A few months ago, Clinovations’ Managing Partner Trenor Williams, MD, and I hosted a series of webconferences on EHR optimization that discussed the steps providers can take to get the most out of their investments.
Halfway through one of the calls, a listener asked: "Is it going to take hundreds of hours and lots of staff to create and maintain an optimized system?"
To some extent, the answer is yes. But health system and medical group leaders shouldn’t let that discourage them from pursuing these optimization efforts. Here’s why.
Two opportunities with multi-million-dollar potential
Several EHR optimization strategies not only improve care team efficiency and enable more comprehensive, coordinated care, but they also bring net new revenue into the practice—usually, more than enough to offset the ongoing costs of optimizing the system.
One strategy aims to increase the capture of Medicare Annual Wellness Visits (AWVs) through workflow redesign and a focus on documentation efficiency and compliance. While these visits are well reimbursed by Medicare, $140 per visit on average, and offered at no cost to Medicare beneficiaries, only 14% of eligible patients actually receive one. Depending on the size of your medical group and your population of Medicare patients, delivering more AWVs can represent millions in incremental revenue. In our work with providers on AWV capture, we’ve quantified $1-$3 million in annual opportunities for mid-to-large size groups.
Another strategy is to more accurately and comprehensively document Hierarchical Condition Categories (HCCs) for Medicare Advantage patients. Today, we’re working with a group of health systems to strengthen HCC documentation through real-time decision support tools that are built into the provider’s EHR workflows. This point-of-care support helps providers better recognize and manage chronic conditions, while improving the accuracy and specificity of documentation. At one organization, these improvements contributed to a 30% increase in their risk adjustment factor (RAF) score—a revenue impact totaling more than $10 million per year.
Execution challenges to overcome
Given the dollars in play, it may seem surprising that more health systems aren’t seeing universally robust returns on their optimization efforts. Here’s the rub: while opportunities are huge, getting to them is more complex and challenging than many leaders predict. Often, organizations that are trying to prioritize AWV and HCC end up stalling, or settling for performance that is well below potential.
To overcome common execution challenges, the first thing health care leaders need to realize is these strategies are about more than the technology. Yes, EHRs must be configured to automate processes, confirm patient eligibility, and, with minimal disruption to providers’ work, capture relevant values and diagnoses. But it’s just as important to address processes of care related to AWVs and HCCs. Sometimes that means redesigning or realigning workflows, and aiming for a single standard across the medical group that will complement the technology changes.
Another critical factor is patient and provider engagement. Patients often don’t know what an AWV entails, why they need it, or what makes it different from any other visit. Likewise, many providers do not fully appreciate the AWV program’s benefits, reimbursement structure, and requirements. With HCCs, the provider may be aware of their patients’ conditions, but may not understand the necessity to document evaluation of complex chronic conditions each year. Education and awareness campaigns are commonly lacking.
Exacerbating all of this is initiative overload. A common refrain among providers: "There are so many things going on in our system, I can’t keep track of it all. Who has the time?" Without sustained focus and highly visible support throughout the organization, it is simply too easy for providers to interpret improvement efforts as "initiatives du jour." In reality, these shouldn’t be viewed as initiatives at all, but as care management disciplines to be honed through ongoing effort. Financial benefits aside, it’s about better patient care.
Although the financial benefits are significant for both AWVs and HCCs, health systems and medical groups should never take their eyes off of the significant non-financial benefits—more accurate capture of patient risk, more informed and engaged patients, and better control of chronic conditions.
The best thing about both of these initiatives: they make it easier for the provider to do what’s right for the patient.