monitoring (with integrated data feeds to EHR)

Tele-medicine iPAD, Skype Already in use in direct pay relationships Especially used in Primary Care/PCMH

In Conclusion: The cost of healthcare is driving change.

Medicare Trust Fund going bankrupt.

Payment methodology is moving away from standard fee for service.

Technology (EHR) is the only realistic way to measure outcomes.

In Conclusion: Many benefits come with the use of technology in a

medical practice.

There is a push for more patient involvement in care.

Position your practice to benefit from these changes.

Any Questions?