When it comes to documenting HEDIS™ measures and recapturing documentation for Risk Adjustment, EMR/EHR access is a hot topic.
On the surface it sounds great…
“You mean our coding team can just go in and get the documentation without having to bother the provider?”
And while it is certainly preferable for your team to have direct access to a provider’s EMR, it’s not a panacea for all things involved in value-based care documentation.
There are several scenarios we’ve seen where EMR integration wasn’t all it was cracked up to be, and we’ll discuss them over the next several posts.
Reason 1: You’ll Isolate Independent Providers
APIs are funny things. It doesn’t matter if an EMR system (of which there are hundreds) is used by a 100 providers or 100,000, it still takes a massive amount of development to create the integrations. That’s why most integrations that are available are only available for the most prevalent systems.
If you have an employed group of physicians, then it makes it easy to say everyone will work through that system, and workflows for record retrieval can be built around its capabilities. But if you have independent providers… what about them? When health plans become too focused on EMR access, they can isolate their IPAs, forget to improve processes for them, and cause even more abrasion.
Perhaps we’ll continue to see consolidation of practice groups under and into health plans, but with recent incentives for rural physicians coming out of CMS, and just anecdotal evidence we’ve seen and discussed, more and more physicians are breaking free from employed positions to regain control of how they effectively treat their patients.
Everyone has different models, and some health plans are moving away from independent providers. However, that’s obviously not going to be possible for everyone, and it’s also going to create a big opportunity for other health plans that know how to build cooperative relationships with IPAs.
But even in those plans with a completely employed provider network and everyone on the same EMR/EHR, there are still hurdles to overcome. We’ll continue discussing those in future posts.