The growing emphasis on value-based care means doctors need detailed patient data for reporting purposes. However, physicians often lack the ability to obtain it. In some cases, the technology exists but practices can’t afford it, while in others, the lack of interoperability among electronic health records (EHR) prevents physicians from accessing the data they need to report treatment and outcomes.
The data doctors need are trapped in various systems across the healthcare landscape as patients move from provider to provider. Tracking down what care each patient has received and getting that data into the primary care physician’s system is a labor-intensive process that takes time and focus away from patient care.
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“The hardest thing is the redundancy,” says Nick Beechnau, DO, a primary care physician in Ravenna, Michigan. “Once you get the information from someplace else, you often have to hand input it into your system. For a lot of things like colonoscopies or pap smears, even if it’s in your electronic health record, you have to report it separately to payers to get full reimbursement.”
About 50% of his payers require some type of data to get reimbursement, and the information they want is always changing. “We absolutely expect more payers to continue to want more data for reimbursement,” he adds.
The biggest value-based care program and driver of data collection is the Medicare Access and CHIP Reauthorization Act (MACRA). Physicians with more than $90,000 in Medicare Part B charges or more than 200 Part B beneficiaries must participate in either the Merit-based Incentive Payment System (MIPS) or as an Advanced Alternative Payment Model.
There are 271 quality measures under MIPS, and doctors must choose six to report. Private payer value-based models vary widely, but like MACRA, typically require the collection and reporting of data.
But even when physicians can get the information they need, it’s often in a format that is unusable or takes a lot of time to dissect, says Keith Aldinger, MD, a Houston-based endocrinologist. After a patient’s two-day hospital stay for chest pain, Aldinger requested the patient’s data. “They sent me 75 pages of digital dysentery,” he says of the report generated by the hospital’s EHR system. “There were redundant pages listing every vital sign. It takes time to go through it and it didn’t have what I needed.”
Naresh Rao, DO, a primary care physician and sports medicine doctor in New York City, is participating in value-based contracts and has encountered problems with how data gets attributed. “Patients coming in purely for sports medicine are counted toward my primary care setting,” says Rao. “They list me as their primary care physician even though I only saw them once for a sports-related back issue. If they go out of network or have expensive procedures done, it’s counted against me.”
These data issues leave doctors in the lurch, experts say, raising the question of whether they can access the information they need for value-based care reporting.
“The government is blind to the facts and pushing ahead with value-based care,” says Aldinger. “Interoperability isn’t there. They need to hit pause, get the interoperability there and then proceed. There’s no reason to keep pushing this.”