The healthcare reform act will change how patient records are kept, medicine is practiced, drugs are dispensed – pretty much just about everything. But nothing will be affected more than how healthcare providers are paid.
My husband, a dentist, worries that fees will drop even more, and he’s not entirely wrong. Healthcare providers have always been paid as fee-for-service; they accomplished the care and they were paid what they charged.
But one of the new facets of the Affordable Care Act is Accountable Care Organizations (ACO), healthcare groups assembled to link doctors and hospitals – and care, to pay. The better providers perform – based on care outcomes and other goals – the better they’re paid, and vice versa. This can’t be done without health information exchanges (HIE).
"Right now, hospitals and doctors are paid on a fee-for-service model, and a fundamental element of an ACO is saying “we're not going to pay you on that model anymore,” Brent Dover, president of HIE technology company Medicity, told Michelle McNickle in an interview with HealthCare IT News. “We're going to pay you to take care of the overall health of this population. The more proactive you are, and the better quality you deliver, we will share that savings with you."It all depends on HIEs, another facet of the healthcare law. The goal of HIEs is to connect doctors, hospitals and patients in a seamless network where they can share information to make better-informed care decisions.
They will be, according to Frank Diamond, managing editor of Managed Care, the foundation of ACOs, and the centerpiece of the Affordable Care Act.
"You really can't get to an ACO unless you have the capabilities that an HIE provides," Dover told McNickle. "It's a foundational element. There's no way for you to identify those patients (who need intervention) unless you know all of the clinical data happening to them at the different points of care."
Dover feels the financial model of an ACO is motivating people to want to know what's going on. One of the most important aspects of an ACO, he told McNickle, “is a doctor needing to know what's going on in a hospital, and a hospital needing to know what's going on with a doctor.”
HIEs also function as a referral system from physicians to hospitals or service centers. "Now they say, 'we save costs by getting results serviced out better, and we increase revenue by having a good physician affinity strategy,’ and that's how we justified our investment in HIE,” Dover revealed.
Without HIEs, ACOs would have no way of “beginning to even understand how to manage the risk,” he told McNickle. “And so health information exchange has gone from a nice thing to have to reduce costs to a business imperative and a foundational element."
“Participation in an HIE will be an essential component of an accountable care organization’s achievement of its mandated functionality and performance,” said Gerry Hinkley of Pillsbury Winthrop Shaw Pittman LLP.
“It's like building streets in a city,” Dover said. The hope is for highways extending out, providing quality care for everyone.
Edited by
Braden Becker
