2016 is the Year of the Patient
By Fauzia Khan, MD
Now that EHR systems are no longer a distant “to do” project and wearable devices track our every move, we can finally acknowledge that information is not only widely available, but actively consumed on a daily basis. Whether we are mapping our daily run or closely managing a chronic condition, these valuable data points are strengthening the patient and provider relationship by enabling more accurate, real-time information that can support more personalized care. As we continue to get back into the swing of “business as usual,” I can’t help but think about the exciting changes that are coming to healthcare in 2016. Will this be the year that we see patients truly at the center of their care?
Here are my top 5 predictions for 2016.
1. More power to patients and families.
With mobile devices and apps at their fingertips, we have reached a tipping point where patients are finally active participants in their own health and wellness. However, much of this information is still fragmented. Therefore, demand for support tools will skyrocket as patients look for ways to enhance overall communication throughout the entire care team and effectively manage healthcare finances. Patients are looking for easy technology solutions that provide holistic support, not individual portions of their care.
2. Thinking beyond EHRs.
EHR adoption is the norm, but with so many varieties of standards, we will never get to true interoperability without landing on a single set of data standards and forcing all vendors to comply and open up their systems. We will finally stop talking about what a barrier EHRs are to innovation and how they control the desktop and access. We will start thinking of apps and systems that either sit on top of or outside of the EHR. Think of EHRs as smartphones with different apps!
Fast Healthcare Interoperability Resources or FHIR is a next-generation HL7 standards framework in healthcare data integration and is meant to facilitate interoperability. FHIR APIs will fuel innovation and we will start to see development of useful apps.
3. Documentation and HCC scores will add to physician office burdens.
The physician office bears many burdens and one of the biggest is continually combatting reductions in Medicare reimbursements. Though it has been around for many years, Hierarchical Condition Category (HCC) is one way to ensure that the physician’s office is being reimbursed appropriately, especially for Medicare Advantage plans. Because of the proven success of HCCs in predicting resource use, the model has been extended under the ACA to determine reimbursement for other programs including ACOs. With value-based reimbursements, more providers are assuming risk and the need to accurately document health status for their patients. Focusing on HCC coding and documentation is now also critical for commercial payers.
4. Chronic Care Management adoption barriers will be addressed.
Physician reimbursement from CMS for 20 minutes of non-face-to-face care per patient per month could provide a new revenue opportunity for physicians and enables greater freedom for patients. Unfortunately, according to recent surveys, half of responding healthcare organizations lack a formal chronic care management structure, and as a result, are missing out on this new reimbursement opportunity. Why are physicians not adopting this program more quickly? Though the program is one with many benefits, there are many barriers that need to be overcome in order to see increased adoption.
The American College of Physicians hopes to see legislation enacted this year to help remove the barriers, specifically waiving the copayment requirement and reducing the overall administrative burden to practices. The American Academy of Family Physicians has also echoed this sentiment. Chronic care management is definitely a topic of interest for many providers and I am hopeful that Washington will address these barriers quickly.
5. CMS will continue its path on alternative payments and release more options. Other payers will follow.
Alternative payment models are here to stay, and we are beginning to see more and more payers follow the lead of CMS. This year marks the introduction of bundled payments with CCJR and more are on the horizon. We will also see the Chronic Care Management Program act as a bridge from fee-for-service to value-based reimbursement. Chronic care management has already been introduced by United Healthcare and Humana, and I expect to soon see other payers follow suit as the benefits of the program start to be seen by physicians.
Fauzia Khan, MD is CMO of Persivia in Lowell, MA.