By Jim Grue, OD,
Ronald P. Snyder, OD, FAAO,
and Michael J. Lipson, OD, FAAO, FSLS
Sept. 7, 2022
Most medical practices have adapted to the changing climate of healthcare by converting to an “outcome-based care model.” It’s time for eyecare providers to make that switch as well. Here is how to do it.
What Will Payors Use Big Data For?
In our last article, “New Information Blocking Rules: How to Protect Your Professional Reputation,” published on July 13, 2022, we promised to further discuss the categories of analytics that payors will likely use to conduct audits to assess your outcome data. In addition to the category of Quality Indicator Analytics discussed in the last article, payors will use big data to create analytics which will show them:
• If your practice has successfully transitioned to delivering care guided by clinical outcome measurements, which is patient-centered, coordinated with the rest of the patient care team, and is outcome-based. Until now, making this transition has been voluntary. The enactment of guidelines to prevent information blocking will make it possible for payors to conduct audits to monitor your transformation.
• If your practice is sending the required reports to other providers, which include annual diabetic eye exam reports and post-op surgical reports when you co-manage cataract surgery.
Why Will Payors Perform these Audits?
The answer is simple. Analytics clearly show that when providers deliver outcome-based care, patients get better outcomes, at a lower cost. Also, patients get better outcomes when your exam data is shared with other providers. A better question is, why wouldn’t payors do these audits?
How to Prepare for these Audits?
Remember when you were incentivized to begin using an EHR? All of the features that your “certified” EHR has provided you as a result of Meaningful Use (MU) and MIPS were not put in place so you could just check-mark a report. They were put in place so you would have the necessary tools to deliver outcome-based care. Two reasons why you should make that transformation:
1) Your patients will get better treatment outcomes
2) Your practice will become more profitable and more efficient
Modifications to your office procedures to use the tools that are already available in your certified EHR will be required. As you read the rest of this article, think about simple changes you can make that will show that you are employing outcome-based care.
The 4 Things to Do to Make this Transformation:
1. Perform a thorough history on your patients
Analytics in most eyecare practices indicate that thorough histories are not being done. Payors expect providers to include any ocular side effects from the patient’s systemic conditions, as well as medications for those conditions, such as diabetes, hypertension and thyroid disease, to be included in the history. You can expect an audit of your practice to include these items.
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Outcome analytics show, for example, that if hypertension isn’t listed in the patient’s Problem List, the diagnosis of hypertensive retinopathy is dramatically reduced. Ensuring that a patient’s systemic conditions are listed in the patient Problem List is directly tied to better care delivery.
A more thorough patient history can be documented with supplemental history data from a third-party service such as Kno2 or Carequality. Ask your EHR vendor to integrate with one of these services. By using a third-party service, you will have a more thorough history, which will meet payor audit requirements. In addition to your documented history being more thorough, it will require less effort and lower your costs.
2. Subscribe to a clinical outcomes registry to analyze your patient clinical outcomes
If you are not currently using an outcomes registry, going back to the hypertension example, you will likely assume you are diagnosing the presence of hypertensive retinopathy every time that it is present. Data shows otherwise. The incidence of hypertension in the population is well known by payors. Payors also know the percentage of patients with hypertension who would be expected to have hypertensive retinopathy by the level of control and length of time the patient has been hypertensive. Payors can easily audit your data to see if it is consistent with these expectations.
The simple solution is to subscribe to and use a service such as Kno2 or Carequality. These services will add systemic conditions, such as hypertension, to your Problem List. Then, at the beginning of the exam, you simply review the Problem List and subsequently find that the percentage of time you identify hypertensive retinopathy will significantly increase.
3. Use the clinical outcomes from the registry to improve patient outcomes
Once you have access to your clinical outcomes data, you will immediately see many opportunities to improve your patients’ outcomes. Payors will know your outcomes data from their enhanced audits. They will then compare your outcomes to those of other providers. By using a registry, you can know and analyze your outcomes data. With that information, you can take steps to modify it to ensure payors see your practice as one with the best outcomes.
4. Share your plan with the rest of the patient care team
Employing a registry to analyze your clinical outcomes, and using those analytics as described, will improve the quality of care that you deliver. Once you evaluate your outcome analytics, you will immediately see the importance of sharing your improved patient outcomes with the rest of the patients’ care team. This will become the basis for a whole new level of referrals to your office from the other healthcare providers caring for the patient. Communication with the care team is done efficiently and securely with “Direct Secure Messaging.”
To get started using Direct Secure Messaging contact your “certified” EHR vendor.
To prepare for payor audits and join the rest of medicine in delivering outcome-based care, we recommend that you:
- Use Kno2 or Carequality to obtain a thorough patient history. You will expend less effort, require less staff time, lower your cost and document a much better history.
- Use a registry to measure clinical outcomes. If you are not using a registry, you will not know what kind of outcomes your patients are getting, but in the near future, payors will be gaining access and measuring your outcomes.
- Use outcome analytics to improve your patient care. You will find opportunities to significantly improve outcomes that are simply impossible to identify if you aren’t measuring them.
- Communicate and share the steps that you are implementing to improve patient outcomes with the rest of the patient care team. You will find there are opportunities to generate referrals from sources you have not previously participated with.
If you initiate these activities in your office, you will find you have more engaged and happier patients, get better outcomes and create a more profitable practice. You will accomplish this with less effort than the way that you are currently practicing.
James E. Grue, OD, is a health-care reform speaker and consultant. To contact him: JimGrue@HealthCareRegistries.com
Michael J. Lipson, OD, FAAO, is the chairman of the OrthoK Advisory Panel of HealthCare Registries, LLC.