Four of the five top issues this year for members of the Medical Group Management Association (MGMA) revolve around health IT. And even the fifth issue--rising costs--has some bearing on technology, whether you look at it as a glass half full (using health IT to increase efficiency) and or half empty (the cost of installing an EHR and learning how to use it).
In order, here are the key concerns of practice managers, according to an MGMA survey:
- Preparing for reimbursement models that place a greater share of financial risk on the practice
- Participating in the Centers for Medicare & Medicaid Services (CMS)' EHR Meaningful Use incentive program
- Dealing with rising operating costs
- Selecting and implementing a new EHR system
- Implementing and/or optimizing an accountable care organization.
Depending on an organization's stage of development, it might be implementing an EHR, attesting to Meaningful Use, preparing to take financial risk for care, or forming or joining an accountable care organization (ACO). But all of these are really points along a continuum that ideally leads toward higher-quality, better coordinated care. And at every step along the way, the indispensable tool is information technology.
One example is physician groups' changing attitude toward quality measurement. Currently, most group physicians are compensated largely on the basis of their productivity, whether that's measured in collections or work RVUs. But several respondents told MGMA researchers that they're adding quality metrics to RVU compensation models and initiating bonuses on such indices as patient satisfaction, health screenings, and hitting certain disease targets. None of that is possible without health IT, even if a practice uses billing data to measure quality.
The same is true for ACOs. When CMS recently announced its draft rules for ACOs, CMS Administrator Donald Berwick pointed out that the use of health IT is a "core competency" of the new organizations. And in fact, the groups that participated in CMS' Physician Group Practice demonstration -- a precursor to ACOs -- all invested heavily in information technology.
As for the various risk models under discussion, no organization that takes financial responsibility for any part of patient care can manage that risk well without having access to data about the utilization and cost of services. ACOs will clearly need health IT for the Medicare shared savings program. CMS' bundling demonstration, which moves into high gear in 2012, will likewise require heavy use of electronic data. And for groups to receive maximum Medicare reimbursement, starting in 2015, they'll have to hit the quality benchmarks in CMS' new value-based purchasing program -- an impossibility without the use of EHRs.
So, from the group practice point of view, health IT is essential to the future of their business. Of course, MGMA member groups have three or more doctors, and many include far more physicians than that. So the MGMA respondents are probably not representative of the many smaller practices that are still in the early stages of figuring all of this out. But in more and more markets, large groups and healthcare systems are swallowing these one- and two-doctor practices. As that consolidation continues, the comprehensive use of health IT to measure and manage quality and risk will become the norm, rather than the exception. - Ken