Medicare reimbursement rejected – 5 essential prerequisites for success in the new world of health care

One of the many challenges that doctors face this year is the transition from volume-based payment to value-based payment. The Medicare Access and CHIP Re-Authorization Act, also known as MACRA, replaces the current Medicare reimbursement plan, service fee, with a new value-based care framework focused on quality, value and accountability. This transformation is the most important effort across the industry as it will impact millions of healthcare providers across the country.

MACRA offers two reimbursement star models, Advance Alternative Payment Models (APMs) or the Merit Based Incentive Payment System (MIPS). The MIPS model is an incentive model that consolidated three existing Medicare quality programs into one. Many independent medical practitioners will choose MIPS because of its incentive benefits and potential to increase net sales through payment adjustments that, in some cases, reward value in primary care rather than volume.

With such a dramatic change, independent medical practice asks: What can we do to thrive under this new value-based care approach?

In this article, I present some tips to help with solo and small healthcare in how to better use information technology tools under the value-based care framework. In addition, we look at how we can improve financial performance while reducing overall costs.

5 tips for small independent approaches to success

1. Robust investment in analysis to predict resumes.

Understanding the patterns in your data allows you to act on trends before they become cost-derivative issues.

For example, by analyzing data on patients being treated. Small practices can more easily mark patients who are likely candidates for readmission. Then tailor patient engagements and interactions specific to these patients. From there, they make quality improvements that can lead to better clinical outcomes. The cost of investing in a population health management solution can help create greater savings in overtime.

Remember, the only way to report these results – and get paid for the service you provide – is through quality data. Look for an IT solution such as a public health management system to help deliver the quality data you need.

2. Allow patients to take control of their own health

Independent health practices should focus on the specific characteristics of their communities to move towards a quality-driven model. Strategies that personalize delivery and allow patients to take better control of their own health are most likely to succeed.

For example, a physician serving a predominantly Hispanic population may consider developing diabetes prevention programs. These programs could focus on helping to limit the spread of the disease.

Developing such programs can help small independent approaches to better define information technology tools. For example, data-driven tools. These tools provide insight into cost and quality metrics and provide the data needed to make care decisions that are consistent with effective clinical practice. This can improve service delivery and greater value-based results.

3. Provide continuous access to mission-critical systems and data

No matter what size your organization is, no organization can afford downtime. In healthcare, system failure costs more than money. They can cost lives. When the flow of data is disrupted, the impact is viral and affects the patient’s health and safety, internal processes and revenue.

High availability is no longer a nice to have, it is a must have. In all industries, high availability (HA) is measured in nine. “One nine” refers to 90% system uptime, “five nine”, a standard reference point, refers to 99.999% uptime. Downtime occurring during the peak hours of patient care will have a greater impact on your organization than downtime occurring during off-peak hours.

For high availability configurations, your IT needs to ensure that there are no disruptions in the flow of data and that patient and administrative functions are performed according to standards. High availability for healthcare services should:

  • Allow scheduled system maintenance and upgrades without interruption in service

  • Responses to unplanned system shutdowns

  • Scale to meet your volume requirements

  • Reduce the burden on your internal IT resources

  • Apply fault tolerance and automatic fault detection

  • Provide 99.999% uptime

Solo and small health practices, which have previously considered downtime as inevitable or necessary evil, need to adapt to increase accessibility requirements. As the amount of cross-border information exchange increases – so will the amount of revenue lost per year. Second of downtime, too.

4. Make alliances to help meet claims and maximize payments

A good way to help maximize payments under CMS payment policy is to form an alliance with another healthcare organization. The right alliance can help meet the demands of payers and patients to deliver quality.

Given the key role that technology plays in today’s health is environment, you must carefully consider the IT implications of any new alliance before entering the partnership. Considerations that can help ensure a successful clinical partnership include:

Give a premium on sharing – Many organizations have different technologies that need to work together. Invest in integration platforms that make connections almost seamless that can streamline and simply share information.

Insist on interoperability. Many organizations have invested in EHR or EMR technology. Forcing alliance partners to change technologies for the sake of uniformity only creates more confusion and disruption. Implementation of an integration model that allows information to be used meaningfully in different clinical systems will increase interoperability.

5. Secure your data

Healthcare data is the new frontier for aggressive hackers seeking an easier and more lucrative way to perform identity theft. The estimated cost of a health care breach is quantified at $ 200 per person. Patient record. This does not include lost business and financial resources. Keeping your applications, patient data and system secure will help maximize your payments during CMS.

When it comes to health care data, you can never be too sure given the facts. Here are steps you can take now to help you practice securing your data better:

  • Recognizes that changes in policies must come from the top tiers of an organization

  • Rate the Rs 5 in your security strategy: risk, redundancy, replication, recovery and responsibility.

  • Review and update your HIPAA compliance regularly. Achieving HIPAA compliance also increases your cyber security.

Between reduced reimbursements and the transition to value-based care, sole and independent healthcare providers face increasing pressure to reduce healthcare delivery costs. In order to protect margins, it is necessary to manage business operations more efficiently

Value-based care equation

The holy grail of achieving optimal value-based care is finding cheaper ways to provide optimal care in a lower cost environment that is also available. More specifically, small independent health organizations will need tools that allow them to measure their outcomes, to thrive in an era of value-based reimbursement.