For many good reasons, the industry (with a nudge from the federal government) has decided to overhaul the traditional “fee-for-service” payment model to shift to value-based care. This approach incentivizes providers to deliver better (as opposed to more) care, in the hope that this will improve healthcare from both a quality and cost standpoint.
The federal 2015 MACRA legislation and CMS’s Quality Payment Program (MIPS and APMs) provide the framework for this transition. Executing it will require considerable effort—and more than a little stress—on all players.
Unfortunately, many physicians and IT professionals are not yet ready to focus their attention on MACRA-related issues. A recent study found that only 25 percent of all healthcare payments in 2016 were tied to alternative payment models. A similar survey also revealed that more than half of all physicians still feel unprepared for MACRA.
On the IT front, the issue is a combination of technology readiness and human capacity. Health IT priorities and budgets this year still are primarily focused on overcoming the challenges associated with electronic health records (EHR) systems and the Meaningful Use program.
The seven-year-old government-led push for all healthcare providers to deploy EHRs created a host of well-documented problems. Rather than enabling a better, more streamlined physician workflow, IT is perceived as being a burden. Doctors are not doing less or more; they are doing the same things and spending more time on them. For instance, doctors often spend time late at night writing their progress notes or reconciling their patients’ medications—tasks that can take up to an hour per patient with many EHRs.
According to Deloitte’s 2016 Survey of U.S. Physicians, three out of four physicians believe EHRs increase practice costs, outweighing any efficiency savings, and seven out of 10 say they believe EHRs reduce their productivity. The American Medical Association’s former president, Steven Stack, MD, has publicly stated that EHRs are the No. 1 frustration of doctors today. A recent physician survey from a leading hospital company also revealed that physician satisfaction with EHRs is only in the 20 percent to 30 percent range.
No other industry would accept customer satisfaction rates at this level. Now the industry is asking them to use the same technology to help them practice medicine in an entirely new way with a focus on quality over quantity. We are setting our doctors up for failure.
This is not to say that value-based reimbursement is poised for failure. The transition holds immense opportunity for the industry and could revolutionize the way that care is delivered. However, it is unlikely that the challenge of value-based reimbursements will be met head-on until the Meaningful Use mess has been resolved.
First, the industry must take a step back and rethink how it operates—and it is going to take some time, creativity and a few missteps to get us there.
Ultimately, the computer must (and I believe will) become as integral and indispensable to patient care as the stethoscope, but there is a long way to go before all clinicians believe we are at that point. The foundation of digitized healthcare—the EHR system—is still a work in progress.
Many hospital executives surveyed in late 2016 said they continue to refine the EHR basics: improving interoperability, workflow and usability. This is important work, of course, because without this foundation, whatever is built on it will not stand, including the tools that are critical to success in the value-based world.
Providers should not let their frustrations with the current state of EHRs sour them on the potential for a value-based transformation. All constituents in the healthcare ecosystem have a stake in bringing the full value of healthcare IT to life, and all have a role to play in making this care model transition happen. With the right technology in place, coupled with the government stepping back from trying to legislate innovation, we can use these technological underpinnings to improve care quality and efficiency across the entire healthcare continuum, and then successfully implement a reimbursement system that encourages and rewards it.
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