By James E. Grue, OD,
Ronald P. Snyder, OD, FAAO,
Michael J. Lipson, OD, FAAO, FSLS
March 2, 2022
A new user to a clinical outcomes registry had an opportunity to review his data for the first time. “I feel like I am back in school about to get a report card!” he said. There is an important message in that statement. Why did he feel that way? Why would a provider be reluctant to see the analytics that represent the quality of care he delivers?
Here is why this doctor’s dread is unfounded given the rich opportunities available when you have clinical outcomes data, and why if he doesn’t start valuing his outcomes data by Oct. 6, 2022, his payors certainly will.
Drive Improvements to Care You Deliver
Access to your clinical outcome analytics represents the first time in your career that you will have accurate data to drive improvements in the quality of care you deliver. Without “real-time” data, you have no choice but to depend on “clinical observation and experience” to drive the decisions you make on how you should deliver care. With analytics, you have data that clearly shows where you should direct your efforts to get the highest return on improved care.
The U.S. is in the process of transitioning away from a fee-for-service model in which providers are mostly paid to do tests and procedures. Reimbursements are still not connected to the effectiveness of the care delivered or to clinical outcomes. Fortunately, all of medicine is moving toward a delivery system in which reimbursements will be increasingly and directly related to clinical outcomes.
The fundamental principle of healthcare reform is that the best way to keep costs down is by delivering the best possible care. The way the system will incentivize providers to deliver the best care is by paying providers who deliver the best care significantly better than the ones who do not. Clinical outcome analytics provide the data payors will use to make those determinations.
Step Two of a Major Transition
The steps in this transition to outcome-based care, in principle, are not complicated. The first step was to incentivize providers to utilize electronic health records instead of paper charts. We are now in the second step of this transition, which deals with interoperability standards. These standards allow powerful data, residing in our EHRs, to be shared with patients, other providers, payors and Health Information Exchanges. October 6, 2022, is the federal government’s deadline for the information-blocking rules to take effect, which will require the information in your EHR be available through interoperability standards to your patients, payors and other providers who participate in the care of the patient.
Healthcare reform was not started by providers. It was initiated by payors to get a handle on out-of-control costs and by patients who felt the care they received was delivered in a confusing and inefficient manner. That hasn’t changed. The current emphasis on interoperability is also being led by payors and patient advocacy groups. This directly relates to the activities that are occurring right now.
You May Not Be Eager to See Outcomes Data, But Payors Are
The October 6, 2022, deadline is not far off, and it is a critically important date in the transition to value-driven care. Unfortunately, there is little activity driven by providers to understand their clinical outcomes. In contrast, there is a flurry of activity on the part of payors, which will gain access, for the first time, to provider “report cards.” By October 6, the 21st Century Cures Act will require that your EHR have the ability to grant access to all patient data in your EHR to authorized outside entities, including payors.
All that data, which the provider at the beginning of this article was reluctant to see, will be available on Oct. 6 to the payors that reimburse that provider for care. This data, residing in your EHR, will paint a picture for the payors of the effectiveness of the care you deliver. Payors know this is powerful data. It will give them insights into the quality of your care that is not possible through clinical observation. Payors understand how clinical outcome data is going to drive the continued evolution of our value-driven healthcare delivery system. Now is the time for you to learn the value of clinical outcomes data. After October 6, 2022, you will not be able to prevent payors from gaining access to the information in your EHR.
The provider, who was reluctant to see his data for the first time, had the same reaction as almost all providers in that situation. The data confirmed that some of his assumptions about the quality of care were in fact true, but in other areas, his assumptions were way off the mark.
After viewing a demonstration of the data that is available to him, this provider’s attitude changed from apprehension to excitement. He was able to see exactly what clinical outcomes look like, taking the mystery out of the process. But more importantly, he now knows where the analytics can be improved and sees a clear path to improvement. He still has time to address those issues before his payors have access to his data.
Other Articles to Explore
Every provider today, whether knowingly or not, is making the decision about who gets his or her report card first. Will it be payors or the provider themselves? Providers, who know their clinical outcomes before payors get access to them, will likely be in a much better position to benefit from the decisions that payors will ultimately make as a result of access to this information.
Healthcare Registries, LLC, has educational materials on its site to introduce you to clinical outcomes. All of the articles and videos on this website are available to providers, at no charge. Visit www.healthcareregistries.com and click on the “Resources” tab. In addition to numerous articles, there is a series of videos that will show you what clinical outcomes look like and how to use them to improve the care you deliver. These resources will also help you understand the new opportunities to expand your practice that outcome analytics provide.
James E. Grue, OD, is a health-care reform speaker and consultant. To contact him: JimGrue@HealthCareRegistries.com
Ronald P. Snyder, OD, FAAO, is the president and CEO of HealthCare Registries, LLC. To contact him: RonSnyder@HealthCareRegistries.com
Michael J. Lipson, OD, FAAO, is the chairman of the OrthoK Advisory Panel of HealthCare Registries, LLC.