Balancing Patient Care and Quality Reporting

There is a tug of war underway in healthcare, and physicians are sitting squarely in the middle. On one side, patients are demanding providers’ attention and expertise to address often complex medical conditions. On the other, there are evolving regulatory requirements, such as those found in the 2019 Quality Payment Program (QPP), which requires providers to regularly submit detailed measures of quality, cost, interoperability and more. As a result of the constant push and pull, physicians are becoming increasingly frustrated and disheartened. Most entered the profession to treat and care for patients, however, they are becoming sidetracked as they try to effectively demonstrate their performance to receive adequate reimbursement.

While achieving the right balance between patient care and regulatory reporting can be tricky, there are a few key things ophthalmology practices can do to realize a steadier equilibrium.  

Identify internal resources to “own” regulatory compliance.

Although every physician has a role to play in meeting regulatory standards, it is important to have someone who takes ownership of the process. Depending on the organization, this may be one person or a team of people who can serve as change agents. Because these individuals are familiar with how the specific practice runs, as well as its strengths and weakness, they will be more likely to suggest the best ways to implement any necessary changes for compliance reporting without overly taxing physicians or disrupting patient care. This group should review new requirements as they emerge and determine what the practice’s response to those should be. They can also serve as champions for understanding new regulations, fostering enthusiasm, getting physicians on board and addressing any questions or concerns staff may have about compliance.

Don’t be afraid to ask for help.

Despite having a strong internal team, there may be times where an outside expert is needed—especially if the practice is struggling with how to fully appreciate the impacts of new requirements or find ways to incorporate them into existing workflows. An outside resource should have deep knowledge of the regulations as well as demonstrated experience with practices of a similar size and scope, better allowing the organization to make more meaningful suggestions and help any change agents in place to implement best practices.

Select measures wisely.

Most regulations, including those tied to the QPP, have some flexibility in how a practice can meet them. To optimize reimbursement while limiting data collection and reporting burdens, practices should carefully consider which measures to report—focusing on areas where the practice shines and where measures most closely reflect current performance. Understanding a practices’ strengths while simultaneously staying up-to-date on measures that have been removed can prevent missteps and unnecessary compliance measures. Recent removals pertaining to ophthalmology include #18 (diabetic retinopathy documentation of macular edema and severity of diabetic retinopathy), #140 (AMD counseling on anti-oxidant supplements) and #224 (melanoma overutilization of imaging studies).

Embrace technology that enables seamless reporting.

Though the healthcare industry has been digital for some time, 4 out of 5 practices still rely on what is considered a “basic” EMRs. Although upgrading a system can be costly, it can mean the difference between realizing an effective balance and falling short. By investing in a solution with built-in compliance tools, such as real-time reminders at the point of care, organizations can streamline reporting while maintaining quality. These features must operate unobtrusively, gathering data or prompting reminders about missing information throughout the patient exam. This allows the provider to collect data organically rather than reviewing documentation at the end of the exam to see if all the relevant metrics and information have been captured. Note that when the system is easy to use it can engender broader acceptance by physicians because the technology does not impede their workflows or distract them from patient care.

Practices should also double check their technology’s certification. The 2019 QPP requirements dictate that physicians must use EMRs that comply with 2015 CEHRT technology standards. For practices that have chosen a cloud-based offering, as long as it is certified, it will also enable the practice to meet this requirement. Plus, compared to other EMRs, cloud-based solutions offer several functionalities that can ease workflow, such as increased portability and flexibility, giving providers more freedom as to when and where they document.

Combining people with technology.

Change can be difficult, and physicians are going through a lot of it right now. Practices that are positioned to successfully navigate evolving dynamics have a strong internal team who keeps tabs on what’s new and serve as idea ambassadors. When this group is empowered with technology designed to simplify the administrative aspects of eye care delivery and foster a more patient-centered experience, the practice can realize meaningful change and achieve the right balance between clinical care and solid financial performance.