Where are we going depends upon where we have been
Where are we going depends upon where we have been

Affordable Health Care

The new “American Health Care Act” of 2017 has just been unveiled in Draft form and it looks as though some aspects of The Affordable Care Act will have to be sustained through a transition period. During that period Financial/Cost data are likely to be the Basis for the final version. Clinical data which is the evidence to support cost are based on patient encounters and procedures by Hospitals, physicians/clinicians in every conceivable treatment setting.

It all sounds very abstract, perhaps even scary not knowing what will happen with reimbursement. The one thing you can be sure of is that Hospitals and Clinicians will continue to provide care and the evidence of whether the care was too costly, inadequately provided, or lacks the quality data of “Best Practice.”

What do we need to do to keep moving forward and challenge the “scary” parts of the new Era in Health Care. Our answer to our clients is know your data and what it tells us and use “Deconstruction” of clinical data to take the scary out of where we need to be.

In a previous article we have discussed “Deconstruction” of Data as way that allows us to see where our institution sits or where our practice(s) are positioned for the challenges we face in a granular fashion.

Why is this so important in our decision making and survival? Major changes to our Health Care System have occurred under the Affordable Care Act. Many of these changes have forced small practitioners to join large practices in order to have the access to Electronic Records and monitoring health outcomes. These outcomes were to be rewarded with “Budget Neutral” bonus payments or sharing of savings. This has caused practice groups to become larger and unnecessarily complex; many practices have been acquired by Health Systems to help them meet the requirements of the ACA? So now where do we stand? In another change “Provider Based Facilities” have gone away. How does a large organization account for the loss of income when such facilities are reimbursed at the same level of a free standing Physicians practice?

Have these ACA changes made a difference in patient access, or quality? We don’t know because the measurements up to this point have been made on so little data that it is not possible to see. Such ideas as paying physicians for outcomes (Budget Neutral) is almost a fantasy and sends a message to all levels of providers that there is no integrity left in the Health Care Sector and that it takes Government to create integrity and quality.

Currently it is the volume of patients that creates income for providers but there must be a better way to have quality and reasonable cost without destroying the spirit and focus of Medical practitioners.

Our suggestion to many of our clients is not only to study the Mass of data available but to become granular in their approach, one patient at a time. Some of our clients are asking their own practitioners some basic questions: “who is managing the patient”, how are we documenting the daily status of patients by each of the disciplines involved in the care so that a “Big Picture” can be seen each day of the patient’s conditions in all of the setting in which care is provided. There is only one question that matters as we round on our patients: “is my patient better today?”   We, as an industry, and the insurers have done plenty of retrospective audits revealing reasons for taking away revenue or dinging the quality of care by examining documentation, coding and claims. We should not forget that physicians are being charged with fraud and some have gone to jail or have had to return large sums of money to the Medicare/Medicaid programs.

We have encouraged a new focus, one which really penetrates each practice from both a prospective and retrospective review, one that looks at the granularity of Care. The basis for the changes in CMS, e.g., forcing the compliance with “Value” reimbursement based upon fantasy rewards. This has sent a message that we who provide care cannot be trusted to maintain and improve integrity and quality without outside compliance. We must disagree by saying we can internalize our concerns discipline by discipline, patient by patient within each practice and within each setting.

We have high standards of care nationally, by clinical discipline; what we need are the data to examine how well we are doing for our patients. The answer is right in front of us, Clinical DATA. This is the point of intersection with “Data Deconstruction. It allows physicians and institutions (in any setting) to turn Data on its (their) heads and see in a very focused way just what one would see under a microscope; it allows practitioners to see in granular fashion what they have accomplished in terms of maintaining standards and watching the status of outcomes of each item on the Patient Problem List. Since we learned that all patients are different despite the use of “Macro Documentation” in our Electronic records, we must now understand the differences, measure the quality and improvements patient by patient.

Integrity cannot be taught, purchased or drummed into the heads practitioners, it has to be internalized and maintained just like good conditioning for a sports person. We must consider going back to basics, using “Deconstruction” as a way of both looking back and moving forward. Viewing patient encounters in a granular fashion, whatever the setting, is a way of making sure that “best practices” are put into place and maintained.

“Best practices” are not only universal but they must be “local”. So one might say, “The best practices are local” and everyone on the team who treats patients incorporates best practice techniques in what they do each day. Our next article will discuss how we rebuild integrity and encourage clinical folks to find it within themselves to be better and sustain quality. The reward is the status of the outcome which is the point of Medicine and the interventions used. It is not the promise of Fantasy rewards.

Cathy Idema, BSN, MPH, FAAHCC.

President and CEO

Website: www.hsmn.com

Email: Cathy@hsmn.com

Phone: 866-908-4226

Health Systems Management Network, Inc