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Implement and track the new metrics and quality measures

August 02, 2016

How do health information technology, population health and pay-for-value all fit together for a behavioral health organization? It’s important to understand the interrelatedness of these elements and how to get your organization started for participation that positively affects your revenue.

Whether you are striving for Certified Community Behavioral Health Clinic participation, Center of Excellence standing, or simply seeking a high-quality, high-value status, the concepts of satisfaction, engagement and health are key elements in this new era of healthcare reform. Reimbursement comes with more strings than before and is no longer a given. While a painful shift, it becomes critical to construct your organizations processes well from the beginning.

Very broadly, incentive programs like the Physician Quality Reporting System, Meaningful Use, and the Value Based Modifier were historically developed for physicians to help improve the quality of care outcomes in our healthcare industry. To determine whether organizations receive an incentive payment versus a penalty, models require reporting on a set of metrics that largely revolve around a physical health model of care. Many thought these programs were optional, and to a certain degree they still are. Yet organizations are starting to see some of these payment penalties coming through and are beginning to wonder why. Non-physician eligible professionals are getting tagged with the penalties. This will get your attention.

Prepare now

So, how do you prepare your organization to engage a model of care that emphasizes value, measures, and population health reporting? Let’s start with some simple concepts and basics in terms of organizational business and clinical processes.

One of the first items to consider is whether you are using an Electronic Health Record (EHR). From firsthand experience, EHRs are not the magic bullet, yet they are critical to ensure data collection. The interdepartmental effort that goes into tracking and reporting measures out of an EHR is huge: end-users must put in the right data in order for it to be reported. Therefore, clinical and technology training must be an ongoing investment you are willing to make.

The EHR must also have the functionality necessary to perform the task, and finding the right EHR vendor partner for this process is critical. Know what you need in an EHR and whether the vendor can produce the needed functionality. Don’t be afraid to ask for verification.

Other items to consider in preparing your organization are:

  • Understanding the new metrics being requested of organizations, how they are defined, quantified, and measured by the Centers for Medicare and Medicaid Services and SAMHSA;
  • Performing a gap analysis of your as-is state and where you need to be so you can start to report value measures;
  • Assess the ICD-10-CM availability in your EHR and the clinical utilization of all necessary codes. To participate in these new metrics, you must have access to the entire ICD-10-CM, not just a subset of selective codes.

This last point can not be underestimated, and it is a foundational component for many of the metrics we are being asked to track. To do this, you must figure out a way to code comprehensively using the entire ICD-series. Why? Narrative text descriptions are not discrete data values and cannot be extracted for reporting purposes. Only by plugging in structured, standardized data will we be able to track and report on some of the metrics required.

Go ahead: start the conversation at your office about truly understanding a metrics-oriented, value-based system of care by leveraging health information technology with innovation and excitement.

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