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MACRA Raises Need for EHR Optimization, Other Improvements

With the final rule for MACRA looming, healthcare organizations and providers have work to do with EHR optimization and other clinical optimization projects.

By Kyle Murphy, PhD

Imminent changes to care delivery and reimbursement under the Medicare Access and CHIP Reauthorization Act (MACRA) heighten the need for EHR optimization and other improvements for providers to remain successful in value-based care, according to a new Impact Advisors report.

Under the legislation (and the forthcoming rule), Medicare providers must choose between the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs) to avoid reductions in reimbursement, the authors note.

In order to succeed in a value-based reimbursement environment, healthcare organizations and provider should consider changes to their operations, several of which focus on EHR use and health IT infrastructure.

One such change entails improving EHR efficiency.

"With providers having more and more to do during an office visit, including everything from preventive care, chronic disease management, capturing quality data, filling care gaps and adequately documenting for both clinical care and billing purposes, it is imperative to the success of healthcare organizations to make provider use of EHRs efficient," states the Impact Advisors report.

Many of these inefficiencies, the authors claim, stem from a lack of EHR optimization efforts following an EHR implementation.

"Most organizations have done little since EHR implementation to actually improve provider efficiency in the system," they continue, "but going forward there will need to be considerable focus on specialty-specific build, minimizing clicks, making quality measure documentation streamlined and intuitive, and presenting providers with feedback in the form of performance dashboards."

The solution comes in the form of increasing EHR usability, and one such feature is clinical decision support systems.

"Clinical decision support is all about driving the right information to the right caregiver at the right time to help them make the right decisions," the authors maintain. "A strategy for knowledge management becomes critical for success in the new paradigm, as does presenting the knowledge in ways that drive correct behavior without interrupting workflows."

EHR technology in particularly and health IT more generally will have roles to play in supporting care coordination efforts of providers:

Certainly one of the key strategies for success in a value-based payment environment is IT-enabled care coordination. This includes predicting readmission risk and providing targeted transitional care to reduce readmissions for diseases like Heart Failure, COPD and Asthma…IT tools are necessary to drive successful care coordination but they aren’t enough. There must also be focus on developing efficient, team-based care workflows to maximize fulfillment of care gaps.

Although not mentioned specifically, the Impact Advisors report emphasizes the importance of improving the patient experience by facilitating a consumer-centric approach to information access, scheduling, and other activities.

Improving the provider experience likewise has benefits for healthcare organizations and involves a health IT component.

"What today’s providers want is to be able to maximize their time spent in patient care and improvement in work-life balance," the authors claim. "That means they need to minimize the time it takes to document their care, and EHRs need to support care activities. Key focus areas for provider engagement are improving usability and documentation and ordering efficiency, improving aggregate views of relevant patient information and clinical decision support optimization."

According to the report, time is of the essence.

"With rapid escalation of value-based payment looming on the horizon, health systems can’t wait to change," the authors advise. "Preparations need to start now, and there needs to be ongoing commitment to clinical transformation for the long term. Organization that fall behind now will have a difficult time catching up and are likely to find themselves on the losing end of the value-based payment spectrum."

Other clinical optimization activities include standing up analytics infrastructure, managing consolidation, reducing variability in care, improving the revenue cycle, and improving the quality and safety of care.




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