At HIMSS19, Medicomp Systems will be debuting a new module in its Quippe Clinical Solution suite that focuses on maximizing Medicare Advantage reimbursement with automated risk adjustment factor scoring and hierarchical condition category documentation.
“For providers participating in Medicare Advantage plans, the correct calculation of a patient’s risk adjustment factor is essential to ensure accurate reimbursement,” said Dr. Jay Anders, chief medical officer at Medicomp Systems.
“However, calculating risk and prospective cost of care is not only important for treating patients covered with Medicare Advantage plans, but rather for any provider participating in risk-bearing value-based payment programs,” he said.
Leaving money on the table
Traditionally, providers have lacked automated tools to ensure they are accurately and fully documenting all of the information required for proper risk adjustment factor scoring, Anders explained. This means they could be leaving money on the table, he said.
“Our new technology helps clinicians identify at the point of care any conditions that are not fully documented or accurately coded to ensure maximum reimbursement,” he said.
With the new technology, provider organizations also will have access to dashboards and reports based on structured information that enables them to proactively identify potential gaps that need to be addressed in coding or documentation, which is essential for any value-based care program, including Medicare Advantage plans.
“They will also have new tools to more accurately forecast expected reimbursement,” Anders said. “Payers could also use this technology to streamline their documentation review and risk adjustment factor scoring processes.”
Trends to discuss at HIMSS19
Medicomp sees a couple of trends as very important at HIMSS19 and beyond and will be focusing on them at the conference.
“At HIMSS19, we will likely hear a lot about artificial intelligence, machine learning, blockchain and other exciting trends – but all of these innovations are putting the cart before the horse, to put it mildly,” Anders said. “To draw quality conclusions from AI queries, you first need data that’s in a codified and structured format, but as much as 80 percent of the patient information within EHRs is stored as free-text and not mapped to data standards.”
In addition, the majority of enterprises are not able to clean and standardize the huge amounts of clinical data created over the last couple of decades as EHR adoption has grown, he added.
“That’s why the most important trend at HIMSS19 we will be talking with attendees about is the importance of delivering ready-access to reliable, standardized and structured data to physicians at the point of care,” he said. “Without such information to power AI or machine learning engines, that technology is simply not going to work.”
Adding new functionality to EHRs
Along those lines, another trend Medicomp expects to focus on at HIMSS19 is making EHRs more usable through expanding the availability of third-party applications so that both clinicians and administrative staff can add new functionality to address their needs.
“Rather than stacking unrelated tech on top of tech, healthcare technology and EHRs need to operate as more of an ecosystem,” Anders said. “Some EHR vendors have been hesitant to open their systems. In some cases, that’s due to an understandable fear of loss of control or the misguided perception that their developers understand physician workflows better than physicians.”
“The most important trend at HIMSS19 we will be talking with attendees about is the importance of delivering ready-access to reliable, standardized and structured data to physicians at the point of care.”
Dr. Jay Anders, Medicomp Systems
In other cases, it’s concern over missed potential revenue opportunities, he added. If the industry ever wants physicians to fully embrace EHRs as a productivity-enhancing tool that makes it simpler to deliver quality patient care, this mindset must change to one of transparency and collaboration, he said.
If asked at HIMSS19 what advice he would give healthcare CIOs when it comes to these and other health IT trends, Anders said that regarding any technology that promises to deliver actionable, clinically relevant information to physicians at the point of care, he urges CIOs to demand to see the technology in action.
Can tech with buzz deliver?
“Many buzzed-about technologies that will be discussed at HIMSS19 are far from maturity and have yet to deliver any tangible results at hospitals or health systems,” he said. “What’s worse, they may compromise clinician productivity, or even more troubling, compromise patient care.”
Instead, he said, CIOs’ priority should be to seek proven, widely implemented technology that intelligently identifies and interprets the disorganized and complex arrays of medical information from multiple sources to support providers in their goal to deliver better care.
The technology should then convert that data into structured, actionable formats and present the relevant elements for each patient encounter, he said. Finally, CIOs need to see in person how the solution delivers this filtered, high-value information as part of the physician’s workflow in the 10 minutes or less they have with the patient in the exam room, he concluded.
Medicomp Systems will be in booth 3901 at HIMSS19.
Email the writer: [email protected]
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