What you need to know about the Medicare Shared Savings Program (MSSP) performance results

A data activation platform company, Innovaccer, recently compiled data regarding the performance of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP). The organization’s report, State of the Union Report for Medicare ACOs, details the results of a proprietary algorithm Innovaccer used “to look at the quality, performance, utilization and expenditure data for every region in the U.S., based on the performance of Medicare ACOs participating in the MSSP in program year 2017.”

The study found that ACOs participating in the MSSP have generated $1 billion in savings since their inception. Going forward, the report adds that “adoption of value-based care models is expected to account for 59 percent of healthcare payments by 2020, as the healthcare industry uses value-based care to address these high-cost utilizers.”

As rising healthcare costs are of concern to patients as well as providers, researchers identified the top measures that contribute the most to healthcare expenditure per capita. Nine of the fifty-three parameters affecting the performance of ACOs were found to “the most significant.” Those included: long-term care hospital discharges; COPD or asthma discharges; skilled nursing facility discharges; emergency department visits; MRI events; unplanned admissions for patients with chronic conditions; use of imaging for low back pain; use of statin therapy; and controlling high blood pressure.”

Social determinants of health were also factored into the ACO performance data, “showing the vulnerability of all the states across the U.S. against the social factors affecting their populations.” The study found North Dakota to be the least vulnerable to social determinant factors and Hawaii to be the most vulnerable. Social determinants of health include socioeconomic factors, education level, economic environment, job opportunities, and social supports.

As of July 1, 2019, ACOs may participate in the Shared Savings Program for agreement periods of at least five years, under one of two tracks: the BASIC track (which includes a glide path for eligible ACOs), or the ENHANCED track, which offers the highest level of risk and potential reward. ACOs participating in the BASIC track’s glide path may begin under a one-sided model and progress through incremental levels of increasing risk and potential reward.

Nick Dealtry
October 17, 2019


Who really owns your patient data?

Implementing a new electronic health record (EHR) system involves many steps, including choosing a new EHR vendor, training staff on the new system, and migrating data from the old system to the new. The process of data migration may bring with it some surprises for the independent physician as well. The costs and challenges of working with your current vendor to transition to your new EHR can be significant for an independent practice.

The costs of migrating data can total tens of thousands of dollars. Many EHR vendors will charge independent practices for migrating their own data or will refuse to provide the data in an acceptable format for migrating to the new system. A recent article in Medical Economics explains that “Another frequently underestimated cost of switching EHRs is the price tag that comes with moving data out of the old application…. This process may involve fees to both the previous EHR vendor as well as the new one.”

The independent physician may also incur costs for managing the data, to ensure that it meets the requirements of standard structure and format. The Office of the National Coordinator for Health Information Technology (ONC Health IT) explains that:

In the absence of a contractual obligation that specifies the EHR vendor’s data transfer requirements, your outgoing EHR vendor may take the position that it can satisfy its obligations by providing you with all historical records in a format that is inconvenient or impractical rather than working with you in good faith to deliver the records in a standardized structure and format that is then generally accepted in the health IT industry.

Additional fees incurred during data migration could include outside consultants necessary for converting data to the acceptable format and archiving certain data that must be kept for regulatory requirements. Independent physicians are advised to negotiate and understand data transfer fees and processes with the initial implementation of the EHR system.

Unlike other vendors, Elation Health can import all the data from your old EHR, no matter the brand, with exceptional results. We can integrate full patient charts, including old notes, into your new Elation experience. We have transitioned data from many other vendors and can work with whatever system you may have.

Nick Dealtry
September 20, 2019


EHR implementation tips

The electronic health record (EHR) implementation process starts before you make the decision on which EHR solution to purchase for your independent practice. You will first need to determine your goals, assess your readiness, and prepare your team for the technology change. Patients will also need to know that you are implementing an EHR system, so communication and education will be necessary to ensure they are prepared as well.

Some EHR implementation tips that will help your independent practice be more successful with your new system include:

Prepare your team. Assess your team’s comfort level and understanding of computers, workflows, and clinical needs. It will be necessary, once your new system is in place, for your team to be trained on the EHR solution and the process used to optimize its effectiveness. They should be prepared to participate fully in learning how to properly use the EHR.

Prepare your patients. When your practice implements a new EHR system, there will be changes in the way you interact with your patients and in the way patients access their own medical data. Preparation and communication before implementation will ensure these changes are positive, benefitting both patient and independent practice.

Develop a plan. Include a timeline for announcing your new EHR, for training, for testing the system, and for fully implementing and using the EHR solution. Share the plan with all team members in the practice and encourage leaders within the organization to assist in implementing the plan.

Install the EHR. Work with your vendor on implementing the new system, migrating your data, and securing training for your team. Elation’s Clinical EHR takes less than one hour to learn and you will receive one-on-one implementation support from our dedicated team.

Seek assistance and guidance when you need it. With Elation, you will enjoy ongoing support. Your practice’s success is our primary focus, and we make it easy to get help when you need it. Contact us with the click of a button, on the phone, or via e-mail for unlimited, free support 24/7.


Nick Dealtry
August 30, 2019


Population health and social determinants of health

A patient’s health can be determined by genetics, lifestyle, and other factors specific to that patient. Other determinants, however, may become more significant factors for that patient and for the population of patients that share similar determinants. These social determinants of health contribute to the patients’ adverse and complex health conditions, such as obesity, heart disease, and diabetes.

Social determinants of health (SDOH), as defined in a recent NEJM article, are “intangible factors such as political, socioeconomic, and cultural constructs, as well as place-based conditions including accessible healthcare and education systems, safe environmental conditions, well-designed neighborhoods, and availability of healthful food.”

The Centers for Disease Control and Prevention (CDC) indicates that “differences in health are striking in communities with poor SDOH such as unstable housing, low income, unsafe neighborhoods, or substandard education.” A 2018 consumer survey “that 68% of consumers had at least some level of SDOH challenges. The most commonly reported issues are financial insecurity and social isolation. Individuals with high social determinants of health stress are 50% more likely to suffer from chronic conditions and 2.3 times more likely to rate their health as ‘fair’ or ‘poor.’”

For the primary care physician, social determinants of health can impact decisions made for population health management, in particular regarding treatment plans, prescriptions, and even nutritional recommendations. The physician must take into consideration whether patients can afford to eat healthy foods, fill their prescriptions, and follow other plans of care that may be out of their range either financially or logistically.

As suggested by Healthcare IT News, “As a better picture can be painted about patient populations, clinicians can better target populations who may be in need of additional services. These small upfront costs can help reduce the need for more major and costly treatment later on.” When the primary care physician develops a more in-depth understanding of the circumstances that patients experience, including such factors as whether they have access to transportation or whether they experience food insecurity, the provider will be better equipped to “find easy-to-solve problems outside of the care environment that can have a huge and costly impact on a patient’s well-being.”

Nick Dealtry
August 2, 2019


IPAs and value-based care

Independent physicians who want to remain independent but who feel the need to be part of a larger organization in order to provide value-based care more efficiently might consider joining an independent physician association (IPA). The IPA offers independent practices more bargaining power but enables all of its members to remain autonomous in their daily practice management.

The AAFP defines the IPA as “a business entity organized and owned by a network of independent physician practices for the purpose of reducing overhead or pursuing business ventures such as contracts with employers, accountable care organizations (ACO) and/or managed care organizations (MCOs).”

Independent practices might be better equipped to participate in value-based care as part of an IPA. As a recent article in Medical Economics explains, the IPA can “help practices transition to value-based care by providing the administrative support, tools and negotiating leverage that comes with size.” The original intent behind the concept of the IPA was to focus on fee-for-service rates, but with the movement toward value-based care, IPAs are now transitioning to negotiating value-based contracts.

Though independent physicians may be understandably concerned about maintaining their independence while joining a larger group, AAFP emphasizes that “Such strategies also enhance physicians’ access to the capital and management resources necessary to pursue cooperative business ventures such as managed care contracts and direct health care services contracts with employers.”

AAFP outlines the many potential benefits for an independent physician joining an IPA, including many that will contribute to more effective and more efficient delivery of value-based care:

  • Appropriate alignment of physicians’ financial incentives
  • Efficiencies in practice administration and management
  • Political influence within the medical and wider provider community
  • Peer support
  • Optimized facilities
  • Enhanced ability to negotiate favorable contracts with other entities such as MCOs, ACOs, radiology, laboratory, and hospital systems
  • Autonomy and local financial and care management control in managed care
  • Improved services, including expanded hours, urgent care, outreach services for prevention, telephone triage, and follow-up expertise.

Nick Dealtry
July 25, 2019


How ACOs could better utilize EHRs

Accountable care organizations (ACOs) are “composed of doctors, hospitals, or other healthcare providers that come together voluntarily to coordinate high-quality care for their patients and agree to be accountable for the total cost and quality of the care provided.” The idea behind the ACO concept is to enable independent physicians to realize the benefits of being a part of a larger organization while retaining autonomy in their own practices. ACOs also work to improve population health.

In May 2019, the U.S. Department of Health and Human Services Office of Inspector General published the results of its research into six Medicare ACOs that use health information technology for care coordination. The study offers “insights into how select ACOs have used health IT tools to better coordinate care for their patients.”

The Office of Inspector General conducted interviews during site visits to four Next Generation ACOs and two ACOs that participated in the Medicare Shared Savings Program. The ACOs were selected for the study based on “their performance on a quality measure focused on care coordination and patient safety, a minimum of 3 years of experience as a Medicare ACO, geographic variation, and recommendations from CMS and ONC (Office of the National Coordinator for Health Information Technology).”

After reviewing how each of the ACOs used information technology, including electronic health records (EHRs), the study concluded that “the full potential of health IT has not been realized.” The ACOs that used a single EHR system across all of their provider networks had the ability to share patient data in real time, optimizing their ability to coordinate care for their patients. However, ACOs that used multiple EHR systems faced challenges.

Interoperability, the electronic sharing of patient information between different EHR systems and healthcare providers, is a major concern for ACOs relying on health IT tools. Coordinating care effectively depends on EHR interoperability. “Achieving the interoperability needed for seamless care coordination places burdens on ACOs to either invest in a single EHR system, or use additional methods, such as non-health IT means like faxes and phone calls, to communicate health information.”

The study concludes by suggesting that “Some of HHS’s proposed initiatives might address concerns and challenges that we heard from ACOs. For example, ONC’s Trusted Exchange Framework and Common Agreement has the promise of facilitating interoperability across health IT networks, which might mitigate the problem that ACOs had in accessing data from HIEs (Health Information Exchanges) with little or incomplete data. With interoperability, an ACO would be able to access patient data even when patients visit providers outside the ACO.”

Nick Dealtry
July 8, 2019


New data shows patient satisfaction and care quality improvements with EHRs

Patients are finding that more physicians are taking advantage of electronic health record (EHR) capabilities than just ten years ago. In addition, those patients believe that their physician’s use of an EHR improves the quality of the care they receive as well as their interactions with their physician. These findings are included in the January 2019 KFF Health Tracking Poll, published by the Henry J. Kaiser Family Foundation.

The poll found that the number of physicians entering patient data into a computer-based medical record, according to the patients responding, almost doubled from 46 percent in 2009 to 88 percent in 2019. Patients participating in the research mostly see the use of EHRs as helpful, although many also had concerns about data security and accuracy.

Among participants in the survey who said their physician uses an EHR, 45 percent said the EHR use has made the quality of care they receive “better.” Almost as many, 44 percent, of those patients also said the physician’s use of an EHR has made their interactions with that physician “better.”

Patient responses differed according to their age group. The youngest patients reported the “most positive effects.” A majority of the poll participants in the age group 18-29 said that the quality of the care they receive is “better” since their physicians uses EHRs. No one in this age group reported their quality of care as “worse.”

Data security was a concern for many of the patients responding to the poll. Over half (54 percent) reported that they felt “very concerned” or “somewhat concerned” that someone might be able to access their confidential medical information who was not authorized to do so. Again, the younger age group had fewer concerns about their privacy with only 42 percent reported being “very” or “somewhat” concerned about an unauthorized person gaining access to their medical record.

Although some patients were concerned about errors in their medical records, 54 percent said they were “not too concerned” or “not at all concerned.” The majority did not think that errors or discrepancies would negatively impact the quality of care they receive from their physicians.

Nick Dealtry
May 30, 2019


What is care collaboration?

Proper and effective medical care often involves multiple providers as well as the patient and the patient’s family. Coordinating that care can mean the difference in the quality and consistency of the patient’s healthcare plan. Communication is a key factor in care collaboration, whether electronic or in person.

In care collaboration, physicians communicate and coordinate with each other to ensure they are treating the patient appropriately. Providers communicate and coordinate with the patient and the patient’s caregivers to ensure that instructions are being followed properly.

The AMA states that collaborative teams “are defined by their dedication to providing patient-centered care, protecting the integrity of the patient-physician relationship, sharing mutual respect and trust, communicating effectively, sharing accountability and responsibility, and upholding common ethical values as team members.”

Care collaboration can be beneficial in crisis situations as well. Researchers at the University of Michigan have found that a collaborative team-based approach, along with the use of medication assisted therapy (MAT), can have a significant impact on the rate of opioid addiction in the US. The researchers found that “many of the two million Americans addicted to opioids can receive treatment and assistance in getting off prescription painkillers or heroin from a primary care team.”

Additionally, a study published by the AMIA Annual Symposium, the authors stated that “experts have agreed that more collaborative, team-based care will be required to meet the increasing burden of chronic disease.”

Collaboration through the use of advantaged technology significantly improves the quality of care coordination by helping to ensure the accuracy of the information being shared as well as speeding up the process by which it is shared. Taking advantage of collaborative health record technology can help with the physician’s main focus – providing the highest quality care for patients.

Elation’s Collaborative Health Record (CHR) enables providers to immediately share updates so that all providers caring for the patient can take action based on the most up-to-date clinical information. Most importantly, the CHR closes care gaps. Providers can decrease duplicative testing and avoid medication errors with uninterrupted communication. Timely sharing of patient information helps ensure care is as efficient and as effective as possible.

Nick Dealtry
May 30, 2019


The movement around independent physician associations

Independent physicians who want the advantages of belonging to a larger organization while at the same time retaining their autonomy are choosing to join independent physician associations (IPAs). An IPA is, according to the AAFP, “a business entity organized and owned by a network of independent physician practices for the purpose of reducing overhead or pursuing business ventures such as contracts with employers, accountable care organizations (ACO) and/or managed care organizations (MCOs).”

IPAs are growing, as more independent physicians recognize that they need collaborative power when negotiating contracts or navigating complex reporting requirements. In fact, the IPA Association of America (TIPAAA) says that it represents over 300,000 physicians who are associated with IPAs.

Independent physicians find that they are able to focus more on their patients and less on administrative tasks when they are part of an IPA. One study, conducted of 1164 practices that had 20 or fewer physicians, has shown that “physicians participating in IPAs provided about three times as many care management services for their patients with more than one chronic conditions as compared to non-participating practices: 10.45% over 3.85%.”

When asked about the movement around IPAs, Scott Kronlund, MD, MS, the President and CMO at Northwest Physicians Network in Tacoma, the largest IPA in Washington, confirmed that there is definitely an increased interest in IPAs among independent physicians. Dr. Kronlund noted that “The marketplace is too complex for private practice physicians to survive on their own — they need help synthesizing data and responding; they need support so they can be flexible in this ever-changing environment.”

Dr. Kronlund added that his group began with 375 members and has grown to over 1,000 independent physicians. He attributes the movement around IPAs to the many challenges faced by independent physicians, including clinical integration, administrative burdens, and negotiating power that helps increase revenue. Many independent physicians are not able to participate in shared savings programs due to the economies of scale. IPAs can also benefit independent physicians by playing a key role in the implementation and optimization of healthcare technology, including electronic health records.

Nick Dealtry
March 27, 2019


Interoperability a focus at HIMSS 2019

Among the many pertinent and educational topics featured at HIMSS19, held in February 2019, was Health Information Exchange, Interoperability, Data Integration & Standards. Participants were encouraged to explore “all aspects of information exchange, interoperability, data integration and standards across technical and administrative strategies that contribute to sustaining the healthcare enterprise and enabling a positive consumer experience.”

HIMSS19 brought together over 45,000 healthcare professionals, including health information and technology professionals, clinicians, executives and market suppliers, featuring the theme “Champions of Health Unite.” Interoperability was a key focus at the conference. In fact, according to an article published by Mobihealth News, interoperability stood out among the extensive list of educational topics presented at the annual conference.

Mobihealth noted that interoperability has been on the conversation and seminar list for several years at the HIMSS conferences, but “this time there was a sense that all the effort that’s gone into creating HL7, FHIR and other data standardization and sharing tools is finally paying off.” The topic of interoperability also included discussion of the new rules proposed by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

Several sessions featured interoperability and the move to artificial intelligence (AI) in the medical field. Sessions included Style Standards to Improve Data Quality and Interoperability, focused on improved interoperability’s accuracy as well as the overall process. Another session, From Print to Interoperability: Cancer Staging in the EHR, looked at leveraging the EHR for cancer staging and transitioning from print to a truly interoperable electronic format for medical records.

The session, Enabling Data Interoperability Across the Continuum of Care, was presented by leaders from CMS and ONC. Presenters discussed the organizations’ goals around health information technology (HIT) vocabularies and how Fast Healthcare Interoperability Resources (FHIR) can enable data exchange.

The conference also featured an Interoperability Showcase where attendees could see technology solutions and learn more about interoperability topics that may impact them.

Nick Dealtry
March 22, 2019