The Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Access and CHIP Reauthorization Act (MACRA) in 2016 and is effective 2017 onwards. While the CMS met its goal of 30% value based payments in 2016, by 2018, the agency intends to bring it up to 80%.
What is MACRA?
Orthopedic practitioners fall under two categories within MACRA. The first is the MIPS (the Merit-Based Incentive Payment System) (MIPS) and the second is the APM (Alternative Payment Models). Practitioners have to start reporting in 2017 while the payment will begin in 2019 based on the stream chosen by the doctors.
MIPS combines the former MU (Meaningful Use), PQRS (Physician Quality Reporting System), and VBPM (Value Based Payment Modifier). Each category of quality, use of resource, advancing care information and clinical practice improvement are given different weightage under MIPS.
The second choice is the APM model where doctors take the “more than nominal risk for the cost and quality of the care they provide.” The payment in APM model is also similar to MIPS where quality and compensation are linked to each other directly.
Orthopedic practitioners can opt out of MIPS if they meet certain criteria of patient volume and revenue. Other than these, the eligibility criteria for APM also includes:
• Using quality measures similar to those specified in MIPS
• Using a certified EHR or electronic health record technology
EHR Solutions from Centricity Practice Solution
Quality scores are the foundation of MACRA and orthopedic practitioners need to focus on quality to stay ahead of competition. Besides maintaining stringent quality, reimbursement cuts are another major challenge that most orthopedic practices are dealing with. Upgrading to newer technologies and solutions are mandatory to minimize the reimbursement cuts. Practices using analog technologies will face a 20% reduction in reimbursement in 2017 while 7% cut in reimbursement will be faced by those using computed radiography.
To meet either MIPS or APM criteria, many small, private orthopedic practices may be inadequately staffed to carry out the exhaustive outcomes and other data.
Centricity Practice Solution has the most comprehensive Electronic Health Record technology that can take over the data management for private orthopedic practices. To be ready for MACRA, quality improvement with intelligent data collection, organization and analysis are critical areas to focus on. Orthopedic practitioners also can meet the eligibility criteria for either payment track– MIPS or advanced APM with certified technology such as GE Healthcare’s certified electronic health record, Centricity™ Practice Solution.
Value based care has encompassed all areas of medical practice, including orthopedics. Meeting the stringent quality standards imposed by MACRA while focusing on revenue are some critical focus areas for most orthopedic practitioners. Besides, investment in new technology and upgrades are other challenges. Using old technology such as computed radiography and analog scales invite cuts in reimbursement.
Given these challenges, orthopedic practitioners need to watch out for the latest technology trends and adapt in time to avoid penalties and improve their bottom-lines. One of the trends to watch out for is the increased migration of patients to outpatient settings. With advanced minimally invasive techniques, many procedures can be effectively performed at outpatient settings requiring minimal stay.
Smart Implants: Embedded sensors in implants that can sense a problem and elute drugs to treat the problem is soon going to be a reality. Orthopedic device manufacturers are focusing on embedded chip technologies that could provide cost effective treatment.
Artificial hips and spinal discs, cranial implants are other major trends that are set to pick up in the coming years.
3D printing and robotics: The emerging 3D technology advances are set to shape the industry in the years to come. Navigated surgeries and robotics are already gaining momentum in joint replacement surgeries and cartilage repairs. Robotic precision is also useful in creating specialized implants with varied designs, sizes and features, besides being available in many materials.
3D printing that can produce custom implants, devices such as plates and screws, knee replacements is another trend to watch out for. Customized implants already are being explored by companies including Medtronic, Biomet and Stryker.
Focus on data management: Data will rule healthcare practices in a big way. Collection of data, monitoring and analysis are top priorities for orthopedic surgeons and practitioners already involved in reporting quality metrics. With MACRA coming into force in 2017, big data management will be critical to every orthopedic practice.
An Electronic Health Record is the most ideal tool that enables capturing and analysis of data in the private healthcare sector as well as in hospitals. Under MACRA, to be eligible for the advanced alternative payment models (APMs) and to opt out of MIPS, the use of a certified electronic health record is mandatory. Orthopedic practitioners can be eligible for APM, which has less stringent reporting requirements than MIPS.
Certified technology like GE Healthcare’s Centricity Practice Solution, provides the resources and support orthopedic physicians need to benchmark performance results, and ultimately, improve the quality of patient care.
SANTA CLARA, Calif., Nov. 1, 2017 /PRNewswire/ — Based on its recent analysis of the revenue cycle management (RCM) industry, Frost & Sullivan recognizes GE Healthcare with the 2017 North America Enabling Technology Leadership Award for its highly customized, scalable, and agile RCM IT solutions for hospitals, ambulatory practices, specialty practices, health plans, billing companies, managed service organizations, and other stakeholders.
Despite the widespread adoption of basic RCM IT solutions, most US healthcare providers still grapple with low operating margins resulting from poor accounts receivable (A/R) performance and high average denial volumes. As a result, hospitals across the country lose approximately $262 billion per year on denied claims from insurers. Frost & Sullivan observed that many large healthcare providers, including accountable care organizations, integrated delivery networks, and group practices, continue to manage revenue cycles in silos, without taking advantage of a RCM IT solution that can drive RCM performance while managing all payment models. This often results in underpayments and lost rebates and incentives from payers.
“Healthcare providers have long struggled with the difficulty of implementing enterprise-wide RCM solutions,” said Koustav Chatterjee, Industry Analyst, Frost & Sullivan. “In addition, physicians, administrators, and other system users believe that the RCM IT learning curve is simply too steep. The complexity associated with the process of developing, deploying, and optimizing proprietary RCM IT solutions drives these providers to rely on external solution and service providers, such as GE Healthcare. In our analysis, we found GE Healthcare’s value proposition to be unique, disruptive, and pioneering from the context of the US RCM vendor market. The company’s solutions integrate with virtually any EHR [electronic health record] and can help facilitate clinical and financial analytics across the enterprise while delivering informed workflows that drive the outcomes that are critical to organizations’ success.”
“GE Healthcare is proud to have been recognized by Frost & Sullivan with the Best Practices Award for Enabling Technology in Revenue Cycle Management,” said Shiv Gopalkrishnan, Vice President, GE Healthcare. “This award is a testament to our commitment to helping our customers deliver the revenue cycle outcomes necessary to enable them to pursue their mission of caring for their community.”
The company’s RCM IT solution begins with their flagship solution, Centricity™ Business, which enables health systems to manage both ambulatory and hospital RCM all on one RCM platform and can be combined with a range of other value-added financial solutions. GE Healthcare takes payer connectivity to the next level by offering Centricity EDI (Electronic Data Interchange) Services to optimize billing process, DenialsIQ™ to reduce the costly impact of denied claims, and Centricity Payer Connect to ensure that customers can monitor, benchmark, and respond to gaps in care in real time and prevent revenue leakage. GE Healthcare provides an integrated, enterprise-level RCM IT platform for a wide range of payer and provider enterprises in the United States.
GE Healthcare’s financial management solution portfolio improves the following:
• Payment experience for patients. Patient-portal connectivity (incumbent or external portal) provides effective scheduling and built-in payment modules for informed financial decision-making.
• Value-based payment model adoption and care management for providers and payer-providers: For healthcare organizations engaged in risk-based contracts and value-based reimbursement ranging from shared savings to global capitation, GE Healthcare provides highly scalable solutions that streamline management of administrative costs, utilization, and care coordination of patient populations.
• Cost management for all: The company’s point-of-service toolkits can estimate patient liability and propensity to pay, thereby preventing loss of revenue. Additionally, with the help of EDI and DenialsIQ, patient eligibility assessment is digitized, claim errors are auto-highlighted, and denials are managed with predictive analytics.
“GE Healthcare enables its customers to achieve tangible financial outcomes that are better than the industry standards,” said Chatterjee. “For example, GE Healthcare’s top 20 ambulatory customers’ average number of A/R days is at least 10% lower than average. This is achieved through its efficiency in A/R management, using a persistent approach to optimizing patient access processes, streamlining billing workflows, pre-adjudicating claims, and automating financial reporting around claim denials’ root-cause analysis and regulatory adherence.”
GE Healthcare has been successful in driving a consolidated, value-based care approach for its customers. The company has demonstrated its proven expertise in streamlining costs and optimizing collections through an impressive portfolio of IT solutions combined with optimization services that ensure greater financial performance. For these reasons, GE Healthcare has earned Frost & Sullivan’s 2017 North America Enabling Technology Leadership Award.
Each year, Frost & Sullivan presents this award to a company that has developed a pioneering technology that not only enhances current products but also enables the development of new products and applications. The award recognizes the high market acceptance potential of the recipient’s technology.
Frost & Sullivan Best Practices awards recognize companies in a variety of regional and global markets for demonstrating outstanding achievement and superior performance in areas such as leadership, technological innovation, customer service, and strategic product development. Industry analysts compare market participants and measure performance through in-depth interviews, analysis, and extensive secondary research to identify best practices in the industry.
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For medical practitioners specializing in Urology, the value of seamless integration between the day-to-day financial operations and the electronic patient records cannot be underemphasized. GE HealthCare’s Centricity Practice Solution provides a customized and integrated system for urologists that enhance efficiency and productivity.
Centricity’s Urology Electronic Health Records offers an in-depth application for Urologists with customized templates that include complaints, history of present illness and review of systems tailored to meet the urologists’ practice.
A powerful integrated software platform
Centricity combines the best of both worlds on a single platform that makes for ease of use and faster processing. The two systems of practice management and electronic medical records can also be independently used if needed.
Centricity is a certified solution keeping up with today’s standards of value-based medicine and industry regulations. Our solution is integrated in-line with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Merit-based Incentive Payment System (MIPS). The MIPS/MACRA payment reforms are focused on giving 60% importance to the quality of care while advancing care information (ACI) and improvement activities are weighted 25% and 15% respectively. Cost is a factor that has zero focus currently, but will be a factor that will attract some prominence in the future.
Customized content for urologists
Using CPS, Urologists can help avoid penalties and earn incentives associated with the MIPS/MACRA program. Electronic prescribing (e-prescribing) and cloud-based reporting are some of the helpful features of CPS. Besides, patients can make use of the platform to schedule appointments and view bills and clinical information. The integrated software system also enables patients to pay bills online.
Centricity Practice Solution software includes customized content and tools for management of the following:
• Prescriptions or orders
• Patient education
Our software offers summary forms that are customized for filling out the history of present illness, review of symptoms that are particularly related to urology. Updated with the prevailing ICD and CPT codes for urology, Centricity’s software solutions enable urologists to capture, submit, and track charges electronically.
Centricity’s Electronic Health Records are perfectly tailored to match the urologist’s practice with the following features:
• Custom urology templates
• Simple e-prescribing
• Create automated treatment plans
• Follow-up/Recall Tracking
• MIPS/MACRA Incentives
• Electronic Data Interchange (EDI)
Centricity Practice Solution’s detailed exam forms for urological procedures greatly helps practitioners optimize their time and increase productivity.
The transition to an EHR platform is often quite overwhelming for medical practices. After the big job of EHR selection and implementation is done, there is a tendency to just go with the flow, that is, not assess gains and tackle potential pain points. Here are some post-implementation best practices to consider.
1. Avoid fixating on the computer screen
Person-to-person and eye contact is essential to customer engagement. When you’re meeting new patients or they’re describing their problems, take your hands off the keyboard and mouse, and give them your complete attention. Even when you have started recording their data, you can continue conversing with them and pointing to the screen to indicate results or other information that they can benefit from knowing.
2. Make staff training a strategic priority
While you may have a training program in place, it should also include feedback from staff and quick resolutions of any adoption challenges that some employees may be facing. One way is to designate one or more super-users with a comprehensive understanding of the EHR system to guide the rest and bring them up to speed. When deployed as an early initiative, this can prevent frustrations and/or sub-optimal use of the system.
3. Keep tabs on resource utilization and efficiency gains
One of the most recognizable benefits of electronic health records is the elimination of hard copies and the hassles of maintaining them securely and continuously. An obvious source of cost savings is the stationery department – ink, paper and printer ink. A bigger advantage is in the area of staff efficiency: your employees can conserve their energy and save time with a digital solution that simplifies and streamlines administration as well as billing and patient communication.
Are these gains apparent in staff or patient satisfaction levels? It will be impossible to start seeing results within a few months, but you should have a good idea one year after the EHR system has been in use. During the early months of adoption, encourage employees to communicate their opinions and concerns openly, and check up on progress and satisfaction after 12 months.
4. Invest in continuous quality improvement
After your EHR system has been in use for a while, communicate a continuous quality improvement (CQI) philosophy that inspires you and your employees to ask what can you do better, where can you be more efficient, how can you save more time, and in what specific ways can you enhance the effectiveness of your practice? Consider the following framework to integrate continuous improvement into your EHR-driven practice:
• Establish a model for quality improvement
• Optimize your EHR keeping in mind how people, processes and the technology itself can help you achieve meaningful use and forward your mission in the future.
• Set metrics to measure the improvement efforts and results
• Confirm that all staff members understand the metrics for success
• Include patients in your quality improvement activities
While there are a number of CQI strategies exclusive to healthcare, one that is relatively simpler to understand is The Institute for Healthcare Improvement (IHI) Model of Improvement.
5. Establish controls for remote workers accessing records
Medical practices can conveniently access their EHR system from a remote location via an internet-enabled device. It has been seen to increase timeliness of interventions, lower overall travel costs for physicians, and enable physicians to simultaneously access the same information to facilitate group assessments and accelerate diagnosis.
Though these benefits are highly appreciated, it can create concerns over data security and unauthorized access. While a complete EHR system (as designated by the Certification Commission of Healthcare Technology) such as Centricity EHR ensures secure transmission of data, it is best to create rules around access for the highest levels of data security.
How exactly do Electronic Health Records benefit patients? Click to enlarge the graphic and see for yourself!
As one of the proud partners of Rio 2016 Olympic and Paralympic Games, GE has supplied the International Olympic Committee (IOC) with innovative health data management software to create Electronic Medical Records (EMR) for all athletes and patients who visit the Polyclinic in the Olympic Village. GE has been supporting team doctors and more than 10,500 athletes competing at the Games. This year’s use of the EMR system has already tracked over 4,000 medical records, including 1,085 diagnostic imaging exams that were performed at the Polyclinic in the Athletes Village as well as at the emergency centers in the competition arenas. Six hundred and ten MRI, 345 X-ray and 130 ultrasound examinations were performed since July 22, when the operations at the Polyclinic started.
The EMR allows doctors to track and analyze in real-time thousands of data points – from imaging scans to medications, dental examinations and allergies of each of the athletes treated at the Polyclinic. The digital solution provides reliable information and helps ensure that clinicians know the medical history of the athlete so they can plan for the best possible outcome. More than 1,000 physicians are involved in caring for the U.S. Olympic team alone.
This year marks the first time team doctors from around the world are able to manage health records through a single system, which enables the unification and analysis of all athletes’ information in the same cloud platform. The system is offered entirely in English as well as Portuguese, in compliance with the Brazilian health laws.
“The gold medal of medical services is a comprehensive, integrated health solution for lesion prevention,” said Dr. Richard Budgett, medical and scientific director for the International Olympic Committee. “Without an adequate medical record, it is difficult to predict which lesions will be more common in given sports in the future.”
A version of Centricity Practice Solution (CPS), the EMR being used at the Rio 2016 Games, was developed specifically for the United States Olympic Committee (USOC). The USOC used CPS during the London 2012 and Sochi 2014 Olympic Games, with outstanding and critical results.
“In the Sochi 2014 Paralympic Winter Games, we had an athlete with a medulla lesion caused by his fall in the snow, which compromised his breathing capacity,” said Dr. Bill Moreau, managing director of the sports medicine division for the USOC. “The athlete was taken to Frankfurt, Germany for additional care, but when he arrived, he was not able to speak. When I accessed his health record, I could verify that he had allergies, which would influence his treatment, and I could see the number of anticoagulants he had ingested,” Moreau said. “It is hard to imagine that just one or two years ago, we would not have been able to access this information.”
Among the advantages of the EMR is the information quality and near real-time analysis and response, increasing the chance of avoiding unnecessary procedures. According to the USOC, the U.S. Women’s Olympic wrestling team saw a 60 percent reduction in surgeries (primarily a result of shoulder lesions), after the adoption of the EMR. This reduction can be at least partially attributed to the ability of the EMR to translate data into insights and identify trends in causation that can inform changes in training and care.
About GE Healthcare
GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE Healthcare (GE) works on things that matter – great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions GE Healthcare helps medical professionals deliver great healthcare to their patients. http://www.gehealthcare.com.
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It is important to disable logins for any employee that leaves your practice. If this is not done, an employee could potentially still connect in remotely to your system. This opens your practice up to a serious cyber security threat. This risk is so great that the FBI and Department of Homeland Security (DHS) recently issued a public service announcement, saying the “increase in insider threat cases … from disgruntled and/or former employees poses a significant cyber threat to U.S. businesses due to their authorized access to sensitive information and the networks businesses rely on.”
How can you comply with regulatory obligations to protect sensitive data or PHI if ex-employees can still enter your systems and delete or modify data? Fines and legal costs can be substantial.
Being proactive is key to protecting your data and your business. To help you do that, we recommend you:
• Conduct regular reviews of employee access, and terminate any account that individuals don’t need to perform their daily job responsibilities.
• Terminate all accounts associated with an employee or contractor immediately upon their dismissal.
• Change administrative passwords to servers and networks when you terminate IT personnel.
• Avoid using shared usernames and passwords.
• Avoid using the same login and password for multiple platforms, servers or networks.
• Notify third-party service companies that provide email or customer support when an employee has been terminated.
• Restrict Internet access on corporate computers to cloud storage websites.
• Restrict employees from downloading unauthorized remote login applications on corporate computers.
• Maintain daily backups.
To protect your business, it’s important that you pay close attention to who has access to what data. Most offices don’t think about this until something happens but you should focus on this [immediately], then you won’t have to worry going forward.