It’s hot in El Paso, and the world of health care in our digital age is heating up as well. Since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) regulations were released on April 27, 2016, there has been a flurry of activity from local, state and national groups. This activity ranges from groups calling for the immediate halting of MACRA, to groups thanking CMS for the simplification of Meaningful Use (MU) by MACRA. Despite all of the rumors that MACRA is going away, this is unlikely. Andy Slavitt (@ASlavitt), CMS acting administrator, is worth following on Twitter for checking out information on MACRA as the landscape evolves.
The Journey to Value (#J2V)
What it is: In May, provider scorecards were sent out to all clinical providers that see patients. These scorecards included measures from Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the Healthcare Effectiveness Data and Information Set (HEDIS), as well as the Delivery System Reform Incentive Payment (DSRIP) and Network Access Improvement Program (NAIP) projects. These scorecards represent a dynamic first attempt at visualizing how providers are measured by CMS and other payor groups. CMS states that it is “focused on three core strategies to drive continued progress and improvement.” These include (1) clinician compensation to incentivize value of care over quantity of services; (2) care delivery through clinical practice support, as well as data and feedback reports to guide improvement and enhanced decision-making; and (3) access to data enabling the use of certified EHR technology to support care delivery.
The coming years may change health care rapidly. With the information that is currently available, it appears that health care organizations and providers will be paid based on measurements that serve as proxies for quality and value. These measures (of which there are over 200), whether they reside in PQRS or HEDIS, are all Clinical Quality Measures (CQMs).
CQMs fall under one of six National Quality Strategy areas:
- Patient and Family Engagement
- Efficient Use of Healthcare Resources
- Clinical Processes and Effectiveness
- Patient Safety
- Population and Public Health
- Care Coordination
Why it matters: Since there are so many measures, input from clinical groups on which measures best meet their needs is necessary. The goal should be to use measures tailored to your patients and the goals of the departments. Whether MACARA, HEDIS or DSRIP, the measurement of quality is going to be the road we march on along in this journey to value. Payments are changing, and they are not increasing unless we can show the value we currently provide. Between CMS and private payors, 50 to 75 percent of payments will be tied to quality and value within the next four years. The Office of Clinical Informatics (OCI) hopes to help our organization prepare for these changes.
Virtual Health (Telehealth) 2
Texas Tech University Health Sciences Center El Paso (TTUHSC El Paso) continues to make inroads and discoveries around what telehealth will mean for the institution as it evolves. Technology around health care access and engaging patients (or health care consumers in this new world) will be important as payment modalities change and patients ask for different ways to engage with the health care world.
Picture this: You get dressed and drive thirty minutes to get to a place you are buying a service. There is no parking; the person who greets you gives you 10 pages of paperwork to fill out with your social security number on almost every page; you then wait a random amount of time to receive services. This is not the picture of a great experience. Many will say health care is a premium service and if patients want it, they should go through the above scenario to get it.
While scarce services in a restricted market may align with such a world view, new, younger, more mobile patients with financial means will push the boundaries of this world view (think Kodak). Already, the Departments of Veterans Affairs (VA) and Defense, Komedix, United Health Care (TTUHSC El Paso’s insurer), which uses AmWell and Doctor on Demand, as well as a host of private providers in El Paso using HealthTap, are filling a void and providing valuable service.
How this will affect you: The Digital Health (DH) team of Clinical Information Systems (CIS) and the Office of Clinical Informatics, in conjunction with the Office of Information Technology, are working to outline a framework that will help the institution enter the telehealth world strategically. Telehealth aims to create improved access (especially mobile access), ease of payment, and avoid the painful in-office process associated with many health care systems. The DH team will be discussing and meeting with clinical and administrative stakeholders to ensure that all approaches align with the clinical, research and service needs of the organization. Alignment with payment mechanisms (i.e., CMS, NAIP, private funding) is crucial to ensuring that the approach integrates and connects into our EMR.
So, What (Else) is New?
The Hospitals of Providence at Transmountain Campus: The Transmountain Cerner project is counting down to the September 1, 2016, go-live. We are very grateful to all of the groups and people who have given their valuable time to make this work. Our own Cerner test environment is up and running. We are reviewing protocols and workflows. Volunteers are welcomed to assist in reviewing and tweaking workflows. The integration into our present lab systems is being tested. Future integration into University Medical Center (UMC) of El Paso and The Hospitals of Providence (THOP) is being planned for the Transmountain hospital go-live January 17, 2017!
Work is underway with THOP to ensure that medical students will have full access to the clinical systems and will be able to do all training activities within the EMR – the days of pen and paper for trainees are coming to an end! Progress continues toward the grand opening of our new clinic on the northwest side of the city!
Analytics: The Digital Health Initiative, alongside other stakeholders, has posted a request for proposals (RFP) for a population health management solution. The aim, in multiple phases, is to bring in an enterprise data warehouse to aggregate our clinical and claims data for normalization and visualization of a host of clinical, business decision and research purposes. The aim is to provide all members of the organization with the ability to access and create, on their own, validated dashboards/scoreboards from one data source and not the plethora of sources we presently have (i.e., centralize the data, but decentralize the reporting). As said previously, anyone should be able to access data — claims, billing and patient-centric — and quickly analyze and create interactive charts. This opens up the possibilities for everyone, from IT to clinicians, administrators and researchers.
OCI updates: We will be involved in a Transforming Clinical Practice Initiative (TCPI), which will launch this month. This CMS-funded program is designed to help clinical organizations achieve large-scale practice transformation to align with value and quality. TCPI will support TTUHSC El Paso, along with selected clinician practices across the country, Emory, University of Florida, Yale, and Moffitt Cancer Center, just to name a few. TCPI will work alongside us to develop our comprehensive quality improvement strategies through collaborative, peer-based learning via our partnership with Vivien, a CMS-certified practice transformation network.
CIS updates: In an effort to improve the patient portal, the CIS group will be engaging clinics over the next few months to re-assess patient engagement strategies and learn new ways to enhance the patient portal, as well as target improvements to the EMR. This fall, CIS will be conducting town hall style meetings to get faculty, staff and resident feedback on how to improve our clinical systems — be on the lookout!
The new residents and fellows recently completed clinical information systems (i.e., EMR) trainings. This was the first year residents completed half of their CIS training online and the second half in-person. The in-person training time was reduced from 8 hours to 3.5 hours. CIS, with assistance from students, residents, faculty and staff, will continue to find ways to improve the EMR trainings. Volunteers are always welcomed!
Digital Health Bytes
- Health care costs are out of control — Read here.
- There’s more to Pokémon than meets the eye — Read here.
- Value-based reimbursement: disturbing the pond — Read here.
- No Uber for health care — Read here.
- The future of care coordination — Read here.
Please feel free to contact me with questions regarding our role in the digital transformation of health care.