How the Affordable Care Act Changes Medical Information Management

How the Affordable Care Act is Changing Medical Information Management

Whichever side of the political fence you're on, there's little denying that the Affordable Care Act – or as it’s become known, Obamacare – is transforming healthcare.

The challenge is to slow spending without sacrificing quality. To put that in perspective, in 2012, the U.S. spent $2.87 trillion on healthcare. With so much aging infrastructure already in place, what will technology’s role be in this transformation? And how will medical information be affected as healthcare records and transactions become more digitized?

Moving Towards Digitization

The foundation for a more modernized approach to healthcare was strengthened in 2010 by an often-overlooked provision included in the Affordable Care Act. An electronic medical records mandate was added to the act for all practices to ensure privacy and bring efficiency to Electronic Medical Records (EMR) systems. Physicians who transition to EMR are eligible for government incentives paid yearly until 2016. The later the date of adoption, the smaller the payment. Physicians who adopt EMR must also meet a minimum requirement of “meaningful use” to receive payment.

Practices that do not transition to EMR do face penalties that increase as time goes on and will be docked a percentage of Medicare reimbursements – one percent in 2015, two percent in 2016, and so on, up to five percent.

Balancing Innovation

In a recent Yale series on healthcare, Robert Galvin, CEO of Equity Healthcare, mentioned the balancing act that lies ahead as the Affordable Care Act’s mandates come into play

A big challenge, says Galvin, is to strike the right balance between governance and innovation. While the mandates are meant to establish guidelines for efficiency, too much similarity can hinder creativity.

“The problem is, when you do that, you really stifle innovation,” Galvin said. “The other side of the curve, of course, is you let a—I guess in the case of healthcare, a trillion flowers bloom and it just becomes chaos.”

And stemming this chaos means that many providers will need to focus on improving their own processes via outsourced process management, systems integration and paperless solutions.

Payment Standards

Many of the solutions that marry IT and healthcare are centered on electronic funds transfer (EFT) and document management. Streamlining the way funds are transferred could save healthcare organizations almost one billion dollars a year over the next decade, according to the American Medical Association (AMA).

What’s significant about the EFT standard is that it finally creates a consistent process. It doesn’t require practices to perform EFT, but if they do, the financial institution sending the EFT will have to use the standard. It’s likely we’ll see a flurry of activity over the next year on both the vendor and patient side as practitioners and providers work to upgrade services and solidify systems in order to realize this cost savings.

The Affordable Care Act’s compliance date for the EFT requirement is January 1, 2014.

Embracing Attachments

Document management in healthcare is also facing a compliance issue due to the Affordable Care Act: attachments. Sounds strange, but it’s not that the industry doesn’t attach documentation to email messages, it just doesn’t have any standards for how they’re handled. And to the industry’s defense, these aren’t just PowerPoints being bounced around.

Technically speaking, the AMA describes attachments as the “documents that need to be submitted to support a claim in order for the payer to adjudicate it.” They can include everything from consent forms and operative reports, to laboratory reports and other clinical documentation.

What the new standard should alleviate is the cumbersome methods of handling all of that documentation. The AMA says the current way of handling any attachments is not only cumbersome, but “very manual and costly, requiring phone calls, faxes, and regular mail.” It’s easy to see how some simple rules around document handling might drive huge improvements. Practices looking to reduce costs would be wise to consider re-examining their document handling procedures, services and products to ensure they are most efficiently and effectively staying in compliance.

Positives Without Politics

The political battle over the Affordable Care Act may be played out during the 2014 elections, but once you remove the political lens from the conversation, it’s clear that the ways that healthcare organizations manage information is already being impacted. Realizing the cost savings promised by the legislation will require providers to be proactive in seeking out areas where they can achieve positive change in how they manage their document and records management procedures.