From just coping to making profits

April 26, 2014

Practices are reeling from the constant state of change they face in terms of chaotic regulatory influences, evolving technologies and increased patient expectations, and it is difficult, if not impossible, to predict how the healthcare landscape will look in the coming decade. The stuttering tremors of ICD-10 illustrate one example of a seismic change that everyone knows is coming, but, like “the big one” in California, no one knows when the earthquake is really going to hit. Preparations for these changes must be made now, but more importantly, preparations for life after these changes must be considered as well.

I spoke with Dr. Todd Rothenhaus, Chief Medical Officer, Senior Vice President of Network Knowledge at athenahealth, just before the most recent delay of the compliance date for ICD-10. He shared with me his thoughts on the (at the time) quickly approaching coding changes, as well as other issues impacting practices now, and how they may be managed in the future.

How should people be preparing for ICD-10?

Dr. Todd Rothenhaus: I think one of the things people should be thinking about is looking hard at vendors that do a more comprehensive, or take a more comprehensive approach, to the support they give to their clients.

We were sitting with 100 percent of our clients essentially on an ICD-10-compliant system. That conversion is done. They have been using it. We have physicians placing future orders with ICD-10 codes for a month or so. It would make sense for folks to start thinking a little bit more about how much their vendor helps with things like Meaningful Use and ICD-10, and all the other regulatory requirements.

Are these things that are built into the service model that the vendor does, or are these opportunities for the vendor to charge a little more for a new module or an upgrade? The total return on investment for practice management hinges on whether or not there is a continuous loop of upgrades, as the government continues to regulate, and start and stop, and change things. It’s really just a good time to evaluate where the vendor is. These regulatory burdens are kind of a sweet spot for athenahealth, because we are in the cloud. We are able to write once and deliver our software changes instantaneously. We can be pretty nimble.

We are heading into a continuous state of insurance, well, I wouldn’t call it a state of insecurity, but we may come close to it. The exchanges are out there, and we are starting to see claims come through the exchanges. I will be glad to share some of that with your readers in about a month or so. We are looking and seeing the patient benefits are really not platinum, gold and silver, but they are closer to silver, bronze and sulfur. There is an enormous patient financial responsibility there. Self-pay is the new battleground.

Where do you think all of this is heading?

Rothenhaus: There are two areas to consider.

If you’re a medical group, combined practice management and EHR is critical. There is so much workflow support that needs to happen in the clinical space. For example, even in the process of making sure patients are efficiently checked in and out, the practice management system – used as a performance tool – needs to help. A unified practice management and EHR is a big deal, and a real benefit, as opposed to this discontinuous workflow that you get with having separate systems.

The second area is the movement to risk. It has become very significant. A lot of people thought this was a national experiment and was going to peter out. I don’t think anyone thought we would have 600 or 700 ACOs in the United States, with a huge percent of the population living in one of the service areas of an ACO. The fundamental shift to risk-based payment is ether going to be a giant national experiment that will take years to unwind, or it is permanent. The additional complexity of a revenue cycle entails clinical activity. In other words, success and risk means really good, honed clinical activity. It means you have got to have a practice management system that is bound tightly and coupled tightly with the EHR. The movement to risk isn’t something that only giant medical groups and active medical centers can do, but something that can be distributed out to smaller medical centers. We feel as though that’s a pretty significant portion of the medical economy. We would like to see those guys be able to do some profit taking in these risk-based systems.

Editor’s note: You can read the remains of my conversation with Dr. Rothenhaus on the HMT website within our “Online Only Features” section.

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