The Executive Suite: 3 ways a community HIE can help boost your medical practice’s revenue

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.

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.

Community HIEs also enable physicians and nurses to keep value parameters top of mind. Pay-for-value parameters change from year to year, and it’s difficult — if not impossible — for clinicians to keep up with multiple value-based contracts. Community HIEs help team members follow important protocols for these patients under value-based performance contracts at the point of care.

Automatic alerts at the point of care also inform physicians when patients haven’t filled recent prescriptions, so they can follow-up. These conversations can, in turn, prevent serious medical issues from developing and help providers outreach to chronic care patients who require financial assistance to afford necessary medications.

Holston Medical Group (HMG), a regional medical group that serves 200,000 patients in northeast Tennessee and southwest Virginia, has achieved substantial success under value-based performance contracts since joining the only fully functioning, bidirectional, common medical record system in the state of Tennessee. Since 2012, access to a community HIE has positioned HMG to:

Increase pay-for-value payments by 44 percent, with more than $13 million in value-based revenue annually.
Increase fee-for-service payments by 7 percent.
Significantly reduce readmissions, with decreases of 7 to 12 percent by payer.
Decrease ED visits, with an ED utilization rate that is 25 percent better than other area providers.

Community HIEs inform service line innovations that draw increased revenue.

Community HIEs can point to trends in hospital admissions and ED visits. That data can help identify the need to add a specialty service line to the practice, such as pulmonary care if data shows that admissions increased for patients with COPD. The data can also support the decision to add after-hours appointments for specific patient populations, for example a pediatric clinic to help parents avoid ED visits for common conditions such as earaches, or for patients who are having trouble stabilizing their chronic condition(s).

Innovations such as these not only boost revenue for physician practices but also reduce overall healthcare costs — an area of concern not just for CMS, but also for consumers, employers and health plans. Today, U.S. healthcare spending accounts for nearly 18 percent of our nation’s gross domestic product, with medical costs expected to increase 6 percent this year. A recent study found that if all U.S. physicians were part of an HIE, Medicare could save $63 million annually on procedures. That’s a goal we should all be working toward.

Data-informed revenue enhancement

Community HIEs demonstrate strong potential to help practices improve quality of care at reduced cost. They also offer practices significant opportunities to increase revenue, such as by supporting compliance with TCM billing requirements.

As practices face decreased federal and commercial reimbursement, exploring the potential to enhance both quality of care and revenue with the support of a community HIE is an important step toward protecting a physician practice’s long-term financial health.