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Recent research points to how community health information exchanges (HIEs) help reduce the cost of care, improve patient safety and decrease utilization and duplication. However, one potential benefit of community HIEs is just starting to be explored: increased revenue.
In an era of value-based care, community HIEs present an attractive opportunity to protect and increase revenue for physician practices.
When it comes to improving value, community HIEs have an advantage over a proprietary HIE, including fewer duplicated procedures, reduced imaging, lower costs and improved patient safety, according to research from Indiana University. Community HIEs enable physicians and other providers to share information about any patient whose data is captured within the HIE, while proprietary HIEs limit access to patient data to certain providers.
Here are three ways physician practices can leverage community HIEs to drive increased revenue.
Community HIEs can support compliance with transitional care management billing requirements.
The Centers for Medicare & Medicaid Services (CMS) estimated primary care physicians could increase collections up to 4 percent by offering transitional care management (TCM) services, while internists could see a 3 percent boost in collections.
However, complying with TCM billing requirements isn’t easy, in part because physician practices have a limited window in which to contact patients after discharge (within two business days) to receive TCM reimbursement. If practices are not aware that a qualifying patient was hospitalized, this makes TCM compliance extraordinarily difficult.
Related: Transitional care management: Coding and documentation in brief
When practices are part of a community HIE, they can establish an electronic admission/discharge/transfer (ADT) feed with area hospitals. This feed alerts practices when Medicare patients are discharged from the hospital to their home or an assisted living center. Such alerts help to ensure staff are aware of patients who require follow up and are able to contact patients within 48 hours of discharge, per TCM billing requirements.
Community HIEs support strong performance under value-based payment contracts.
Community HIEs give providers a critical line of sight into the care needs of complex patients, thereby boosting practices’ ability to enhance health outcomes at a reduced cost. For example, patients often neglect to share information that could be important to determining next steps in care, such as a visit to the emergency department (ED) with complaints of chest pain.
However, when practices have access to a community HIE, they can build automatic notifications into their electronic health record (EHR) that alert physicians to patients’ recent care interactions. So, in a few clicks, a physician could be alerted to a recent visit by the patient to an ED or urgent care facility and could then drill deeper to view details about the encounter. With this information in hand, the physician can explore the reasons for the visit, such as complications related to a patient’s chronic condition. These ensuing one-on-one conversations could lead to adjustments in the patient’s chronic care plan, effectively improving health outcomes and patient satisfaction while reducing costs.
