For decades, interoperability has been a dirty word for hospitals and health systems. No matter how much they have worked at it, paid for it, and thrown IT resources at it, return on investment has been difficult to prove. This has been especially true when executing a community physician alignment strategy to expand care collaboration with unaffiliated physician groups to drive new referrals and revenue into the hospital.
The first step in many physician alignment programs is to formalize partnerships, acquire outside practices, or set up community physicians on the same instance of the hospital’s electronic health record (EHR) platform. Accountable Care Organizations (ACOs) and the Centers for Medicare & Medicaid (CMS) Bundled Payments for Care Improvement (BCPI) program have promoted business models to help expand value-based care with the goals of increasing care efficiency and profitability. In some cases, these regulatory changes and commensurate technological innovation have made it possible for systems to realize new revenue, help to drive clinically integrated networks, and achieve Medicare Shared Savings in the millions of dollars per year.
But, even the most integrated systems have large numbers of primary care providers (PCPs), specialists, and other outside practices for which these options are not practical. To succeed, hospitals need to do a great job of communicating with outside physicians, commit to meeting physicians ‘where they are,’ and make sure the hospital or system is the easiest choice to work within their community. These objectives should be met while accommodating the often modest IT resources or different EHR vendors in use in outside practices.
For example, it is more important than ever to automatically send every outside physician meaningful and timely notifications about their patient’s emergency department (ED) visit or inpatient stay. These should not be spartan “check the box” notifications, which are often only a few lines of text with minimal clinical or demographic information. The outside physician and administrative team should get the precise information needed about the patient encounter to continue treating the patient without any burdensome technology changes or costs. The same is true for empowering the recipient to respond and contribute to care planning while leveraging their existing clinical and clerical workflows.
The state of health IT has progressed so that hospitals have practical solutions to reach virtually every outside provider with notifications, send complete or partial medical records, consult summaries, and physician messages. However, even with incredible new technological possibilities, how can today’s hospital IT groups justify the cost, especially in the shadow of the clinical, financial, and operational impacts of COVID-19?
Three broad categories create financial upside for hospitals looking to extend interoperability, including:
– Regulatory incentives
– Operational offsets and efficiency
– Reputation and revenue gains
Improved interoperability will also yield strategic and patient quality improvements, but these can be more challenging to measure in the short term.
Regulatory Incentives
Over the past 20 years, regulation has been met with mixed results. Meaningful Use brought a financial windfall to the industry to implement EHRs, but most hospital systems have now entered the penalty phase under the updated Promoting Interoperability (PI) program. If your hospital still has incentives to gain, look for them. If not, you may be facing penalties in the year ahead, and the penalty for not achieving PI interoperability goals can be substantial—as much as 2-3% of last year’s Medicare reimbursement.
Despite nearly universal EHR deployment, fax continues to dominate healthcare communications so the most problematic PI criteria for many hospitals have been implementing Electronic Referral Loops. Successfully meeting this requirement garners up to 40 of the 50 points to satisfy PI, and third-party provider directories and other technologies can quickly increase certified digital information exchange with outside practices. Cloud-based solutions in particular are more cost-effective to implement and don’t require point-to-point integrations that were once necessary to exchange data between EHRs or facilities. This doesn’t just improve compliance and help your hospital avoid a hefty penalty; it can be the cornerstone of your strategic and business value enablement.
The eNotification component of the CMS Interoperability and Patient Access Rule is due on May 1, 2021, for most hospitals. You can choose to “check the box” by leveraging sparse, incomplete methods through your HIE or EHR or consider looking for a solution that delivers notifications to every provider (including those in other states or on another EHR). Some even include collaboration capabilities that support your long-term physician alignment strategy. If you are trying to woo community providers, the CMS Final Rule serves as the perfect opportunity to expand your reach with better data sharing in a recipient-friendly format.
Operational Offsets & Efficiency
Most health systems can identify plenty of financial offsets and demonstrable efficiencies to justify expanded community provider engagement with interoperability programs. Once these technologies and processes are up and running in hospital customers, we typically see numerous legacy processes and tools that are no longer useful or can be scaled back — phone calls and faxes among them!
By far, the greatest operational burden on IT groups is the variety of manual processes needed to maintain current engagement workflows. Consider the amount of time your team spends updating the EHR Provider Directory, handling faxed-based referral processes, dealing with fax and direct messaging failures, maintaining portals for outside providers to request medical records, coordinating complex cases with outside providers, and more. I am often stunned to learn the many dozens of people who are often involved in keeping these legacy processes running.
Reputation & Revenue
Community physicians are the lifeblood of almost all hospitals. When they have a positive experience with your facility, easily receive the information they need and get good feedback from their patients, they are more likely to refer to your facility again. In short, the most compelling value of community physician alignment is about accelerating your organization’s leadership and revenue growth. The right interoperability investments flow straight to the bottom line, improve patient care quality, and improve both patient and physician satisfaction at once.
At your facility, consider the impact of the following when making a case for interoperability spend:
– Significantly slashing referral failures and their associated revenue and patient care risks
– Increasing testing and specialty services utilization by community providers
– Reducing medical record requests from outside practices
– Supporting virtual care programs with timely post-visit data sharing
– Measurable decrease in physician frustration and burnout
– Eliminating CD-burning to share image files
– Increasing patient satisfaction when the hospital and PCP share their medical record, images, and lab results seamlessly
Treating community physicians as the equal care partners they truly are, especially by sharing relevant and timely patient information, will return big dividends. If outside providers can easily receive and reply to information from your EHR and both their clinical and clerical staff can meaningfully communicate with their peers in your organization, you will realize the true intent of healthcare interoperability.
About Dr. Peter S. Tippett
Dr. Peter S. Tippett is CEO of careMESH. He is a physician, scientist, business leader and technology entrepreneur with extensive risk management and health information technology expertise. One of his early startups created the first commercial antivirus product, Certus (which sold to Symantec and became Norton Antivirus). As a leader in the global information security industry (ICSA Labs, TruSecure, CyberTrust, Information Security Magazine), Tippett developed a range of foundational and widely accepted risk equations and models.
Tippett is board certified in internal medicine and has decades of experience in the ER. As a scientist, he created the first synthetic immunoglobulin in the lab of Nobel Laureate Bruce Merrifield at Rockefeller University. His PhD in Biochemistry (Case Western Reserve University) included among the first computer modeling of biologic processes. He also holds a B.S. in Biology from Kalamazoo College.
