How Will Meaningful Use Affect RCM?

Alex TateBy Alex Tate, Health IT Consultant, CureMD
Twitter: @CureMD
Twitter: @alextate07

Meaningful Use is the incentive program with the intention of helping physicians provide better care to their patients through financial rewards and punishments. Those Eligible professionals (EPs) who choose not to demonstrate meaningful use of electronic health records (EHRs) are about to face a 1% penalty in their Medicare reimbursements. These penalties will increase by 1% each year until 2019 when they finally cap-off at 5%. And just to make it that much more aggravating, EPs won’t get away with a one-time demonstration, they must continue to demonstrate meaningful use each and every year through 2019 to avoid these penalties.

The Centers for Disease Control and Prevention has reported that, by the end of 2013, 78% of office-based physicians were using some form of EHR and 69% were planning on applying for meaningful use incentives.

Meaningful Use and Its Effects on RCM
Since the advent of value-based (VB) care and reimbursement models, more and more physicians are being held accountable for the value of the services they provide and being paid for that value instead of for the services themselves. The big question of course is, how will meaningful use affect the Revenue Cycle Management systems and operational processes that have been in place and supporting a fee-for-service structure for decades?

Additional Costs
Let’s start with the most obvious effect of meaningful use on RCM which is the added high cost providers are expected to absorb to pay for software and extensive training. An InformationWeek survey estimates that 62% or providers who are currently or plan to implement an EHR will wind up spending more than 20% of their yearly IT budget on meaningful use-related projects in the coming year.

And, in a “damned if you do, damned if you don’t” scenario, those EPs who decide they can’t afford the software upgrades and necessary training to comply with meaningful use are still going to get hit with those nasty penalties. So, either way, providers can expect a financial disruption of some sort.

Cumbersome Enrollment Ultimately Means Delayed Incentive Payments
Large physicians groups require proxy access to be able to manage enrollment and attestation after the 90 days. Let’s say a healthcare facility has put up the money to invest in a quality EHR system and desires to implement meaningful use objectives on behalf of their physicians. But, without proxy access, it’s a bit of a nightmare to have 300+ physicians enroll individually and attest. A centralized process where the attestation can be done on their behalf is greatly needed.

Although CMS has been made aware of the issue, they have not set a timeframe in cement as to when that proxy will be given. The result is, the groups that are ready to enroll and start their 90-day demonstration are waiting and waiting, and all of that waiting translates into delayed incentive payments and a loss of revenue.

The Incentive Payments are a Pittance
The phrase “incentive payment” sounds very appealing until you realize it only covers 20-25% of the overall costs most providers are faced with when implementing an EHR to become compliant. In order for providers to not take a significant hit to their revenue cycle, two things need to happen: 1) There needs to be an increased level of funding by the government and 2) physicians who plan on signing up for meaningful use may want to speak with their bank about a loan or second line of credit that will cover the added expenses.

Meaningful Use Sheds new Light on RCM Systems
In order to be truly successful in a value-based market, physicians must know what is happening with their patients clinically, financially and demographically. The great news is RCM systems are ready, willing and able to offer this data. In fact, they have been collecting this data for years, hoping someone would notice and ask for it.

Thanks to the continual health care reform changes, data is now front and center. So, providers can no longer see their RCM system in a one-dimensional light, but acknowledge and use the many tools provided that will help house, pull, integrate, aggregate, mine, and present data as necessary.

Understanding True Cost of Delivering Care
Meaningful Use has the ability to help providers truly understand the cost of delivering care to their patients, especially to expensive populations. Only by understanding these costs and matching them to revenue can providers truly manage their revenue cycle and gain the control necessary to succeed in a value-based economy.

There are a host of tools that can help you understand the cost of care your practice is delivering:

  • Cost Accounting Systems track costs across the continuum of care.
  • Scheduling Systems can incorporate referral management so your front staff can easily Manage Patient Care Coordination.
  • Population health management systems help you manage care for a defined population.
  • Productivity management systems manage all of the resources associated with your clinical processes.
  • Health information exchanges collect and share essential patient data from multiple sites of care delivery.

This is not a comprehensive list of tools by any means but simply to illustrate how you may gain hold of your Revenue Cycle Management to determine exact costs of care. Many of these tools are already included in your EHR system, so check with your vendor if you’re unsure.

There’s no denying that Meaningful Use comes with its own forms of pros and cons. There’s also no denying that Meaningful Use is a reality whether we like it or not. While added costs can definitely be expected, the key is to use this new value-based model to your advantage to gain even more control over and manage your revenue cycle.