To balance priorities, consider the 2014 requirements
PaykocHealthcare organizations know all too well the challenges of balancing capitated services and government incentives for meaningful use (MU) and ICD 10. For optimal revenue recognition and patient outcomes, organizations must ensure that reimbursements, contracting, physician services, administration, and billing are precisely aligned. Added to this burden, the latest changes to MU2 create another layer of complexity organizations must address in the year ahead.
For integrated delivery networks (IDNs) that provide managed care administration, implementation of the right system requires thoughtful finesse. IDNs must work closely with vendors to ensure their EHR meets the needs of the clinicians, improves patient safety and care coordination, captures and scrubs the correct charge information for payers, while accounting for the latest HIT incentive and payer requirements.
Many of organizations mitigate revenue cycle opportunities and challenges through designated subcommittees. The work of these subcommittees ensures the system will meet payer and government requirements. And, if the subcommittee identifies issues with capturing the right information for payer and government requirements, it can proactively escalate the issue to leadership. Otherwise, organizations may leave money on the table and potentially incur future penalties.
Ideally the implementation and use of EHRs will reduce hospital costs and increase patient safety. By following MU recommendations for medication management, for example, hospitals will likely see a reduction in adverse drug events (ADEs). It is estimated that over 770,000 people in the U.S. are injured or die each year in hospital from adverse drug events, ultimately costing up to $5.6 million each year per hospital. While it is unclear if hospitals have capitalized on these savings, the numbers are compelling.
According to an estimate published by Health IT.gov, the cost of purchasing and installing an electronic health record ranges anywhere from $15,000 to $70,000 per provider. For an IDN that tried to implement three different system, that equates to $450,000 to $2.1 million for each full installation (with roughly 300 providers). Debt of this magnitude cannibalizes any benefit of aligning with EHR incentives and creates an absolute need to recoup the initial investment.
To balance your priorities, consider the 2014 requirements. >>>
Three-month reporting period
All providers are now required, regardless of their stage of MU, to demonstrate MU for a three-month EHR reporting period. Medicare providers may elect to report clinical quality measures (CQMs) for the entire year or select an optional, three-month reporting period for CQMs that is identical to their MU reporting.
Exclusions and vital sign objectives
All eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs), are now responsible for adhering to the latest changes in MU1. This includes new requirements for electing exclusions toward menu objectives, age limits for recording and charting changes to vital signs, and new exclusions toward reporting height, weight, and blood pressure.
Objectives to view, download, and transmit all health information or admissions online
To better align with the new capabilities of certified EHR technology, CMS is replacing MU1 objectives for accessing information online with the capacity to view, download, and transmit this information.
Reporting of CQM
All providers, regardless of their stage of MU, must report on clinical quality measures to CMS. Eligible providers must report 16 of the 29 CQMs and eligible providers must report 9 of the 64 CQMs.
System alignment may seem insurmountable, but the slow and diligent work builds a foundation to grow and achieve greatness.
Carrie Yasemin Paykoc, MBA-HA, MS, is a senior instructional designer at The Breakaway Group, A Xerox Company, which provides a research-based approach to expedite end-user adoption that allows for healthcare professionals to quickly adopt new technologies.