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    Evolving your practice to meet quality-based reimbursement


    As such, many practices may find themselves having to invest in a broader set of EHR features or an entirely new software plus data connections to their EHR. Common features of these tools often include dashboards, learning aids, and lists of patients and specific clinical data points pertaining to measures and metrics the practice is interested in. Unfortunately, these programs often only contain a portion of a practice’s patients—the portion associated with the payer or program. Either way, it is critical to understand that implementing population health strategies requires more than just an EHR system. 

    These strategic investments must also include staff time to learn, understand and implement the use of these tools. When it comes to participating in the QPP, spending time, money or both must be considered investments with a long timeline to return on investment. 

    To this end, it is highly unlikely that the training and software will show significant financial returns in under 24 months. Even the two-year timelines established by the QPP (data reported this year will impact payment in 2020) only captures a small part of the time it takes to develop and integrate a population health program. As such, in addition to understanding the tools that are required for transformation, it is equally important to understand the financial impact.


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    The move to a population health-focused practice takes investment and yields returns that may span multiple years and come in the form of avoided penalties and earned bonuses from a variety of payment sources. Truly a mind-boggling accounting endeavor.

    Transformation is about human resource management

    The ultimate goal of all this change is to yield the sort of organization that layers thinking and action at two levels: the care of individual patients and for groups of patients. This requires staff in new or expended rolls to oversee the necessary granular steps for successful data capture, changes in care delivery based on insights from the analysis of that data and reporting the best of this data to CMS or other entities.

    This notion spawns several questions:
    • Who in the practice selects measures that are reflective of the work done by the clinicians?

    • Who understands and can train others as to where in the workflow needed discrete data elements can be captured and where in the EHR those data are recorded?

    • Who monitors the integrity of the captured data?

    • Who institutes and monitors improvement programs when gaps in data integrity are identified?

    • Who ensures there is accurate and timely transfer of data between the electronic health record and whatever analytics packages are being employed?

    • Who monitors and reports insights from the analytics package that allows clinicians to be alerted to gaps in clinical performance before data is reported to the payers?

    Next: The pace and price of change

    Adam J. Weinstein, MD
    Adam J. Weinstein, MD, is vice president of medical affairs, clinical IT services for DaVita Kidney Care, a part-time nephrologist in ...

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    • [email protected]
      Or...you can just opt out altogether and quit worrying about QPP. If you're an independent practitioner, this is an option. See Direct Primary Care.

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