With the recent Supreme Court ruling on the Patient Protection and Affordable Care Act, there is little doubt that CMS' Hospital Value-Based Purchasing program will come to fruition. As the October 1, 2012 start date for the program looms, hospital executives may be deciding which health information technology initiatives are most crucial to surviving reimbursement reforms. According to "Getting From Volume to Value in Health Care: Balancing Challenges & Opportunities" published in Forbes Insights, 47 percent of healthcare executives claim health information exchanges are their top IT strategies and spending priorities for surviving the Hospital VBP Program.
The Hospital VBP program focuses on quality measures specifically for Medicare patients. However, since commercial reimbursement models are also moving toward value-based purchasing, hospitals may need to utilize HIEs as a method for increasing clinical quality and receiving payments across all patients and reimbursement types.
"[The move toward value-based purchasing] is just another indication of where the healthcare industry is heading. It makes sense that the government — the main payor for healthcare services — would expect a higher quality of care for its money. Consumers paying for commercial products would expect the same type of quality," says Dave Caldwell, executive vice president of Certify Data Systems.
In order for hospitals to achieve higher quality services — and succeed in the CMS Hospital VBP program — coordinating care across the healthcare continuum is important. This is where health information exchanges will have a massive impact. "VBP is all about measuring quality and then paying on quality rather than volume. For this reason, HIE within a hospital is obviously important. Two other key components are electronic health records and data analytics. While all three are essential, if you can't exchange data to reach quality measures, then the digitized data is not as impactful," says Nancy Fabozzi, principle analyst in the healthcare practice of Frost & Sullivan.
Initiative
If there was one mistake that hospitals have made, Mr. Caldwell says that not many hospitals have taken the initiative to work with HIEs. More hospitals seem to be waiting for a leading hospital or their state to set an example on HIE strategy. Although some health systems like Advocate Health Care and Memorial Hermann have been successful with HIEs, other hospitals should try to take the initiative as much as they can. "Despite incentives like the American Recovery and Reinvestment Act of 2009, many organizations have decided to wait and see what their state does, or just to wait in general. In my perspective, I think that is a risky proposition to expect a state to support a private enterprise with an HIE," says Mr. Caldwell.
Full data integration
Electronic health records have allowed hospitals to digitize a great deal of data, increasing the data's functionality and impact on quality. However, a lot of patient data is still silod within hospitals. According to Ms. Fabozzi, hospitals need to integrate all of their data, including financial and administrative data, in order to be successful with VBP. "Hospitals have not done a good job of putting all their data pieces together within the organization as well as external to the organization. Digitizing the data is the first step, but the data also has to flow. The industry is never going to get full VBP reimbursement without robust HIE internally and externally," says Ms. Fabozzi.
Data standards
According to Ms. Fabozzi, there is lack of data standards for EHRs which complicates a hospital's ability to exchange data. "One diagnosis can be referred to in many different ways. Without standards around patient identification, clinical data and terminology, the quality of data may be questioned," says Ms. Fabozzi. When the quality of the data is questionable, the quality of the care may also be questionable. For this reason, it may be difficult to make a realistic assessment on quality and value, and this can hamper the data exchange.
Although there are some major barriers, some hospitals have been successful with HIEs. Here Mr. Caldwell and Ms. Fabozzi discuss five approaches to help hospitals and health systems with HIEs so they may produce the interoperability and improved quality measures the healthcare industry desires.
2. Be realistic. It is important for hospitals to be realistic with their goals and expectations for the HIE. According to Mr. Caldwell, the mentality that independent physicians are going to put all of their patient data into a central repository without any incentive or guarantee that their patient data will be protected is asking too much. Hospital executives need to understand physicians' concerns in order to properly work with them on an HIE. "Hospitals need to understand the business model for the employed and independent physicians they rely on. Then, they need to set realistic goals for the amount of exchange they expect to occur," says Mr. Caldwell.
3. Learn from the past. According to Mr. Caldwell, hospitals need to use the past to inform future work with HIEs. "The industry has been pushing for a centralized HIE model, but so far that has not worked. It has rarely worked in other countries. The problem is that no matter how much we think healthcare is altruistic, there is competition in the industry," says Mr. Caldwell. Rather than trying to set up a centralized model, Mr. Caldwell believes that each hospital should assess what is necessary for interoperability for itself and its community. The goal should be to improve quality of care through networked interoperability in a distributed model rather than trying to set up a centralized HIE.
4. Set up clear goals for value outcomes. According to Mr. Caldwell, it is very important to have a clear goal for an HIE from the get-go. "There has to be clear goals around quality parameters especially since HIEs are driven most by reaching value," says Mr. Caldwell. Ms. Fabozzi agrees that in order for an HIE to enable the quality outcomes hospitals need for success in VBP payments, the value goals need to be clear. "Officials need to ask themselves what they are measuring and why. Why do those measures equate value? What do really need to know? What will give a clear estimate of the value of care? You can exchange data, but if you are not clear on why certain data is exchanged and under what standards, then you are not going to reach the value you need," says Ms. Fabozzi.
5. Conduct a thorough vendor evaluation. The market is highly saturated with HIT vendors which can make selecting an HIE model or vendor confusing and overwhelming. Mr. Caldwell recommends hospital executives conduct a thorough evaluation of HIE vendors in order to heighten their chances for selecting a stable HIE vendor. "Some HIE vendors can be misleading in their marketing. In addition, the amount of vendors in the market creates a lot of noise. When hospitals spend a lot of time and effort with an HIE company, they do not want to be unsatisfied at the outcome. They need to do their homework and compare their options," says Mr. Caldwell.
UPMC-Backed Health Information Exchange Connects Pennsylvania Hospitals
Catholic Health Initiatives Launches HIE Project
The Hospital VBP program focuses on quality measures specifically for Medicare patients. However, since commercial reimbursement models are also moving toward value-based purchasing, hospitals may need to utilize HIEs as a method for increasing clinical quality and receiving payments across all patients and reimbursement types.
"[The move toward value-based purchasing] is just another indication of where the healthcare industry is heading. It makes sense that the government — the main payor for healthcare services — would expect a higher quality of care for its money. Consumers paying for commercial products would expect the same type of quality," says Dave Caldwell, executive vice president of Certify Data Systems.
In order for hospitals to achieve higher quality services — and succeed in the CMS Hospital VBP program — coordinating care across the healthcare continuum is important. This is where health information exchanges will have a massive impact. "VBP is all about measuring quality and then paying on quality rather than volume. For this reason, HIE within a hospital is obviously important. Two other key components are electronic health records and data analytics. While all three are essential, if you can't exchange data to reach quality measures, then the digitized data is not as impactful," says Nancy Fabozzi, principle analyst in the healthcare practice of Frost & Sullivan.
Health information exchanges: The industry is lacking…
Unfortunately, some hospitals have struggled with implementing and utilizing HIEs. Generally, the three following barriers face hospitals the most often.Initiative
If there was one mistake that hospitals have made, Mr. Caldwell says that not many hospitals have taken the initiative to work with HIEs. More hospitals seem to be waiting for a leading hospital or their state to set an example on HIE strategy. Although some health systems like Advocate Health Care and Memorial Hermann have been successful with HIEs, other hospitals should try to take the initiative as much as they can. "Despite incentives like the American Recovery and Reinvestment Act of 2009, many organizations have decided to wait and see what their state does, or just to wait in general. In my perspective, I think that is a risky proposition to expect a state to support a private enterprise with an HIE," says Mr. Caldwell.
Full data integration
Electronic health records have allowed hospitals to digitize a great deal of data, increasing the data's functionality and impact on quality. However, a lot of patient data is still silod within hospitals. According to Ms. Fabozzi, hospitals need to integrate all of their data, including financial and administrative data, in order to be successful with VBP. "Hospitals have not done a good job of putting all their data pieces together within the organization as well as external to the organization. Digitizing the data is the first step, but the data also has to flow. The industry is never going to get full VBP reimbursement without robust HIE internally and externally," says Ms. Fabozzi.
Data standards
According to Ms. Fabozzi, there is lack of data standards for EHRs which complicates a hospital's ability to exchange data. "One diagnosis can be referred to in many different ways. Without standards around patient identification, clinical data and terminology, the quality of data may be questioned," says Ms. Fabozzi. When the quality of the data is questionable, the quality of the care may also be questionable. For this reason, it may be difficult to make a realistic assessment on quality and value, and this can hamper the data exchange.
Although there are some major barriers, some hospitals have been successful with HIEs. Here Mr. Caldwell and Ms. Fabozzi discuss five approaches to help hospitals and health systems with HIEs so they may produce the interoperability and improved quality measures the healthcare industry desires.
5 ways to be more successful with HIEs in face of value-based purchasing
1. Support creation of consistent data standards. According to Ms. Fabozzi, data standards need to be created around terminology and data exchange for HIEs to be successful. While one organization cannot do this on its own, hospitals and health systems can support the government in its work toward creating standards for data and HIEs. "A lot of the sticking points with HIEs come from data standards. However, they are the first step toward a successful HIE. There is no question that the industry needs to implement standards for data," says Ms. Fabozzi.2. Be realistic. It is important for hospitals to be realistic with their goals and expectations for the HIE. According to Mr. Caldwell, the mentality that independent physicians are going to put all of their patient data into a central repository without any incentive or guarantee that their patient data will be protected is asking too much. Hospital executives need to understand physicians' concerns in order to properly work with them on an HIE. "Hospitals need to understand the business model for the employed and independent physicians they rely on. Then, they need to set realistic goals for the amount of exchange they expect to occur," says Mr. Caldwell.
3. Learn from the past. According to Mr. Caldwell, hospitals need to use the past to inform future work with HIEs. "The industry has been pushing for a centralized HIE model, but so far that has not worked. It has rarely worked in other countries. The problem is that no matter how much we think healthcare is altruistic, there is competition in the industry," says Mr. Caldwell. Rather than trying to set up a centralized model, Mr. Caldwell believes that each hospital should assess what is necessary for interoperability for itself and its community. The goal should be to improve quality of care through networked interoperability in a distributed model rather than trying to set up a centralized HIE.
4. Set up clear goals for value outcomes. According to Mr. Caldwell, it is very important to have a clear goal for an HIE from the get-go. "There has to be clear goals around quality parameters especially since HIEs are driven most by reaching value," says Mr. Caldwell. Ms. Fabozzi agrees that in order for an HIE to enable the quality outcomes hospitals need for success in VBP payments, the value goals need to be clear. "Officials need to ask themselves what they are measuring and why. Why do those measures equate value? What do really need to know? What will give a clear estimate of the value of care? You can exchange data, but if you are not clear on why certain data is exchanged and under what standards, then you are not going to reach the value you need," says Ms. Fabozzi.
5. Conduct a thorough vendor evaluation. The market is highly saturated with HIT vendors which can make selecting an HIE model or vendor confusing and overwhelming. Mr. Caldwell recommends hospital executives conduct a thorough evaluation of HIE vendors in order to heighten their chances for selecting a stable HIE vendor. "Some HIE vendors can be misleading in their marketing. In addition, the amount of vendors in the market creates a lot of noise. When hospitals spend a lot of time and effort with an HIE company, they do not want to be unsatisfied at the outcome. They need to do their homework and compare their options," says Mr. Caldwell.
More Articles on Health Information Exchanges:
Kaiser Permanente, Social Security Administration Launch HIE PilotUPMC-Backed Health Information Exchange Connects Pennsylvania Hospitals
Catholic Health Initiatives Launches HIE Project