Financial/Revenue Cycle Management

The move toward population health and alternative payment models has seen providers embracing innovative approaches to care delivery, including significant investments in health information technology, according to the spring 2016 Economic Outlook survey from Premier. The study – which polled health system chief executive officers, chief financial officers and chief operating officers – found the requirements of the Affordable Care Act and the demands of population health management leading to big changes in care processes. Most notably, Premier found that the expansion and integration of post-acute care networks is a major priority, cited by 95 percent of C-suite respondents as a key area of focus over the next three years. At the same time, almost as many execs said that project is the biggest challenge their health systems will face in the coming years. "As healthcare continues to transition from an acute-care hospital focus toward an integrated system of providers, the creation of high-value post-acute care networks is essential for success within alternative payment models, such as bundled payment programs and accountable care organizations," Premier COO Michael Alkire said in a statement. Health IT, of course, is an essential enabler to this task, and 84 percent of respondents indicated that technology continues to represent a place for significant capital outlay. Still, challenges remain. More than two-thirds (68 percent) of respondents said their health systems are successfully accessing data from the ambulatory EHRs of their employed physicians. But barely one-third (38 percent) said that they're successfully accessing data from affiliated or non-employed physician networks. "Many affiliated practices lack the proper incentives to invest in high-cost data sharing agreements and interoperable interfaces. We urgently need public policies that require health IT interoperability standards so that providers can access data from any system," said Alkire. Interestingly, one area that's often overlooked with regard to pop health is one that's also ripe for innovation, according to Premier: the supply chain. Many providers are running disparate software systems to track procurement, accounting and contract management, according to the report – leading to "system-wide blind spots" that can hamper efficiency efforts. The expansion of affiliated practices have only complicated matters, according to more than half of poll respondents. "By marrying all the functions associated with purchasing across the continuum on a single IT platform, materials managers can close gaps and generate the significant savings needed to succeed in the new world of payment reform and cost cuts," said Alkire.

Some experts are predicting a spike in denials beginning on Oct. 1, 2016 when the Centers for Medicare and Medicaid Services will require claims to be more specific. Forward-looking providers are assembling teams to prepare now. 

Family Medical Specialists in Florida is using care management technology to get paid under CPT code 99490, and the practice has already gotten buy-in from almost every eligible patient.

Advanced analytics and machine learning technologies are critical to pinpointing problems in large datasets that could be losing providers money. That’s why some organizations are investigating every single denied claim to better understand trends. 

Hospitals are starting to hire younger, more diverse people to handle the new coding. The shift will likely benefit healthcare organizations in time, but it won’t happen overnight.  

Analysts say that with less focus on meaningful use and ICD-10 settling down, many healthcare organizations are turning their attention to revenue cycle technologies amid the shift to value-based care.

Looking into its crystal ball – or perhaps digital spreadsheets – PiperJaffray analysts see big plays in the RCM market. That potential is so large, in fact, that Cerner alone has a $40 billion opportunity, and it ranks fifth in market share.

Caleb Anderson says changing payment models are likely to make hospital executives rethink revenue cycles, and consider outsourcing services to Cerner or one of its competitors, including athenahealth, eClinicalWorks, NextGen, Conifer and others.

Arguing that too many well-meaning providers are facing financial penalties from meaningful use, the American Hospital Association called on the Centers for Medicare and Medicaid Services this week to offer more flexibility. Specifically, AHA says hospitals that meet 70 percent of meaningful use requirements should be deemed as having complied with the program. With the current "all-or-nothing approach," writes Ashley Thompson, AHA's senior vice president of public policy analysis and development, "failure to meet any one of the requirements under the Medicare and Medicaid EHR Incentive Programs has meant a provider would not receive an incentive payment; more recently, it has meant a provider would be penalized." [Also: Hospitals press HHS on meaningful use] Given the huge complexity and high hurdles of meaningful use, the fact that a hospital missing a given threshold by small amount leads to overall failure is "unfair to providers that make good faith efforts to comply," according the March 22 letter to CMS Acting Principal Deputy Administrator Patrick Conway, MD. CMS has told AHA that it doesn't have the statutory authority to offer anything less than that absolutist approach, according to the letter. But AHA offers a legal analysis that suggests that's not true: "We believe that CMS possesses the authority to eliminate the all-or-nothing approach to meaningful use and that the agency should do so." Among the arguments put forth by CMS for the necessity of an all-in requirement: The law requires more stringent MU measures to improve quality over time; certain measures capture policies, such as health information exchange, that are specifically required by statute; use of a "qualified EHR" must meet all the requirements, not some, in order to meet the law's objectives. The agency has also argued that a more flexible framework wouldn't reduce providers' reporting burden anyway – a contention with which AHA "respectfully disagrees" but points out isn't statutorily binding anyway. "We strongly believe that CMS is not legally required to maintain its  all-or-nothing approach to meaningful use," AHA argues, but instead has "ample legal authority" to adopt a more forgiving approach like the 70 percent threshold it suggests. "This flexibility would support providers who have implemented IT functionality but may not have optimized each function sufficiently to meet the full set of requirements in the EHR Incentive Program in order to avoid a payment adjustment." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

The National Quality Forum has published its guidance for the new Merit-Based Incentive Payment System. NQF's Measure Applications Partnership examined some five-dozen MIPS performance measures, proposed for implementation in 2017, from which data would be collected to track eligible providers' performance in 2019. "As the U.S. healthcare system increasingly shifts to a performance-based payment system, MAP’s role (is to serve) as an impartial advisor bringing stakeholders together from across the healthcare spectrum," NQF’s chief scientific officer Helen Burstin said in a statement. To that end, MAP offered some suggestions to the U.S. Department of Health and Human Services for better aligning with multiple federal healthcare programs, namely the Medicare Shared Savings Program. [Also: Meaningful use will still be part of MIPS reimbursement, CMS official says] Chief among those was that aligning of measures should be a top priority, and not just for MIPS programs and alternative payment models, but across all federal programs and with states and the private sector where possible. Indeed, NQF found that gaps still exist across clinician-level programs – most notably in patient-centered areas such as patient-reported outcomes, functional status and care coordination. These measures should go beyond patients' experience with the healthcare system to the impact of healthcare on patients' health and well-being. Meanwhile, MAP urged continued exploration of the impact of socioeconomic status and other demographic factors on measure results, noting that the program should be taking into account when providers are caring for high-risk populations. NQF also weighed in on measures for public reporting on CMS' Physician Compare website. With regard to those most useful for consumers and patients, MAP expressed a preference for those focused on care coordination, population health, appropriate care and on outcomes – especially those that are patient-reported. Twitter: @MikeMiliardHITN