Knowledge Expansion

Uncovering revenue opportunity in your existing EHR data

Insight Article

Electronic Health Records

Providers increasingly lean on analytics to reveal care gaps and inefficiencies in the battle for better outcomes and lower costs in healthcare. Data-driven cost reduction and care intervention efforts pose significant return on investment to physician practices over the long run. To get there, practice administrators should consider clinical analytics and care coordination as means to mitigate the unpredictability of reimbursement in a pay-for-performance world.

To shore up funds to support value-based care initiatives, providers should find ways to use data currently available in their EHR to improve revenue cycle performance. By streamlining processes and optimizing technology already in place, practices can build a stronger revenue cycle foundation heading into the Merit-Based Incentive Payment System (MIPS) and other value-based payment programs.

Optimizing your EHR for revenue success

Practices can alleviate many revenue cycle issues through EHR customization, yet many fail to customize the system beyond the creation of initial templates during implementation. A 2017 MGMA Stat poll found that 11% of respondents do not analyze their EHR data at all. These missed opportunities to derive actionable intelligence hinder performance improvement initiatives and shortchange the benefits of EHR technology investments.

As a first step, practices should designate a clinical transformation leader or team that can bridge the gap between clinical and technical expertise to optimize the EHR with practice-specific processes in mind. Archive data tied to outdated quality measures. Implement workflow prompts to intervene at common points of error and oversight. Ensuring effective EHR data capture is critical to enabling analytics in the practice.

EHR optimization also should be aligned closely with any required clinical quality measure (CQM) reporting. The ability to capture and trend CQM performance data will determine payment adjustment factors under MIPS and other quality payment programs. Practice administrators can achieve positive payment adjustments under MIPS by optimizing EHR resources with the following checklist in mind:

  • Engage physicians, administrators and other end users in EHR assessments and process adjustments early in the process to support adoption and buy-in. Articulate the goals behind CQM tracking. Quantify the financial impact that poor EHR documentation can have on the facility and individual clinicians.
  • Design EHR builds around the specifics of the practice’s elected quality reporting program. Set field requirements or workflow prompts to ensure all data variables required under your reporting path are captured. In multispecialty settings, take advantage of shared metrics across specialties whenever possible to reduce clinician reporting burden.
  • Track and report beyond minimum data requirements to identify which CQMs represent your strong areas. As you trend performance over time, pare down to focus on metrics that show the most promise for the practice. Keep competitive benchmarks in mind given the peer-comparison nature of MIPS scoring. Consider your performance relative to peers.
  • Document workflows at the point-of-care to identify opportunities for greater EHR process efficiency. End-user pain points often reveal areas for workflow improvement. Tailor EHR views by end-user role, particularly in multispecialty settings where nonapplicable CQMs can overwhelm clinicians during documentation.
  • Use dashboards to track quality measure performance and encourage improvement among stakeholders. Visual representation of performance trends helps administrators and end users understand collective and individual progress. This insight can highlight emerging problem areas and offer a point of intervention to shield against long-term revenue impacts.
  • Use analytics to uncover variance in care management practices and related outcomes among patients with similar conditions. High-performing clinicians and care delivery approaches can yield new standards and best practices that can be applied in other areas. This exercise will lay the groundwork for population health initiatives moving forward.
  • Review performance data by care team and location to identify learning opportunities among physician stakeholders. Internal visibility into peer performance can motivate physician stakeholders. Performance metric insight also can influence physician compensation plans and incentive distribution within the practice.
  • Explore CQM data submission options with your EHR vendor well ahead of reporting deadlines. MIPS offers both EHR-based and registry-based reporting paths. Most specialties can submit CQM data via their EHR but some will have to rely on paid registry reporting to submit. It is important to make sure your EHR functionality supports your reporting strategy.

Establish a culture that emphasizes ongoing EHR optimization to ensure the practice can continually adapt to evolving reporting program requirements. Monitor EHR data trends to glean insight into care gaps and utilization problem areas. Use that knowledge to inform front-end process adjustments and staff education programs designed to address identified issues.

By proactively streamlining EHR data capture, practice administrators can lay the groundwork for improved, analytics-driven revenue capture today and support positive payment adjustments down the road under MIPS.

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