The Centers for Medicare and Medicaid (CMS) has determined that patient engagement is essential to solving the cost and quality crisis in the United States health care system. As a result, CMS is requiring physician practices to provide easily accessible ways to exchange health information with patients and with other health care providers through electronic health records (EHR).
The recent implementation of these changes, related to the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), Meaningful Use (MU) and the Merit-based Incentive Payment System (MIPS), are driving the adoption of patient portals and direct messaging systems in physician offices. Those systems provide tools to share information with other health care providers and to engage patients in the management of their own health, says Andrews Dean, CPHIMS, CPHI, CHDA, CPPM, CPC. Dean is a MACRA/MIPS Consultant with Pivot Point Consulting.
"There is a lot of uncertainty in Health IT right now because of the new presidential administration's potential impact on health care technology adoption. However, there is universal agreement that MACRA and value-based reimbursement aren't going anywhere," Dean says. "There may be changes at the margins, but the core concepts are not likely to change because of the bipartisan support for repealing the old sustainable growth rate and adoption of value-based care."
Because the new MACRA rule went into effect on January 1 of this year and release of the final rule did not occur until fourth quarter 2016, many EHR systems are having difficulty keeping pace with programming changes required because of the quick turnaround time.
"Many EHR systems have not yet been 2015 certified by the Office of the National Coordinator for Health IT, and there is some uncertainty about smaller EHR systems going through the effort required," Dean says. "That could lead to some of those small systems being purchased by larger systems. Otherwise, physicians could abandon those that aren't 2015 certified because of the penalties for not using a certified EHR product. Recently, CMS released the 2018 Quality Payment Program proposed rule which makes being 2015 certified a bonus instead of a requirement. This will remove the penalty for next year for staying on 2014-certified EHR technology."
A patient portal typically connects to a provider's EHR and provides patients with varying levels of information about their health. Common features of portals include the ability to view medical records such as lab results, medications, and upcoming and past appointments. Some systems allow a patient to request a new appointment and medication refills as well as sending a secure message to the physician.
"The functionality of the patient portal varies widely, depending on what type of portal is used and how it is implemented. Most practices have some form of portal that helps with patient communication and can increase the efficiency of practice operations," Dean says. "The portal can reduce unnecessary phone activity by allowing patients to communicate with the provider online, and patients can request information on their own time, day or night."
Patient education is another big feature of many portals. "A typical physician visit is brief, so there isn't always time to cover all information a patient may need," Dean says. "Through the portal, the doctor can provide a patient with more thorough information about a diagnosis or instructions about dietary guidelines or other topics."
Patient satisfaction is a major underlying component of patient engagement, which is a MIPS goal. Most people are happy to access information through the portal immediately instead of waiting on hold or for a call back from the provider. "The portal also helps reduce operating costs and health care costs across the continuum, because patients become more involved in their care," Dean says.
Dean adds that patient satisfaction is set to become an even bigger issue in the health care industry. "Some insurers already are asking for a rating of providers, because they want to know how happy patients are with the services provided by their physician practices," Dean says. "The insurers want to know that their patients are having a good experience and that they are getting value from the network providers."
Direct messaging is a standard communication protocol that EHRs use to communicate with each other. Each physician and health care facility has a direct address, similar to an email address, but can only be used to send protected health information from one EHR to another. "Interoperability is another big priority for CMS, and direct messaging allows different platforms to share information securely without the need to fax or mail hard copies of a patient record," Dean says. "This requirement has been one of the more challenging areas for Health IT because of the number of different EHR platforms and the different design of databases used to store patient information. It can also be a problem for some users if they don't know the direct address of the person they are trying to reach."
Dean says that direct messaging can be challenging, because is all push-based, meaning that entities are sending data instead of pulling it. "It is not a demand-based exchange platform, and most people prefer to request data, instead of it arriving without being prompted," he says. "While direct messaging can be used to respond to medical information requests and is a basis for electronic patient referrals, it is not widely used. However, because of the new focus on health information exchange resulting from MACRA implementation, direct messaging technology is expanding rapidly."
Dean expects CMS to continue its push for the use of more IT products in the future. "I think they will continue to encourage interoperability, exchange of health information, and patient engagement. These areas will continue to be priorities for CMS because they view this to be part of the solution for ever-increasing health care costs," he says. "If they can reduce so much exchange of paper, maybe they can reduce medical errors. That, in turn, can reduce operating costs."