In remarks at the Medical Group Management Association’s annual conference in Las Vegas on Oct. 24, Farzad Mostashari, M.D., national coordinator for health information technology, said that despite the anxiety felt by medical groups over the uncertainty of payment reform, leaders can arm themselves with information, make partnerships with regional extension centers (RECs), and start adopting electronic health records (EHRs) to measure and monitor patient care. He emphasized that the information derived from the EHR will be the foundation to provide more coordinated and cost-efficient care.
“There’s this enormous and largely unproductive anxiety out there in providers that is at a higher pitch than I’ve seen it in the past 20 years since I went to med school,” he said. “‘What is it going to mean for us to thrive as a business if we don’t know what the rules are going to be?’
Seeking out Information
Mostashari advised the medical group leaders in attendance that there was something they could do to prepare for the uncertainty, and that was to plug into information sources. “You’re going to need better information about the quality of care you provide that you can benchmark, information about productivity, and you’re going to need to have tools not only to measure and monitor, but to improve on specific things,” he said.
Mostashari recommended that medical group leaders to seek the expertise of their local RECs, partner groups and organizations, and most importantly, to seek advice from attesters that can answer first-hand the questions of their peers. In one example of how important EHRs were to become in the future was the value to those practice leaders looking to retire and turn over their practices. Mostashari said a new physician in this electronic age doesn’t want to take over a paper-based practice. “No matter what the future is going to bring,” he added, “the one thing you can do today to prepare for that future is to move forward on electronic health record adoption and meaningful use.”
When speaking about medical group CIOs’ challenges dealing with an ever-expanding priority list of health IT to-do’s that include among other things, 5010 data conversion, meaningful use, ICD-10 transition, quality reporting, Mostashari related a relevant conversation he had with Stephanie L. Reel, vice provost for information technology and chief information officer, The Johns Hopkins University. “In this conversation she said, ‘We’re going to get to meaningful use just as a byproduct of preparing to be an ACO,’ and I said, ‘That is the best news I’ve heard all day,” Mostashari told his audience. “That means we’ve got it mostly right.”
Quality Reporting Harmonization
Many CIOs in the industry say one of the most valuable things the Centers for Medicare & Medicaid Services could do to lift some of the administrative burden in healthcare reform would be to harmonize all the programs to which providers must report quality measures. “It’s a terrific idea, and it makes a ton of sense,” Mostashari said. “There’s no one at HHS that is not on board with it. I think it also loses an opportunity to focus the message. Someone said quality measurement is at least about as much as telling people what matters, as it is about accountability. If we’re using all different measures for all different programs, it ends up being a lot of noise.”
One roadblock that Mostashari mentioned that made it difficult to harmonize quality measures is that each program has its own legislative requirements and mandates regarding what is to be measured and how. “The other problem is that all those programs have their own history,” he said. “So any movement to harmonize means you’re changing what you’re doing, and that’s more work, right? If I’m coming into this fresh, then it’s easier for me to do a single rule; but if I’m already reporting to PQRS, and I’m already reporting for meaningful use, any harmonization means I have to do work, change the code, change the data collection.”
The timing of all these programs that have different regulatory timeframes also adds to the challenge, as well as the fact that not everyone is going to be using an EHR or be a meaningful user. “If you look back at the last three or four regs having to do with quality measures, the insistence and the signaling that we’re moving towards harmonizing is actually happening,” Mostashari said. He added that the next challenge is to get health plans to coordinate with Medicare and Medicaid to use the same sets of quality measures for their quality improvement programs.