How value-based reimbursement is shifting information-blocking paradigms

Inadvertent information-blocking can create costly problems in an unexpected area – value-based reimbursement (VBR).

Back when all payments were fee-for-service, life was simpler. You provided the service, you made sure to bill with the correct procedure code, you got paid. Information-blocking focused on two goals. The first was to prevent providers from denying or delaying access to their electronic health information (EHI). The second was to make sure that marketers, criminals, and other unauthorized people or businesses had no access to that information whatsoever.

In 2008, the Medicare Improvements for Patients and Providers Act (MIPPA) ushered in the beginning of a different system: value-based reimbursement. Additional laws followed. So did VBR programs: from end-stage renal disease quality and hospital readmission reduction (2012), to hospital-acquired condition reduction (2014), to merit-based incentive payments (2019).

States have their own VBR programs, too. A total of 48 states and territories (DC and Puerto Rico included) have implemented some form of value-based reimbursement. (Only West Virginia, Indiana, Georgia, and Mississippi haven’t.)

These and other laws and programs no longer focus on separate office visits, lab tests, and hospitalizations, with separate records kept by separate providers. Instead, they focus on an integrated picture of the patient’s outcomes and overall health.

Each program has its own standards and measurements for patient outcomes. Failing to meet them triggers reduction in reimbursement. So does failure to document and report them properly. The goal is to provide better care – faster and without unnecessary and redundant procedures.

Those reductions can cost hospitals millions of dollars a year.

Meeting VBR standards (and improving patient outcomes in the process) requires coordination between providers at all levels. And coordination requires shared, current, instantly accessible information. (This is particularly important for patients seeing more than one specialist.)

Achieving that can be harder than it sounds. That’s because most, if not all, of a patient’s EHI is stored in stand-alone digital silos. Each silo is maintained by a different doctor, group practice, lab, hospital, etc., providing care to a given patient. Each contains just part of the patient’s EHI. VBR’s holistic approach calls for horizontal communication connecting different doctors, labs, hospitals, and other providers serving the same patient.

That doesn’t exist yet.

There’s no central “cloud” for patient EHI. There isn’t even a medical equivalent of the three credit-reporting companies. And while there are localized regional health information exchanges, they’re limited in scope and aren’t always compatible with everyone else’s software.

Here are eight ways to speed the flow of information instead of inadvertently blocking it:

  1. Make sure you’ve applied to be in the HHS and relevant states’ VBR programs. There can be significant cash penalties if you don’t.
  2. Identify initiatives for improving your organization’s quality of care, achieve them, and report it. That way, you’ll get full, not reduced, Medicare and Medicaid payments.
  3. Check your own electronic health and medical records departments for silos under your own roof. With its higher level of security and patient privacy protections, your behavior health system may pose information-sharing problems.
  4. Make sure your IT people fully understand how your EHI and information-sharing systems work.
  5. Have information-sharing software and hardware in place. Make sure it’s truly interoperable and compatible with providers in your system, health exchanges, and providers you haven’t shared information with before.
  6. Proactively review and beta-test any patient information-related software before it goes live – just as you would with billing software.
  7. Educate your staff and providers to make sure they understand what reporting policies and procedures are in place, what to document, how to document it, and why.
  8. Make sure your compliance and operations people are engaging and on the same page.

Different VBR initiatives are in different stages of development and enforcement. So you’ll need legal counsel with health care expertise and information-blocking laws and regulations knowledge to keep you up to date. And a team of expert compliance professionals to give you clear, actionable ways to keep your system in compliance.

Switching to interoperable information sharing may not be quick and easy. But in the new VBR environment, it holds great promise of much better health for your patients – and better financial health for your organization.

In today’s VBR environment communication, connection, and information sharing is more important than ever. See how YouCompli can help you speed the flow of information that’s so vital to your patients’ – and your organization’s – health. YouCompli is the only healthcare compliance solution combining actionable regulatory analysis with a simple SaaS workflow.

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