Data reporting is key for success in VBP: challenges and cost

In the Value-Based Payment world (VBP), physicians are financially rewarded or penalized depending on the quality of care they provide or the outcomes their patients achieve. In order to determine which providers win and which lose in this scenario, data analysis is essential. This means that providers – many of whom only recently began implementing electronic health records – are now responsible for managing a tremendous volume of patient data. This responsibility comes at a high cost.

Challenge #1 – Data capture

Systems are in place to capture details about every patient encounter. To comprehend the level of detail required, consider the number of codes included in ICD-10, the coding system released by the Federal government in October 2015. ICD-10 includes roughly 68,000 codes, each of which correspond to a specific symptom, or a diagnostic or therapeutic intervention. Theoretically, physicians must be familiar with 68,000 different codes that indicate the precise reason for a patient encounter, as well as the examination, clinical testing, and treatments performed. When one considers that the previous version of codes, ICD-9, contained roughly 13,000 codes, it becomes clear that the current coding system that is the foundation of data capture for physicians is more than five times more complicated than its predecessor.

Challenge #2 – Accuracy

Given the complexity of the current coding system, ensuring accuracy is a major hurdle for many practices. In fact, a study in JAMA published last year found that just 23.5 % of EHRs contain data that agrees with patient-reported information regarding symptoms. Inaccurate or inconsistent data can hurt a practice by failing to report the full scope of services provided, thereby limiting reimbursement.

Challenge #3 – Lack of Standardization

Quality metrics may vary between private payers, federal and state value-based programs. This can present challenges to physicians who feel that they must measure the same metrics in a variety of ways in order to participate in a variety of programs. Further, claims data may lack the detailed information included in clinical data, which creates a discrepancy when claims data is used for quality purposes.

Challenge #4 – Storage & Security

Two sides of the same coin – storage and security of data are significant areas of concern for independent physicians. On-site or cloud-based storage options each offer their own pros and cons. Maintaining the security of patients’ protected health information as stipulated by HIPAA places the onus on physicians and their staff to implement technology-based and human safeguards on data.

These are but a few of the hurdles that independent physicians must overcome in order to participate in the ever-growing and evolving value-based payment programs that are essential to their survival.

Most find that it is simply not possible to manage this process on their own. Business consultants, IT companies, EHR providers and others are available to assist. HITS Consulting Group offers its clients a turnkey solution to managing many of these challenges, enabling physicians to focus on caring for their patients while we handle the data capture, management and reporting functions required by VBP programs.

How do you manage these challenges? Join the conversation here.

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