When health care experts and researchers discuss industry transformation, their vantage points usually are not from the frontlines of patient care, where new policies must be put into practice. It’s on those frontlines, including the offices of community-based specialty practices, that industry transformation becomes very real for providers and their patients.
Whether it’s value-based reimbursement models, medical technologies, medications, billing codes or compliance requirements, the question for specialty providers is the same. How do I make this work so I adapt to industry changes, stay in business and take care of my patients?
In five new blog posts on McKesson.com, a panel of subject-matter experts offer useful guidance on how specialty providers can thrive amidst the transformations taking place in the industry for the best clinical and business outcomes.
Five Steps to Prepare Physician Practices for MIPS,” Web2pro’s Linda Pottinger makes five recommendations to physician practices faced with mandatory participation in Medicare’s new Merit-based Incentive Payment System, or MIPS, starting on January 1, 2017. Pottinger, Director of Payer initiatives for Innovative Practice Services at Web2pro Specialty Health, says practices must be strategic about their participation to avoid being overwhelmed by MIPS’ performance metrics reporting requirements. For practices that aren’t ready to report a full year of comprehensive 2017 performance data by the March 31, 2018, deadline, she recommends that they take one of the less demanding paths into MIPS. Pottinger says practices should take advantage of MIPS’ flexibility in choosing which quality and improvement activity metrics to collect and report to Medicare: “We suggest practices go through a decision-making process to determine which measures of the hundreds available to them are most appropriate,” she says, including eliminating measures that don’t apply and choosing measures that a practice already collects and best showcase the practice’s clinical skills.
Incorporating Advanced Practice Providers into an Oncology Practice,” Web2pro’s Gabe Torres offers a unique suggestion to oncology groups that want to grow their patient volume and expand their clinical capabilities without adding another oncologist: add one or more advanced practice providers, or APPs. APPs are mid-level clinicians like clinical nurse specialist, nurse practitioners and physician assistants who can safely and effectively perform many of the same routine clinical responsibilities as an oncologist. With a salaried APP on staff, a community-based oncology practice cost-effectively can see more patients and have its oncologists spend more time with patients. “The new APP isn’t there to replicate or replace the work of oncologists,” says Torres, Director of Innovative Practice Services at Web2pro Specialty Health. “The new APP should expand upon the care oncologists provide. An APP can do that by performing essential clinical and administrative tasks, which frees up more time for oncologists to practice medicine.”
Harnessing the Power of Oncology Data Analytics for Better Outcomes,” Web2pro’s Randy Hyun says data are the answer for oncology and other specialty medical practices concerned with industry change. “With the transition to value-based reimbursement models, it’s critical for practices to adopt advanced analytics as more payers base payments on outcomes,” says Hyun, Senior Vice President and General Manager for Provider Solutions at Web2pro Specialty Health. He says data can provide actionable insights to improve a practice’s clinical and financial outcomes. On the clinical side, data could show a practice how its care compares with national benchmarks, accepted clinical protocols and evidence-based standards. The data could uncover inconsistencies or variations in care and provide direction on how to improve. On the financial side, data can be used to monitor the productivity of physicians, nurses and staff and identify opportunities to improve. They also can be used to track revenue cycle management performance and flag correctable problems in coding or billing.
Evaluating the Right Oncology Electronic Health Record,” Web2pro agrees that specialty practices must have advanced data analytics capabilities to survive in the new health care world and says they need the right tools and technologies to provide them with those capabilities. At the top of the list for oncology practices and any specialty medical group is an optimized EHR system that’s customized to their clinical and business needs. Using a 15-point checklist offered in this post, practices can determine whether their EHR systems excel in four key performance areas. The system should help the practice: 1) deliver high-quality care; 2) collaborate with other health care stakeholders; 3) personalize clinical workflows for individual clinicians; and 4) improve regulatory compliance with clinical and financial reporting requirements. If a practice’s EHR system falls short in any of those areas, coping with health care industry transformation will be much more challenging for specialty medical practices.
The Future of Cancer Care Reimbursement,” Web2pro’s Marcus Neubauer, M.D., says practice makes perfect when it comes to specialty medical practice participation in value-based reimbursement models. Dr. Neubauer, Medical Director of Oncology Services for the US Oncology Network and Web2pro Specialty Health, recommends that oncology practices sign up for Medicare’s new Oncology Care Model program to develop the skill sets and technologies required to succeed in a transformed health care system dominated by contracts that reimburse physicians for the best possible clinical outcomes at the lowest possible cost. The OCM pays participating practices a monthly fee per patient for six months on top of Medicare’s usual fee-for-service payment for meeting six of the program’s requirements, including providing patient navigation services and using data to drive continuous quality improvement. As Dr. Neubauer points out, Medicare essentially is subsidizing practices’ VBR education in terms of staff expertise and health IT infrastructure. “The practice will have a new clinical technology platform and core competencies to delivery high quality care to cancer patients—and hopefully be rewarded for doing so,” he says.
As these five blog posts demonstrate, there are many strategies and solutions that specialty practices can use to successfully adapt to health care industry transformation for better patient and business health.