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Why an EHR System is Necessary to Excel in the ERA of MIPS (Part One)


Dr. Jason Weisstein is presenting at the AAOE 2017 Annual Conference in Indianapolis. His session, titled “Strategies to Outperform Your Peers in the New Era of Value Based Healthcare and MIPS,”will be taking place Saturday, April 22 from 4:00 – 5:00 PM.

As an orthopaedic surgeon, it is still astonishing to me how many of my peers are unaware of the full implications of the Medicare Access and CHIP Reauthorization Act (MACRA) and how or why they need to be ready and what they can do to prepare. With the industry switch to value-based care under the Merit Based Incentive Payment System (MIPS) the need for technology, specifically an electronic health record (EHR) system, is now, more than ever, a necessity. I often hear a lot of grumbling from colleagues on needing to implement an EHR system and how they are pointing the finger at EHR systems as the cause of physician burnout. I strongly believe (I am an active EHR system user and actually help to code a specialty-specific EHR system) that implementing the right technology will eliminate this perceived burden and will help you excel under the new reimbursement model, and put you on the path for financial success.

As a physician, having the right EHR system in place can ensure your practice achieves clinical, financial and operational success. While there are many components to your MIPS score, I want to focus in on a few factors that can be key differentiators with EHR system vendors including structured/discrete data, real time analytical tools, and specialized registries. Having these features in the EHR system you use in your orthopaedic practice will put you on the path to excel under MIPS.

The Value of Structured/Discrete Data
It is certainly understandable that selecting and/or switching your EHR system is an investment of time, money and training. Working with a company that has the ability to capture structured, actionable data and automate patient and regulatory compliance documentation in near real-time is crucial. While you need to thoroughly vet an EHR vendor, it is crucial to focus on the importance of data, specifically what is known as discrete or structured data. Discrete/structured data is the opposite of narrative data. It is capturing specific data points with each patient encounter. Let’s look at a non-clinical comparison.

Think of the Microsoft Office Suite. Microsoft Word would be considered narrative data – everyone inputs different text and writes about the same topic differently. The text is loose and not captured in the same fashion, and you would not be able to compare apples to apples from one user to the next. The opposite of this is Microsoft Excel which would be an example of structured/discrete data. Information is tracked in a standardized fashion in organized fields with formulas, and you would be able to compare data from person to person, business to business since it was captured in the same way.

Now let’s bring it back to why this matters. Structured data is mineable data – data that can be uniquely identified retrospectively. Such data is important for group analytics, research, and the imminent obligations the government and payers are placing on orthopaedic groups.

You want to employ an EHR system to automatically capture all the data you need at the point of care to build and report your composite MIPS score to maximize financial success.

Importance of Analytical Tools
Now let’s transition into the topic of analytical tools within your EHR system. You want to look for a vendor that offers analytics tools that will: 1) document near real-time comparative benchmarking of quality and cost to peers, and 2) illustrate financial visibility to improve your bottom line and operations.

It is essential to have access to this real-time comparative benchmarking of both quality and cost data to succeed under MIPS. It should not only show individual clinician performance and practice performance, but also where you fall when compared to other orthopaedic surgeons.

Having access to financial visibility can aid in improving your bottom line and operations, which goes far beyond a MIPS score. Having peer-to-peer comparisons in real-time will give you the chance to make changes if necessary to better operationalize your practice.

From patient check-in to discharge, your analytics tool should enable you as a specialist to identify and track key clinical, financial and operational metrics to uncover insights to help optimize your practice. It should also help you measure and enhance your performance in making high-quality medical decisions and keeping costs down.

From my experience, your EHR system’s analytics platform should allow you as an orthopaedic surgeon to:

●      Unlock in-depth clinical data, billing, and financial reports to augment the built-in reporting tools of your EHR and practice management systems.
●      View real-time, national benchmarking.
●      Spot and respond to trends in payment patterns.
●      Compare outcomes and performance with other providers.
●      View charges, payments, and adjustments by payer groups.
●      Identify trends in reimbursement patterns before they affect cash flow.

Maximizing Specialized Health Registries

Another differentiating factor with EHR systems can be specialized health registries. One of the available additional measures under MIPS is active engagement with a clinical data registry which falls under the Advancing Care Information (ACI) and Improvement Activities for MIPS.

Having the ability to report to disease-specific registries for orthopaedics are key for participating in improvement activities. True population health improvement should be built upon outcomes not just claims.

Some examples of orthopaedic specific registries could include but are not limited to:
●      Medial Meniscus Tear, Acute Registry
●      Plantar Fasciitis Registry
●      Low Back Pain
●      Herniated Disc, Cervical Registry

Working with a vendor that is a qualified registry and can submit the MIPS data on your behalf is a valuable asset and can aid in increasing your MIPS score and getting ahead of the competition.

Stay tuned for Part Two to learn what EHR systems mean for the future of private practices and what you should look for in an EHR system.

About the Author
Dr. Jason Weisstein is the Medical Director of Orthopedics at Modernizing Medicine. He will be presenting on the topic of “Strategies to Outperform Your Peers in the New Era of Value-based Healthcare and MIPS” during the 2017 AAOE Conference.


By: Jason Weisstein, MD, MPH, FACS on in News