Medicare Reimbursement Declined – 5 Essentials for Success In The New Healthcare World

One of the many challenges physicians are facing this year is transitioning from volume-based payment to value-based payment. Medicare Access and CHIP Re-authorization Act also known as MACRA replaces the current Medicare reimbursement schedule, fee-for-service, with a new value-based care framework that’s focused on quality, value and accountability. This transformation is the most important industry-wide effort that it will impact millions of healthcare providers across the nation.

MACRA offers two reimbursements path models, Advance Alternative payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). The MIPS model is an incentivize model which consolidated three existing Medicare quality program into one. Many independent medical practice will opt for MIPS due to its incentivized benefits and potential to increase net revenue through payment adjustments, that in some cases, reward value in primary care rather than volume.

With such dramatic change, independent medical practices are asking: What can we do to thrive under this new value-based care equation?

In this article, I present some tips to aid the solo and small healthcare practices on how to better utilize information technology tools under value-based care framework. In addition, we look at how to improve financial results, while reducing overall costs.

5 Tips for Small Independent Practices to Succeed

1. Robust investment in analytics to predict re-admissions.

Understanding the patterns in your data allows you to act on trends before they become cost-draining issues.

For example, by analyzing data information about patients being treated. Small practices can more readily flag patients that are likely candidates for readmission. Then tailor patient engagements and interactions specific to these patients. From there, make the quality improvements that can lead to better clinical outcomes. The cost of investing in a population health management solution can help to generate higher savings overtime.

Remember, the only way to report on those outcomes – and get paid for the service you provide – is through quality data. Look to IT solution such as a population health management system to help provide the quality data your require.

2. Empower Patients to Take Control of Their Own Health

Independent Health practices should focus on the specific attributes of their communities to move toward a quality driven model. Strategies that personalize delivery and empower patient’s to take better control of their own health are the most likely to succeed.

For example, a physician who serves a predominate Hispanic population may want to consider developing diabetes prevention programs. These programs could focus on aiding in limiting the spread of the disease.

Development of such programs can help small independent practices better define information technology tools. For example, data-driven tools. These tools provide insight on cost and quality metrics, and provides the data needed to make care decisions that are consistent with effective clinical practice.This may improve service delivery and greater value-based outcomes.

3. Deliver continuous access to mission-critical systems and data

No matter what size your organization is, no organization can afford downtime. In healthcare, system failures cost more than money. They can cost lives. When the flow of data is disrupted, the effect is viral and impacts patient health and safety, internal processes, and revenue.

High availability is no longer a nice-to-have, it’s a must have. Across all industries, High Availability (HA) is measured in nines. “One nine” refers to 90% systems uptime, “five nines”, a standard reference point, refers to 99.999% uptime. Downtime that occurs during peak patient care hours will have a larger impact to your organization than downtime occurring in off-peak hours.

For high availability configurations your IT needs to ensure there are no interruptions in flow of data and that patient and administrative functions are being performed according to standards. High availability for healthcare should:

Allow for scheduled system maintenance and upgrades without disruption in service
Respond to unplanned system outages
Scale to meet your volume requirements
Reduce the burden on your internal IT resources
Employ fault-tolerance and automated failure detection
Provide 99.999% uptime

Solo and small healthcare practices that have previously regarded downtime as inevitable, or necessary evil, must adapt to increase availability requirements. As the volume of information exchange across increases – so will the amount of revenue lost per second of downtime.

4. Form alliances to help meet requirements and maximize payments

A great method to help maximize payments under CMS payment policy is by forging an alliance with other healthcare organization. The right alliance may help with meeting requirements from payers and patients for delivering quality.

Given the central role that technology plays in today’s health are environment, carefully consider the IT implications of any new alliance before committing to the partnership. Considerations that can assist in ensuring a successful clinical partnerships include:

Put a premium on sharing – Many organization will have different technologies that need to work together. Invest in integration platforms that make connections nearly seamless, which can streamline and simply information sharing.

Insist on interoperability. Many organization have invested in EHR or EMR technology. Forcing alliance partners to change technologies for the sake of uniformity only creates more confusion and disruption. Implementing an integration model that allows information to be meaningfully used in different clinical systems will increase interoperability.

5. Secure your data

Let Your Body Do The Talking Through Nutrition Response Testing

At its most basic definition, nutrition response testing is a professionally administered battery of tests in which answers to health questions and ailments are sought via the body’s central nervous system. By manipulating the body by way of individual positioning, movements, and other manipulation techniques, the practitioner can then record nervous responses and draw certain conclusions from them. Each response is associated with a particular problem or ailment within a particular part of the body and can thus be interpreted as actionable health suggestions and change.

Administration

Anyone can easily become concerned at the thought of tampering with the nervous system, but this type of test is quite simple and just requires the physical manipulation by the practitioner upon the patient. There are no machines, electrical currents, or adverse effects to then be concerned with. In fact, the patient is sure to be tougher on their body on a typical day than the test practitioner would ever come close to during these simple manipulations.

How, Why It Works

So, how exactly does it all work? To get down to the science of it, one must understand how the central nervous system works. When certain movements or actions take place in a limb or other body part, the nervous system immediately runs its myriad of reporting and communications relays throughout the system. These interactions take place by way of neurotransmitters, axons, neurons, and dendrites all working in tandem to assess and communicate the current events to the brain and body alike.

Essentially, the nutrition response testing practitioner will manipulate certain parts of the body, record the nervous responses that are noticed, and draw subsequent conclusions from that gleaned information. The test can be administered in a broad sense so as to provide a sort of whole-body check or in a more accurate area of focus or concern. The patient is then able to take this information and advice and apply it to their daily habits in nutrition and personal activities.

A Sample Outcome

To get a better picture of the process, let’s take a look at a hypothetical patient and health dilemma. Jack is a middle-aged man that is experiencing energy-drain and exhaustion like never before in his life. After checking some other areas to no avail, he consults with a Nutrition Response Testing Practitioner.

After going through the test, he is made aware of a specific trace mineral that his body is now lacking and needs more of than most others. He then goes on to try supplementing this mineral into his diet, and sure enough, the problem quickly diminishes. If not for this particular testing method, it’s unsure if Jack could have ever truly discovered this issue by other means, medical or personal.

Finding The Right Nutrition Response Testing Practitioner

The NRT practitioner should be a medical professional that is well-versed in nutrition, the nervous system, and physiological responses in general. When choosing the right practitioner, ask questions to be sure that they are a good fit for this new healthcare alliance being created. Most importantly, find out their level of experience in this area as well as their abilities as they pertain to your particular medical concern.