Healthcare // Electronic Health Records
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5/12/2011
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What's The Quality Of Your Healthcare Quality Reporting?

As pay-for-performance programs take center stage, you'll need expert data-gathering skills to get fully reimbursed.

No one ever said that data gathering for healthcare quality reporting would be easy. Fact is, it's usually time-consuming and tedious. Almost as much fun as cleaning out your file cabinet.

Vendors can supply a variety of tools and services to ease the pain, but until practices switch to electronic medical records, the work involves lots of paper cuts. Still, it's a necessary part of a medical practice. For instance, in accountable care organizations, which were recently established under healthcare reform, clinicians can share financial rewards from payers, but only if they improve patient care and outcomes and reduce costs. Top-notch quality-of-care reporting will be essential for an ACO to prove it has reached the necessary performance benchmarks needed to get these incentive payments.

And even if your facility is not part of an ACO, the bar will be raised. You will have to meet a variety of patient quality standards as the Centers for Medicare and Medicaid Services and private insurers transition from traditional pay-per-service to new pay-for-performance reimbursement programs.

Insurers Share The Pain

Health plans need to gather quality related data about patients from doctors and hospitals in the plans' own efforts to report on their performance. About 90% of the country's health plans report on their performance using the National Committee for Quality Assurance's healthcare effectiveness data and information set, or HEDIS, care measurements. HEDIS offers 75 measures, including the care of specific groups of patients such as those who have had heart attacks and patients with chronic conditions like diabetes and asthma. Among other things, the HEDIS measures look at whether those patients are receiving recommended tests, treatments, and other care linked to better outcomes.

Health plans have traditionally used their HEDIS performance measures to self-examine areas they need to improve, such as whether member patients are receiving recommended preventive care services.

The health plans also report their HEDIS information to employers who regularly shop around for the best health plans to offer their workers. Similarly, consumers can access HEDIS data from the National Committee for Quality Assurance through its annual State of Health Care Quality reports to see how plans stack up.

Another challenge facing health plans: Under healthcare reform, they will soon need to meet certain clinical standards to be part of new health insurance exchanges from which the uninsured will be required to purchase health coverage if they're not eligible for public health programs like Medicare or Medicaid, or if their employers don't offer health insurance.

To report their HEDIS performance measures, health plans must first retrieve, collect, and extract records data from the healthcare providers who actually care for these patients. Health plans want to know, for instance, if the doctors in their plans are providing older patients with cancer screenings and pediatric patients with childhood immunizations.

With health plans being judged for their performance in providing their members with coverage for these care services, the health plans will in turn put pressure on their participating doctors and hospitals to deliver recommended care services that have been linked to better patient outcomes. But as already mentioned, collecting and gathering this data for reporting purposes today isn't easy for the health plans or the healthcare providers they work with.

Why? It gets back to the paper cuts: "A majority of healthcare providers still use paper or only have partial EMRs," said Amy Rees Anderson, CEO of MediConnect Global, a company that provides medical record retrieval, digitization, and management services.

MediConnect assists health plans in gathering large volumes of healthcare providers' paper and electronic records to extract data used for HEDIS reporting.

The company retrieves paper and electronic records from healthcare providers, then makes digitized versions of the information available to health plans in a workflow system. Health plans can securely access the information via a portal, and the data can be extracted and entered into HEDIS reporting forms.

These services simplify work that often involves health plan workers making on-site visits to healthcare providers' offices to gather data from paper charts Anderson said.

As more healthcare providers transition to e-health records and roll out data warehouses containing patient information, collecting data for reporting should get easier.

But maintaining momentum of healthcare providers meaningfully using e-health records--including for reporting purposes--might get difficult once the HITECH Act's $27 billion incentive program ends in 2015, Anderson said. At that point, some health plans and insurers may be inclined to reward healthcare providers with small financial incentives per claim just to keep the doctors using the EHRs and, in turn, making reporting a bit easier, she said.

In the meantime, some medical practices are already tackling quality initiatives and performance reporting in a serious way with the help of business intelligence software and digitized patient records.

Digitalized Practices Take The Lead

South East Texas Medical Associates, a 29-physician practice in Beaumont, Texas, rolled out IBM Cognos BI tools about two years ago to analyze data from patients' e-health records as well as to glean insights into the care its clinicians provide and the outcomes of individuals with chronic illnesses. The tools also enable the practice to audit and adhere to HEDIS and other quality care measures on a daily basis.

"Get started; no matter how long you plan or analyze, you will always find new ways of improving care," said Dr. James Holly, the practice's CEO.

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