EHR UPDATE

USING EHR & ACA TO YOUR ADVANTAGE

Strategies for using the new healthcare requirements to build your practice and serve your patients better

BY BRAD ROURKE

The 2015 federal budget earmarked almost $1 trillion to fund U.S. healthcare. The trillion dollar figure includes Medicare, Medicaid, and Health and Human Services. The healthcare budgetary allocation tops any other budget item including defense. Today there are roughly 100 million Americans enrolled in Medicare or Medicaid.

Beginning January 1, 2014, the Affordable Care Act (ACA) mandated that all Americans have health insurance for at least nine months of the year. The individual mandate, coupled with the country’s aging population, will significantly increase the need for eyecare.

For these reasons, there is no better time in terms of opportunity to be a doctor of optometry or be involved in the eyecare profession than right now.

OBJECTIVES TO EMBRACE

The objectives of the ACA are to increase the quality, availability, and affordability of health insurance. The law is intended to curb growth in healthcare spending, as healthcare spending has been rising at an unsustainable rate.

Furthermore, the three objectives of the Meaningful Use (MU) requirements of the electronic health records (EHR) program are:

►►► Improve the efficiency of healthcare delivery.

►►►Engage patients more fully in their healthcare.

►►►Improve care coordination and the population’s health.

As you can see, these MU objectives are consistent with the ACA objectives and promote a number of benefits:

►►► Improve the quality of life of patients.

►►► Extend the length of life of patients.

►►► Ensure sufficient monies will be available in the Medicare trust fund to pay for healthcare needs of future generations.

It would be difficult to successfully argue that these objectives of the ACA and MU are bad for the populace, although it could perhaps be argued that the objectives do not justify the legislated means to reach those ends (in particular, the individual insurance mandate). Regardless, these means are in place to meet the stated objectives through rule of law.

KEY OPPORTUNITIES

Whatever the long-term feasibility of the ACA and MU program may be, the law is currently effecting permanent change in the landscape in which eyecare providers function.

Therefore, eyecare providers have a choice: They can use to their advantage the existing legislative landscape or grumble about it.

The former is the winning strategy. It places the doctor and clinical staff’s attention positively on the patient. The latter, with newly coined terms such as the ‘new Mediocre’, serves to negatively impact eyecare staff morale and detract from the focus of patient care.

This is not an “if you can’t beat them join them” strategy. It is a strategy that uses the existing healthcare landscape to the eyecare profession’s advantage. It is a strategy for practice building and for providing better patient care.

Here are some of the key Stage 2 MU core objectives and a few specific strategies to use the MU requirements to your (and your patients’) advantage.

►►► Generate lists of patients by specific condition to use for quality improvement, reduction of disparities, or outreach.

This is a great feature your EHR must have. Have your staff use it to identify appropriate medical prevention reasons to recall your patients.

►►► Use clinically relevant information to identify patients who should receive reminders for preventative or follow-up care.

Similarly, this is a great feature your EHR must have. Have your staff use it to identify a reason to recall your patients.

ACA CHALLENGES

There have been attempts to overturn parts of the ACA law. For example, the ACA state Medicaid expansion requirement was overturned by the Supreme Court in June of 2012. However, that court upheld the individual mandate component of the law based on Congress’s power to levy taxes.

Recently, the Supreme Court agreed to hear another case: King vs. Burwell. The issue is whether or not the IRS can issue tax credits to patients who have purchased health insurance through FEDERAL exchanges.

The law stipulates that healthcare insurance tax credit subsidies are available to people who buy health insurance through STATE exchanges. Thirty-five states have elected not to establish healthcare exchanges, and are relying on the federally established exchange (healthcare.gov). If the Supreme Court finds in favor of King, healthcare tax credits subsidies would be disallowed.

At the moment the IRS is administratively permitting healthcare insurance tax credits for the 35 states that do not have exchanges. If King prevails, it is not likely to be without consequences to the feasibility of the ACA. The Supreme Court is set to hear the case next month.

►►► Use certified EHR technology to identify patient-specific education resources.

This feature will offer you real-time reasons to engage with your patients. Use it to ensure they know why they need to return to see you.

►►► Use secure messaging to communicate with patients on clinical matters.

Health and Human Services requires your EHR vendor to provide a secure method to engage with your patients about their healthcare needs. Use it to engage with patients regarding why they need to return to see you.

ACA STRATEGIES

Below are a few strategies to use the effects of the ACA requirements to your provider’s advantage:

►►► The inclusion of pediatric vision care as an essential health benefit and disallowing health insurance annual, lifetime, and existing condition limitations will result in more demand for eyecare. Re-engineer your patient workflow to see more patients. Incorporate super-scribes into your workflow.

►►► The ACA legislation requires the Centers for Medicare and Medicaid Services (CMS) to establish a physician comparison website (medicare.gov/physiciancompare/). Be sure your super-scribes are documenting and submitting Clinical Quality Measures and Physician Quality Reporting System requirements for you. Use the comparison site to ensure you favorably compare.

►►► Establish relationships with primary care providers. Make it easy for PCPs to communicate with you electronically. The ACA has promoted and funded payment models such as Accountable Care Organizations (ACOs) that are significantly reliant on PCPs.

Be aware of any ACOs being established in your area and consider how you could be involved. The AOA has published an ACO guide and toolkit (aoa.org/documents/ACO-Guide-2013.pdf)

Apply for hospital privileges in your area to solidify referral sources. The AOA has also published a Hospital Privileges manual.

For more information, visit aoa.org

PROPOSED STAGE 3 MU MEASURES:

►►► Searchable electronic progress notes will become a core requirement rather than menu set. Have your staff use this mandated search feature to identify patients to contact in order to ensure they are following your treatment plans. Consider offering these patients alternative treatments as healthcare advances.

►►► Order tracking to ensure compliance. If this feature reaches the final rule, your EHR must support the ability to electronically trigger notifications to providers when order results are not returned by an indicated date. It is easy to see how this will enhance patient care and improve the doctor-patient relationship.

►►► Offer electronic patient completed intake forms. Your EHR vendor will be required to provide electronic intake forms. This will allow you to offer patients intake alternatives: traditional paper with clipboard, staff interview, or web-enabled devices. Give patients what they prefer!

►►► Provide off-visit summaries to patients with actionable information and instructions pertaining to the visit. Office visit summaries will no longer be basic Rx and diagnosis information. Your EHR must provide the functionality to engage with your patients more effectively by giving them easily produced treatment plan instructions.

Simply put, use the requirements of MU to engage your patients more thoroughly and expand the scope of care you can offer them. If you can’t beat them, use them!

In conclusion, eyecare professionals have two choices with regard to healthcare reform. You can choose to focus on the potential downside of the reform efforts, which may include lower reimbursements, the need to see more patients to retain the same income, increased reporting requirements, and more regulations.

Or, you can choose to use these changes to your benefit and implement strategies to build your practice. Consider these changes an opportunity to care for more patients.

If you can’t beat them, use them!

Brad Rourke is the president and CEO of Williams Group, a practice management consulting and EHR firm based in Lincoln, NE.