Healthcare Reform & Technology: Positioning Your Practice for the Future

1. Healthcare Reform & Technology: Positioning Your Practice for the Future Presented By: Maureen West McCarthy, CPA Snyder Cohn, PC Jonathan Krasner BEI (Business Engineering, Inc.) February 28, 2012

2. The Reform Landscape • Improved Outcomes • Reduced Cost (ACOs, Shared Savings) • Readily available (and usable) information • Health Information Exchange (HIE) • Provider to Provider • Patient to Provider

3. The Reform Landscape • Engage patients in their treatment • Patients responsible for their own health • More direct costs borne by patients • Emphasis on preventative medicine and wellness • Patient Centered Medical Home (PCMH)

4. Ultimately…. Change in the Way Providers are Reimbursed • Fee for Service Quality Based Payments? • Capitation for a full range of services? • Hybrid? (i.e., fee for service with quality based incentive)

5. Models are still being worked out and tested; however FFS will not continue indefinitely.

6. What is an ACO? • Accountable Care Organization • Payments based on outcomes • For larger organizations, but small practices can participate. • Outcomes adjusted for patient panel • Every major carrier has an ACO model

7. * The American Recovery and Reinvestment Act (ARRA), and specifically the Health Information Technology for Economic and Clinical Health Act (HITECH) provisions have resulted in an intense focus on the use of technology in the healthcare setting.* EHRs are the “foundation” for outcomes measurements.

9. The ‘carrot’ = Stimulus $$ for Meaningful Use of Certified EHR Technology

10. The ‘stick’ = Medicare penalties starting in 2015 for NON-adoption and Meaningful Use of EHR

11. Medicare Meaningful Use • Physician payments are 75% of Medicare allowed charges • Penalties – reduction in physician fee schedule • 10% increase in incentives if physician practices in a designated health professional shortage area • At the Secretary’s discretion, Medicare payments can go down as much as 5% in 2019 and beyond

12. CMS has reported that over 176,000 eligible professionals and hospitals have registered to receive stimulus money. $2.5 billion was awarded in 2011.‘the train has left the station’

13. We believe ……THE PRIVATE CARRIERS WILL FOLLOW SUIT. Outcomes-based payments can’t realistically be measured and determined using paper records.

14. What Can Physicians (Ideally) Expect with EHR Use? • Improved Efficiencies (i.e., ‘real time’ info sharing and updating of patient charts) • Fewer Medical and Rx Errors • Improved care coordination and ability to make quick, informed decisions (emergencies)

15. What Can Physicians (Ideally) Expect with EHR Use? A more automated, streamlined practice.

16. EHR and Billing System Integration: • Complete charge capture (services and tests performed) • Coding documentation • Reduction in staff time for data entry • Increase in speed of payments

17. Cost Benefits of EHR: • Less storage costs (medical records) • Reduction in number of staff (after full implementation and training – might take a few years) • Reduction/elimination of transcription costs

18. Using an EHR: Data vs. Information • Data is information in raw form. • Information is processed data that is usable in decision making. • With EHRs, we often have too much data BUT want and need information.

19. Using an EHR: Data vs. InformationMake sure your EHR is providing you with information and not just data.

20. Evidence-Based Care: • Ability to report system data for specific population/illnesses/conditions • Use of shared data to determine optimal treatment (i.e., what has worked and what has not for patient populations) • Disease Management & Care Coordination

21. Evidence-Based Care: • Reporting of quality metrics (generated by EHR) to CMS and carriers • Higher utilization of ‘best practices’ (i.e., a patient with a given condition receives the same treatment, regardless of the setting)

22. Engaging Patients: Assisting patients in becoming more knowledgeable and informed about their care. • Patient portals • Automated phone and text reminders • Customized patient education • Personal Health Records (PHRs)

23. Transitioning to EHR: • Design processes around new technology and continually build on them (not a ‘one-time’ event) • Staff training and implementation plan • Define and put ‘rules’ in place • Need ‘buy-in’ from all users (especially physicians) in order to be successful

24. Why Else Purchase an EHR? • Attract new physicians • Makes a practice more marketable • Makes a practice more valuable • Attract patients

25. Beware…… • Choose the right system for your practice and specialty • Fully understand the system • Software capabilities • Maintenance and support agreements (additional training included?)

26. Beware…… • Compliance with privacy requirements • Use templates carefully (do not over-rely on them) • Increase in payor audits

27. Other Technologies to be Adopted in 3 – 5 Years: • Remote monitoring (with integrated data feeds to EHR) • Tele-medicine • iPAD, Skype • Already in use in direct pay relationships • Especially used in Primary Care/PCMH

28. In Conclusion: • The cost of healthcare is driving change. Medicare Trust Fund going bankrupt. • Payment methodology is moving away from standard fee for service. • Technology (EHR) is the only realistic way to measure outcomes.

29. In Conclusion: • Many benefits come with the use of technology in a medical practice. • There is a push for more patient involvement in care. • Position your practice to benefit from these changes.

30. Any Questions?