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Value-based Care to Test Small, Rural Provider HIT in 2017

Having a better understanding of the challenges associated with the transition to value-based care will help these small and rural providers in 2017.

Value-based care for small, rural providers

Source: Thinkstock

By Joncé Smith

- While healthcare providers are reaping major benefits from technology such as EHR systems, the new year is also bringing significant attention to the technology-related challenges faced by smaller, rural and often more isolated, healthcare providers in the midst of the national shift toward value-based care.

A recent Government Agency Office (GAO) report details many of these challenges in its attempt to underscore a lack of preparation among small and rural medical organizations for the movement away from traditional, fee-for-service medicine. Small and rural facilities are significantly less prepared for value-based care models than their urban counterparts and must climb an uphill battle as financial and staffing resources limit patient care capabilities, according to the report.

Fortunately, alongside the challenges of shifting healthcare environments, the new year also presents an abundance of opportunities for providers in small towns all over America. Having a better understanding of the transitional issues can help these providers maximize opportunities, and be better prepared for the year ahead.

Financial constraints

One of the biggest challenges among small and rural practices is the lack the financial resources to upgrade to newer, better EHR systems or to optimize existing systems to achieve health IT interoperability. Financial limitations also hold these medical practices back from taking on the initial downside risk of some Medicare value-based reimbursement programs or the investment responsibilities necessary to meet reporting and data sharing requirements.

A lack of resources to fund health information technology upgrades has also stymied clinicians in their ability to participate in the cost of EHR data sharing with outside systems. Considering the potential of an Affordable Care Act (ACA) repeal and possible implications upon the Medicare Access & CHIP Reauthorization Act (MACRA), healthcare providers may worry about unpredictability in payment models and their ability to recuperate investment.

Staffing limitations

On top of the financial constraints, small and rural health providers have a harder time maintaining and educating staff.

With limited staff, practices do not have the resources to pull individuals away from their usual duties to focus on EHR and application training, not to mention take on the cost of outside training aide. Without education, practices will continue outdated fee-for-service care and inefficient workflow patterns. In turn, they will not optimize their EHR system and collections processes, streamline data entry, or manage and analyze data for quality measures.

Keeping staff employed at small and rural practices can also be problematic. These practices struggle to retain staff when competing against the lure of large healthcare systems. Geographic location limits patient engagement and population health management as well, as patients are less likely to complete wellness visits and other health maintenance steps when they have to commute long distances or have more limited access to physicians. 

Patient engagement

Financial and staffing limitations that strain small and rural clinical practices also ripple into patient interactions and wellness care. A recent Black Book survey found that in small hospitals with 200 beds or less, 92 percent of patients discharged didn’t understand engagement tools and monitoring systems, compared to 55 percent of large hospitals which include patient portal orientations at discharge.

This is alarming, considering that 57 million Americans live in rural areas of the country, according to the American Hospital Association, and depend on hospitals to give them as much direction as possible with regards to their care.

The survey also revealed, alarmingly, that 92 percent of nurses felt they lacked time and resources required to implement proper patient technology literacy. Discharge or appointment follow-up miscommunication, limited physician interaction from EHR input and health IT security concerns have all widened patient mistrust as well.  Nearly 60 percent of patients are skeptical of health technology, including portals, mobile health apps, and EHRs, while almost all are concerned with their health information being shared with retailers, employers and the government, the study revealed.

A high level of skepticism may contribute to inaccurate population health management. While the survey included feedback from providers at all types of hospital settings and their patients, 89 percent of patients reporting to withholding information from providers last year alone. In this cycle of miscommunication, patient distrust in healthcare IT has jumped from 10 percent in 2014 to 70 percent now.

Building back patient trust

While patients who rely on small and rural medical clinics and hospitals may feel reluctant to utilize tools, such as portals, or feel wary of health IT capabilities and security, a growing number of positive developments in health IT have the potential to change the course of medicine for patients and most isolated practices:

Mobile health:. The use of mobile health apps doubled from 2013 to 2015, according to a 2016 PwC, and is expected to grow in 2017. These apps can help medical groups improve outreach and patient engagement efforts, and keep patients out of the hospital.  In addition, 60 percent of patients reported willingness for physician video visits, while 81 percent of clinicians said mobile health information access helps better coordinate patient care. M-health capabilities can expand small and rural providers’ impact on patient follow-up care and wellness decisions for improved care delivery.

Telemedicine: Congress’ 2016 passing of the Expanding Capacity for Health Outcomes (ECHO) Act is another positive step for remote and rural health providers to offset development and staffing limitations. The act expands Project ECHO’s model to pair academic medical specialists with primary care providers through virtual clinics for mentoring with behavioral and population health management. Proven through several academic studies, Project ECHO’s model mitigates rural physicians’ feelings of isolation through cost-effective access to specialty care best practices.

Interoperability: Small and rural health providers are often at the mercy of their EHR vendors in terms of willingness and capability of data sharing. With the passing of 2016’s 21st Century Cures Act, the federal government has now clearly defined data blocking and its commitment toward holding the private sector accountable for transparency in healthcare IT. This puts pressure on vendors to enable interoperability, which better connects small and rural providers for better patient care and safety across patients’ medical journeys.

MACRA: As physicians across the country still lack understanding of MACRA, small and rural providers have no time to waste in comprehending reporting requirements, along with exceptions, to maximize reimbursement opportunities. For example, those participating in Medicare Part B for the first year are exempt. Many small practices who charge $30,000 or less under Medicare Part B or those who provide care for 100 or fewer Medicare patients per year are exempt. Given the option of Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS), most small or rural providers will fall under MIPS. However, they have flexibility in reporting with a test pace, for a partial year or full year of data for neutral (at test pace) or positive payment adjustment of four percent for 2017. In addition, Congress will provide $20 million a year for technical assistance to practices with 15 or fewer eligible clinicians participating in MIPS.

While challenges for small and rural providers continue in the new year, 2017 will also bring numerous opportunities. Understanding and monitoring each of these hot topic health IT developments will better prepare small and rural providers for the changing healthcare landscape in the transition toward value-based care.

About the author

Joncé Smith is Vice President of Revenue Management at Stoltenberg Consulting.



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