The healthcare industry saw significant change in 2015, from reimbursement reform to coding transitions. Health IT played a big role in bringing about those changes, which will continue into 2016.
Here, we summarize some of the biggest changes, their impact in 2015 and some of the expectations for how those changes will affect the healthcare industry in the year ahead.
Changes in Physician Reimbursement
After many years of complaints and false starts, an alternative was found to replace the controversial Sustainable Growth Rate formula that was supposed to contain the growth of physician payments. The new approach, the Merit-Based Incentive Payment System (MIPS) will weigh multiple factors, as well as incorporate IT use into the mix. However, much work remains before the new system will be ready for use.
The ICD-10 Transition
As the October 1 compliance deadline approached, so did the tension for providers and payers about the transition to the ICD-10 coding system. But, overall, healthcare organizations managed the transition well, as a result of extensive planning, focused training and excellent cooperation within segments of the industry. While coding productivity has been impacted, now the industry will need to become proficient in the use of the new codes.
Meaningful Use Stumbles, Accommodations Help
The Meaningful Use Incentive Program for adoption of EHRs advanced very slowly in 2015, with providers struggling to meet objectives that would enable them to attest to achieving Stage 2 of the program. In March, the Centers for Medicare and Medicaid Services announced a plan to make it easier to achieve Stage 2, but a final rule wasnt released until October; a significant delay that didnt provide much-needed relief for providers. A Stage 3 final rule also was released, which also irked provider organizations because Stage 2 attestation was lagging. In this next year, much work lies ahead on determining the future of the program, including determining the final form of Stage 3 of the program.
Value-based Care Ready to Accelerate
The Centers for Medicare and Medicaid Services is moving relatively quickly toward value-based care. The agency announced in early 2015 that it will tie 30 percent of its total provider payments to quality and value by the end of 2016, and 50 percent by 2018, through alternative payment models such as accountable care organizations and patient centered medical homes. Thats causing providers to rethink the information technology theyll need to succeed under this new reimbursement model. Providers also are seeing the importance of analytics in improving their odds of succeeding with new reimbursement approaches.
Genomics on the Rise
On Jan. 20, 2015, President Obama announced the Precision Medicine Initiative in his State of the Union address. Through advances in research, technology and policies that empower patients, the PMI will enable a new era of medicine in which researchers, providers and patients work together to develop individualized care. The President called for $215 million in fiscal year 2016 to support the initiative. The PMI highlights how genomic information will influence care delivery and will impact IT approaches going forward.
Mega-Hacks Rock Healthcare Industry
If there was any doubt that health data is an inviting target for hackers, that lingering cynicism vanished in 2015. Cyber attacks that affected Anthem (78.9 million individuals), Premera Blue Cross (11 million individuals) and Excellus BlueCross Blue Shield (10 million individuals) were among the major incidents announced this year. The extent of these attacks and the cost to remediate the hacks demonstrated the serious nature of solidifying security. Meanwhile, healthcare organizations will continue to take steps to improve their security posture.
Mobile Health Empowers More HIT Adoption
Smartphones, connected medical accessories and apps grew in popularity and acceptance in 2015, and providers are accelerating efforts to determine how to fit mobile technology into their overall IT strategies. Experts predict that care will begin to shift into the palms of consumers hands starting in 2016, helping to drive down costs, increase access and fulfill the publics desire for anywhere, anytime monitoring, diagnosis and treatment.
Analytics Helping Industry Cope with New Pressures
As providers increasingly used electronic health records to gather data on their patients in 2015, awareness grew that simply having the information aggregated wasnt enough. As the country shifts to new approaches for reimbursing care, providers began to consider new ways to use analytics to improve their ability to provide the best care at the least cost. Many of the countrys providers are just beginning to use analytics and early in efforts to improve population health.
Doctors Now Flexing HIT Influence
Large organizations of physicians became more vocal in 2015, seeking to influence various aspects of health IT. For example, the American Medical Association achieved compromises on the transition to ICD-10 that softened the potential negative impacts of the code switchover. The AMA is now under the leadership of new president Steven Stack, M.D., a recognized an expert in HIT. Its becoming more vocal in pushing back against provisions of the Meaningful Use program, and the usability of electronic health records.
Pressure Grows to Connect, Promise of Standards
More organizations began to work together to achieve interoperability and the electronic exchange of health information. The Office of the National Coordinator for Health IT has highlighted interoperability as one of the top goals for the nation in 2016. Work continues on standards and hopes for using HL7s FHIR to achieve information exchange remain very high.
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