Treating the Old Wounds of Transition to Advance Value-Based Care

Elizabeth Gardner


ARRA. HIPAA. Meaningful Use. Value-based Care. MACRA. And so it goes…The only thing certain about today’s healthcare industry is that it will continue to evolve. In the last few years we’ve seen the industry navigate through the challenges of achieving meaningful use, pivot to value-based care and now enter the ever-intimidating, somewhat ambiguous world of MACRA. Only the strong survive. Merger and acquisition is pervasive. And, somewhere, under all of it, still lies the heart and purpose of the transformation – the patients. The patients who for so long, have so desperately hoped that after all the talk of change and all of the chaos of transition, they would ultimately be able to consistently access timely, high quality care at an affordable price.

Unfortunately, nothing about any of this is simple. While providers move to deliver on value-based care and, now, MACRA requirements, they must also continue to tackle the multitude of symptoms and ailments created by the speed of transition. First and foremost, change is not cheap – particularly when you consider the fact that providers are still working to optimize reimbursements under the new value-based care model. The cost of doing business for healthcare providers is increasing while the reimbursements realized are declining. That means in order to roll out the process and system enhancements required to shift to value-based care and deliver on MACRA reporting requirements, providers must employ strategies to free up and reallocate large sums of resources and budget from other areas of the business.

Additionally, there are significant improvements to be made in the space of data integrity and usability. Keep in mind, only a few years ago the industry made the mass move to the EMR. The transition happened in a short period of time given the complexity of the feat. Data capture processes where not standardized and EMR systems were not fully mature. So while providers might have made the transition deadline, they are now stuck managing the errors and efficiencies that are inherent in the adoption of any new process or technology. This is specifically apparent in the Enterprise Master Patient Index (EMPI), which lies as the heart of effectively reporting on value based care initiatives. Like any manual process, the capture of patient information is subject to human error. Something as simple as a name change due to marriage or divorce could result in the creation of a duplicate patient record. Inconsistencies also emerge when changes to patient information are made in a single system but are not propagated or replicated across all systems. In either scenario, providers are left with incomplete or inaccurate information – and this challenge is only further compounded by merger and acquisition activity. According to a study done by AHIMA, the average duplicate rate hovers around 8% while in MPI databases with more than 1 million records the rate increases to 9.4%. Considering MPI errors inhibit a provider’s ability to track a patient’s treatment across the continuum of care, negatively impact the reliability of the information and, in turn, increase the risk of unnecessary treatment and test duplication, these error rates are highly concerning. In short, EMPI errors drive up the cost of care and down the quality of patient outcomes which is the opposite of the intent of value based care. So, while the expense of clean-up might be high, doing nothing is far more costly – and risky.

Unfortunately EMPI, though used as an example, is just one of many foundational elements wherein gaps, inaccuracies or inefficiencies have emerged as a result of or throughout the transition process. The full spectrum of processes that govern the integrity, accessibility,usability andsecurity of data across all critical information sources and types needs to be addressed. Yet, due to the resource constraints of today’s environment, many providers succumb to the pressure to simply “bandage” these gaps and press forward, foregoing the deployment of a proactive, enterprise-wide governance strategy . This is approach is short sighted. As you know, you can bandage up a cut but if you haven’t treated the source of the infection; you’ve only compounded the problem. Similarly, the untreated “wounds” left in the information governance framework of many providers will result in an “infection” that becomes increasingly more pervasive, painful and costly to treat as the years progress. This puts us right back to where we started. Nothing about any of this is simple. In this case, however, it seems the best approach mirrors the advice providers so often give their patients, “for optimal outcomes practice preventative care and early intervention.”

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