As Medicare and private payers move toward more value-based care reimbursements, physicians need information to both accurately report data and monitor complex patients across multiple providers.
As Medicare and private payers move toward more value-based care reimbursements, physicians need information to both accurately report data and monitor complex patients across multiple providers. But with interoperability still years away, doctors often struggle to get the information they need. Physicians face many challenges when it comes to tracking quality data and finding solutions for getting the information needed even when technology isn’t compatible.
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Medical Economics spoke with Jay Anders, MD, the chief medical officer at Medicomp Systems, a technology company that provides medical data solutions, about the challenges doctors face in tracking data across the healthcare industry and sorting through it once they have it.
Jay Anders, MD
Medical Economics: What are the biggest technological challenges facing physicians at smaller practices as the industry moves toward value-based care and the data tracking/reporting it requires?
Jay Anders: Physicians are struggling to figure out how to manage the vast amount of data being dumped on them, thanks to the “success” of interoperability initiatives. Advancements in technology have made it easier to exchange clinical data, and, providers are now more willing to share data because value-based care models incent well-coordinated care. However, many physicians, especially those in smaller practices with more limited resources, have very few tools to efficiently organize the data into actionable information that enhances patient care.
Physicians are also being asked to track and report on more and more clinical measures, many of which change regularly to address the latest regulatory and reimbursement requirements. Each time a new initiative is introduced, doctors must adjust their workflows and perform additional tasks that are disconnected from everything else in their workflow. Despite the existence of tools that could improve workflows efficiencies, many practices do not have the financial resources to invest in these technologies. As a result, many physicians end up spending more time figuring out how to fulfill reporting requirements than they do delivering patient care.
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ME: What are the obstacles to tracking patient data when a medically complex patient is crossing through various doctors’ offices and health systems?
JA: Today healthcare has an abundance of clinical data on patients, thanks to the widespread adoption of electronic health records (EHRs). Despite the wealth of data, however, physicians often don’t have ready access to the right data at the right time for good clinical decision-making. Interoperability advances are making it easier to share data across doctors’ offices and health systems, but too often the data in sent in chunks that must be manually interpreted and organized by the receiving provider.
We now need technologies to help providers take their highly disorganized incoming data and format it in such a way that makes it easily searchable and available to clinicians at the point of care. One way to do this is to leverage technology that intelligently identifies, interprets, and links medical concepts and maps them to standard nomenclature, such as ICD-10, SNOMED, RxNorm, and LOINC, and then enables them to filter and see the lab results, medications, orders and co-morbidities for a specific diagnosis.
Next: Will doctors ever see true interoperability?
ME: Interoperability is important, but doctors are frustrated with the slow progress. Will doctors ever see the day when all their EHRs can “talk” to one another and will it deliver on its promises?
JA: True interoperability will be difficult to achieve unless the industry embraces well-defined standards. That being said, we are getting closer, thanks to the wider use and acceptance of FHIR, CDA and other standard terminologies. However, we must remember that “talking” is just noise unless both parties are able to hear and interpret what is being said.
Having the technical ability to send data between systems is only the first step. Next, we need to format the data so that it is easy for recipients to “hear,” interpret, and apply to the correct patient. At a minimum, the data must be coded to a usable standard so it is more easily assimilated to existing information and made actionable at the point of care. Also, when creating new data through the documentation process, physicians need tools that facilitate the capture of high-quality data in structured formats are easily exchanged and interpreted with minimal manual intervention.
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ME: With the current state of technology and interoperability, what are some ways physicians can obtain the data they need to successfully participate in value-based care programs, such as the Merit-based Incentive Payment System (MIPS)?
JA: Physicians participating in value-based programs such as MIPS must track and report on clinical quality measures (CQMs) in order to achieve financial bonuses and avoid penalties. Most of the 271 possible CQMs in MIPS require clinical decisions that are best made at the point of care.
In order to comply with MIPS quality reporting without sacrificing physician productivity, practices need to incorporate clinical decision-support tools within their EHRs. The tools should support the integration of CQMs and be readily available at the point of care and within physician workflows. They should work behind the scenes and automatically monitor quality compliance, identify which CQM requirements are being met, and advise the clinician of potential care gaps. By leveraging such technology, physicians can take immediate action at the point of care and ensure successfully participation in quality-reporting programs.
Next: Is MIPS fair to doctors?
ME: Is it realistic for the government to expect the necessary data tracking and reporting for MIPS when the technology is still not optimized to do so?
JA: The short answer is no. This has been a long-standing issue with many government programs. When we think back on Meaningful Use and its iterations, the program was revised and delayed multiple times until a workable structure was identified. I believe the same will happen with the MIPS program. Technology exists today to help providers comply with the new reporting requirements, but EHR vendors have been slow to offer innovative solutions that make it easier for providers to achieve regulatory compliance.
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From a clinical standpoint, it’s very hard to criticize MIPS’s quality measures in terms of being medically appropriate and aligned with best practices. However, it’s unrealistic to expect physicians to comply with these new regulations without updated technology. We need to close the current technology gaps before providers are required to link a significant amount of their practice income to the MIPS program.
Jay Anders, MD, is the chief medical officer for Medicomp Systems.