5 Ways Affordable Care Act Affects Reimbursement


The Affordable Care Act (ACA) enters the mature phase of its implementation, which is going to impact physician revenue in different ways – some favorable, others not much. Therefore, it is time for physicians to prepare for challenges ahead.  Here are 5 ways that the ACA will impact your income in the years to come.

Extra services covered in insurance

According to the ACA, more services will be covered by insurances that were not covered previously. This step has gained immense support because “patients who have insurance and access to primary care have better health outcomes,” said Jeffrey Cain, MD, President of the American Academy of Family Physicians (AAFP).

Now patients won’t have to pay from their pockets for medical services like blood pressure checkup, mammography, childhood and autism screenings, and contraception.

CureMD- Affordable Care Act

Increase in patient volume

More and more Americans will be insured in the years ahead and looking for primary and eventually specialty care. This means primary care practitioners can now enroll new patients bringing more money. However, most of these patients will come from low-income families, who will be insured on subsidized rates and pay out of pocket.

Increase in out-of-pocket payment patients

Practitioners will be forced to rethink their patient payment policies because of changes in the ACA that will increase the trend of out-of-pocket charges. Kaiser Family Foundation found out in a survey that 72% of employees had a deductible for single coverage, which was 20% more from 2006. It further reported that annual deductible for 72% of employees was $1,097 in 2012, which was 88% higher since 2006.

Rise in penalties will impact reimbursements

CMS incentive programs, Meaningful Use and Physician Quality Reporting System (PQRS), will reduce or stop payments from 2015. Meanwhile, physicians who haven’t complied with the programs will bear financial penalties.

From fee-for-service to pay-for-performance model

Accountable Care Organizations (ACOs) are a breath of fresh air for the physicians trying to decrease cost without compromising quality. This new payment model, pay-for-performance, was introduced to maximize the benefits for patients to improve quality of care while reducing costs. However, as the Model matures, physicians will be required to report their performance to CMS in order to participate in the shared savings.

mHealth: The Way Forward


The rate of development in the mobile technology industry is unparalleled and it is now making headway in the field of health IT. The recent influx of medical professionals adopting the latest sophisticated tools to enhance care delivery and engage patients has meant that consumers now expect technology to simplify everything.

Healthcare providers are not the only ones looking to accept these technological advances, as their patients are demanding mobile applications to monitor their own health. Mobile health or commonly known as mHealth refers to the practice of medicine, public health surveillance and patient engagement through mobile devices such as tablets, phones etc. This can provide a means for care givers and patients to access clinical records from anywhere, patients able to request prescription refills or appointments and most importantly the ability for patients to monitor their health constantly and from anywhere in the world.

In a recent hearing launched by the Subcommittee on Communications and Technology, Jonathan Spalter, chairman of Mobile Future, an organization that represents innovators across the wireless community said, “Nowhere is that promise of future innovation and opportunity greater than mobile health. Our message today is that the innovation and vision exist now in both the medical and technology communities working together collaboratively. This progress will proceed, in many respects, as rapidly as government allows.”

The mobile health market is expected to reach around $26 billion by 2017. According to a recent report, there are close to 100,000 mobile health applications and more in development by well known health IT vendors. Not only are there a number of mobile phone applications for patients but there are many in the making for healthcare professionals.

The Manhattan Research Survey estimates that in 2012 there were approximately 75 million users of Mobile Health or mHealth, who not only searched for health related issues on their mobile phones through popular search engines, but also actively used mobile phone applications to monitor and improve their health. In the same report, it was stated that almost half of the older population (55 plus) were using mobile devices to search for health related issues.

Electronic Medical Records or EMRs were originally built to be run on devices which were platform specific. This has changed with the rapid development and commercial use of technological innovations. Web-based EMRs have now allowed doctors to be truly mobile and can run on any platform or device; whether it be a computer a standard office computer, a laptop, tablet or a Smartphone. Although the demand for mobile-health solutions is increasing, some in the healthcare community remain skeptical about the implementation of such solutions.

David Levy, MD, global healthcare leader, PwC says, “Despite demand and the obvious potential benefits of mHealth, rapid adoption is not yet occurring. The main barriers are not the technology but rather systemic to healthcare and inherent resistance to change. Though many people think mobile health will be ancillary or bolted on to the healthcare industry, we look at it differently: mHealth is the future of healthcare, deeply integrated into delivery that will be better, faster, less expensive and far more customer-focused.”

There are always obstacles for any potential technology to fully integrate with and possibly overtake current technological systems, but there is no denying that mHealth is the way forward for the healthcare industry. A recent study undertaken by PwC shows that a majority of consumers predict that in the next three years, mHealth will vastly improve the quality, cost and convenience of the entire care delivery process.

 

Medical Device Interoperability


Medical devices are of paramount importance to patient care and well being such as the equipment used for clinical measurement, for instance x-ray imaging, temperature, blood pressure and critical life support. Although we depend heavily on modern medical equipment to treat patients, the devices used in practice are usually not interoperable and cannot connect with other devices. This inadvertently causes accidents which may easily be prevented through an interoperable network of devices.

In a traditional intensive care unit, patients are given treatment with the help of numerous devices such as ventilators, electrocardiographs and vital sign monitors. Most of the time, the manufacturers are different for each of these devices, which makes it harder for these devices to be integrated accordingly.

According to a report by the World Health Organization, there are approximately 1.5 million various medical devices in more than 10,000 different types of device groups available globally. These devices are instrumental for effective prevention, diagnosis, treatment and rehabilitation of diseases, and can be used in different settings such as clinics, hospitals and homes by patients, individuals and healthcare workers. They can also be integrated to a cloud Electronic Medical Records network which can make it easier for healthcare providers to record and monitor the performance of these devices.

Peter Pronovost, MD, Medical Director for the Center for Innovation in Quality Patient Care at John Hopkins University sheds some light on the reasons we need interconnected medical devices. “Medical devices need to share data, so that they can better inform clinicians and help patients,” said Mr. Pronovost. “By doing so, we can both improve quality and reduce costs.”

Similarly, a report by Deloitte states that 61% consumers are interested in using a medical device for checking their condition and electronically share that information with their healthcare providers through the use of technologies such as the EMR or Patient Portal.

medical devices

Through the use of medical devices integrated with Electronic Medical Records, precious lives can be saved. For example, surgery procedures require surgical instruments and radiotherapy units are required to treat cancer patients. In the example of a cancer patient, an infusion pump giving pain medication to the patient can share and exchange data with the vital signs monitor to ensure that the patient is not being given a higher dose.

Joseph M. Smith, MD, Chief Medical and Science Officer of San Diego-based WHI said, “We see an enormous opportunity to use information technology and device innovation to bring about the much needed transformation in healthcare delivery.” He further added, “Today’s hospitals are filled with medical devices that are unable to share critical data, creating potential dangers to patients, as well as inefficiencies that put a tremendous financial burden on our healthcare system.”

 

EMR Implementation – The Expert Advice (Part 1)


With the government’s initiative to take healthcare into the new era of technology, practices of all sizes are vying to make the transition from paper to electronic documentation. For any practice seeking to make this conversion, a thorough analysis of their operations is required in order to assess how the implementation of an EMR solution should begin. Various operational aspects of the physician’s office have to be factored in prior to the beginning of the EMR implementation phase. Ray Parker, an EMR implementation specialist at a major health IT organization, gives us his take on the subject matter explaining the approach that practitioners should take in order to ensure a smooth execution of the system within their offices.

First and foremost, general practitioners and specialists alike have to identify the specific needs of their practices, while fully comprehending the reasons for conversion from paper to electronic medical records or a switch to a different EMR vendor. They have to ask whether they are looking to expedite documentation and reporting, and whether their existing solution inadequately equipped to handle these needs. Regardless of the motives driving physicians towards adoption, their eventual goal may well be common i.e. complying with Meaningful Use measures. If they are conforming to the standards set by CMS, the practice efficiency and expedition of operational processes is expected to improve by leaps and bounds. A significant determinant while finalizing your selection of the vendor should be the qualifications of the vendor organization (with special emphasis on the quality certifications) and subsequently judging the capability of the vendor in terms of meeting your practice requisites.

During the process of ascertaining the clinical and administrative requirements of the practice, some fundamental questions need to be answered and communicated with your vendor. For instance, how many clinicians are based within the practice, the workflows they follow, how many staff members need access to the system and what will be the corresponding training requirements etc? The practice has to be prepared beforehand to convey the entirety of its needs to their chosen service provider preceding a demo of the vendor system. For example a practice might want to stop getting paper faxes and want to receive their faxes electronically instead, or a practice may want to opt for an electronic lab interface with a local lab company. To help the vendor understand specific practice requirements, it’s very helpful to ensure that providers share their existing clinical data templates and specialty specific workflows before scheduling a demo with the vendor.

With respect to implementation, it’s of utmost significance that communication between physicians and vendors is crystal clear regarding data preservation requirements of the practice. Keeping into mind the legal ramifications of maintaining historical data (which varies from state to state), a provider has to aptly determine how much data has to kept and migrated. The vendor must be able to meet these necessities or propose appropriate alternatives to avoid unwarranted outcomes. Size and nature of their data plays a huge role at this stage, as clinical and billing data from older/outdated EMRs is very tedious to extract and even more complex to migrate. Apart from the data requisites of the practice, the clinician should also communicate any specific hardware requirements with their vendor. This provides an opportunity to the vendor to deal with any hardware compatibility problems that may arise at a later stage.

SaaS & Healthcare – Where is the link?


We have seen the influx of information technology revolutionize almost every industry over the last few years, with one innovation after another expediting the exchange of information among organizations and individuals. The same holds true for the healthcare industry, where the term health IT has dominated discussion between physicians, hospitals and government funded institutions. The rate of innovation in health IT has been incredible, especially with the advent of Cloud-based Electronic Medical Records (EMR) and Health Information Exchanges (HIE). These new solutions have helped providers escape the barriers of traditional server based technology and be connected with their patients from virtually anywhere in the world.

Today, mobile technology is paving the way for the future of affordable and accessible care delivery. Physicians have always looked for ways to respond to the needs of their patients quickly even from outside of their offices. SaaS EMR(s) and online Patient Portals have made this possible, as physicians are able to access the medical records of their patients directly from their cell phones, tablets and laptops. However, many physicians across the nation remain unaware of the functionality and benefits of SaaS EMR(s) or why it has become so popular.

The influence of SaaS upon the healthcare continuum is evident once we take a closer look at solutions such as EMR, practice management, patient portals. SaaS allows for a pay as you go service, where the data captured at the provider’s practice is stored on virtual servers outside of the physician’s office. This means that via SaaS, providers no longer need to maintain hardware equipment or perform data backup.Subscription fees are usually paid on a monthly basis, while customer support is usually available round the clock.

As with other innovations in technology, drawbacks and concerns always emerge after implementation. In this case, the primary risk of implementing SaaS in healthcare is the potential threat to safety and integrity of sensitive patient information.The long term preservation and confidentiality of this datais the responsibility of the respective SaaS EMR vendor. Most SaaS vendors today assure their clients of the safety of their information by complying with strict HIPAA guidelines. There are additional guidelines outlined in the Meaningful Use program by the CMS, thanks to which SaaS in healthcare will experience a 20% growth by 2017.

Providers must ensure their due diligence when choosing a SaaS health IT solution. The vendor must assure the provider of their compliance with HIPAA and other information security standards such as ISO 27000 etc. Providers should ideally request their vendor for copies of recent audit reportsalong with the any information security certifications before making their final decision. In light of the aforementioned characteristics of SaaS and health IT, it is easy to construe that providers looking to go paperless at this stage must give preference to Cloud technology over traditional server based technology. This will ensure the long term viability of their health IT investment.

 

Practice Management Software – Modernizing Practice


Swift health information exchange is the need of the hour in the healthcare sector, with most doctors converting to electronic documentation with EMRs. With clinical documentation and health information exchange taking precedence, doctors have little time to focus on office administration and profitability. However, established EMR vendors now offer the perfect solution for such practices in the form of “all-in-one” software packages. These packages provide practice owners with a single solution accommodating clinical documentation, office administration, scheduling and billing along with advanced reporting capabilities. Without the need to run two separate software (EMR and Practice Management), these competitively priced packages reduce acquisition cost and provide better value.

With health IT adoption on the rise, there are now hundreds of vendors in the market trying to capture their share of the care community. This has meant that vendors are now looking to offer greater value to their clients, in an attempt to stay ahead of competition with offerings such as the aforementioned “all-in-one” software packages. Standalone practice management software (PMS) is by no means a new concept in healthcare. However, it’s recent popularity can be directly attributed to the government’s backing of electronic health information processing and dissemination.

As EMRs deal with the clinical operations within a practice, PMS simplifies administrative tasks such as scheduling, monitoring appointments, follow ups, insurance verification, billing and reporting etc. With the right amount of training, practice staff can accomplish routine tasks much faster, with less errors and duplication. The right solution can ensure better coordination between clinicians and their staff to improve the overall efficiency of the practice – saving time and money for patients and physicians. Furthermore, the incorporation of features such as OCR (optical character recognition), online insurance eligibility verification, text messaging (alerts and reminders) and data mining reports etc., has drastically improved practice profitability and eliminated redundant workflows in small practices.

Fortunately for providers, not all among their staff can access sensitive patient information or the billing information related to the practice. Role based access and audit trails prevents unauthorized staff access, while allowing administrators to restrict individual users in the practice from accessing any one or multiple patient charts. In light of the aforementioned characteristics of “all-in-one” health IT solutions, providers now deem it more beneficial for their EMR to be integrated with practice management software. Providers looking to start their journey towards a paperless office must ensure that the practice management capabilities of their chosen solution are not overlooked. As a consequence, their health IT investments will generate greater value and returns, while guaranteeing peace of mind in years to come.

 

EMR and Practice Management – Changing the Dynamics of Healthcare


The introduction of interoperable health IT solutions had a significant impact on the entire healthcare industry. All conventional rules of medical practice were modified and providers across all specialties strive to stay in business with the ever changing regulations and new health standards. The adoption of EMR in the healthcare sector was a game changer, as conventional methods of storing, retrieving and documenting clinical data became obsolete overnight. The potential benefits of EMR technology were the major reason behind the introduction of Meaningful Use incentives for providers – helping promote widespread adoption.

EMR adoption was on the rise, but so was the increase in provider specific requirements, often based on specialty and practice setting. It has taken a while for the physician community to fully utilize EMR technology, as initial EMR solutions were limited in functionality and usability. The rising patient volumes and pressure from insurance companies, and other regulatory bodies meant that physicians now needed to accomplish a lot more clinical documentation whilst complying with the administrative and security requirements. This led to the integration of EMR systems with Practice Management software. Standalone practice management solutions existed before the introduction of EMR technology, but with the advent of interoperable “all-in-one” solutions rendered such standalone systems redundant.

This meant that EMR vendors now focused on amalgamating their systems with practice management software to retain market share. For clinicians, the appeal of reduced hassle with the integration of practice management was a better option that ensured optimum financial and clinical performance. Subsequently, physicians could now focus on patient care without having to worry about increased office administration.

With the number of vendors rising by the day, EMR and Practice Management technology is rapidly evolving – with specialty specific EMR systems now making their presence felt. Healthcare professionals are no longer satisfied with basic EMR functionality and thus look for a solution that caters to their specialty specific clinical content and workflows. As the care continuum strives for improved clinical outcomes, it would require a great deal of effort from vendors and providers to help develop solutions that meet their specialty requirements.