As a country, we are about to enter the next phase of health care reform; we are moving from a fee-for-service system to an outcome-based system. PECAA is pleased to be the primary organization in the eye care industry to take on the mission of helping eye care providers successfully prepare for the changes that are coming.

PECAA’s new Integrated Eye Care Initiative (IECI) is designed to make providers aware of the implications of major changes in health care reform influencing the eye care industry and to not only be informed and prepared, but to position themselves to take advantage of a plethora of new opportunities that are becoming available. These opportunities include the ability to negotiate for higher reimbursements, become full participants in local integrated care delivery networks and ultimately, deliver better patient care.

There are a few key things that are helping drive the next phase of health care reform:

1) EHR Functionality – Allowing Patient Data to Flow Easily & Efficiently Between Providers

The core features that are already in certified electronic health records (EHRs) are going to help drive the next phase of change within the health care system. Whether providers currently use these powerful capabilities or not, the country already has the core building blocks in place to deliver outcome-driven care. These features include: 

  • Structured data that includes e-prescribing of medications.
  • The ability to create standardized reports in the form of transitions of care documents, exam summary reports and other clinical documents. The power of these documents lies in the fact that the information they contain can be automatically extracted from the documents and placed into databases and other receiving EHRs without any human involvement.
  • Electronic communication capability through Direct Messaging (which is already in any certified EHR) allows any provider to send electronic patient information to any other provider or organization in the country using a certified EHR.

These are powerful features that when implemented efficiently within EHRs, create the basis of a healthcare infrastructure that is capable of supporting outcome-driven care by allowing patient health information to flow easily and efficiently between providers. The problem is that under the first phase of healthcare reform (led by the Affordable Care Act and Meaningful Use), it was completely voluntary whether providers, working with their EHR vendors, incorporated these powerful features into clinical practice. The majority of healthcare did not voluntarily adopt broad based usage. This led to the passage of the 21st Century Cures Act, which is the second driver of where health care reform is headed.

2) The 21st Century Cures Act – Empowering the Patient

Since most providers and EHR vendors have not voluntarily incorporated the features discussed above into clinical practice, the 21st Century Cures Act takes that decision out of the hands of providers and EHR vendors and puts it directly into the hands of the patient.

Exactly how the act will be implemented is still being determined, but it is clearly designed to significantly affect how patient health information is shared. Providers will have to send patient data anywhere the patient wants it to go. There are even financial penalties proposed on providers and EHRs that are unable or unwilling to meet that request.

Every provider owes it to themselves to become familiar with the 21st Century Cures Act. PECAA has many resources to help you understand this very significant piece of legislation and the implications for your practice in the near term and long term as we learn more about how it will be implemented.

3) Health Information Exchanges Are Making Outcome Data Available to the Patient

The ability for the patient to control their data makes patients the third driver of where healthcare is heading. Patient data will soon be broadly shared, analyzed and structured into different formats by third parties to empower the patient to better understand and take a more active part in managing their care.

The implications of patient total control of their data are extensive. Google, Apple, and Amazon are only a few companies now entering different aspects of healthcare because they will now have access to patient data. Health Information Exchanges are already expanding. In fact, a few states have already passed legislation mandating all health information be reported to state HIEs by all healthcare providers.

Once the data is in HIE’s and other data repositories, the data is going to become subject to powerful clinical outcome analytics. Whether providers decide to participate in outcome-driven care or not, patients are going to have the ability to compare their outcomes against the outcomes other providers are delivering. The ability for patient data to be in one place for big data analytics will completely change the fundamental way that healthcare is delivered in the country.

Perception is important. How will patients perceive the experience level of a provider that has thousands of patient results reported, versus a provider that has very little or none? One of the most important decisions providers are having to make now is anticipating what affect those analytics will have on the patient’s choice of practitioner, and which providers payers will want to select to be on their payer panels.

While health care reform may seem overwhelming on a grand-scale, it actually provides eye care with numerous opportunities. Our goal through PECAA’s Integrated Eye Care Initiative is to help providers learn what they should already be doing in their practices today, implement changes to begin delivering outcome-based care, and start measuring outcomes to be able to negotiate with payers for increased reimbursements.   

Interested in Learning More About PECAA’s Integrated Eye Care Initiative?

PECAA’s Integrated Eye Care Initiative is included in a standard PECAA Membership and comes at no additional cost to Members. Enjoy an arsenal of resources helping providers understand health care reform, how it will affect them (on both a local and national level), and enjoy access to PECAA’s IECI Advisors that will help you navigate and implement changes in your practice that will help shape the future of the eye care industry.

We would welcome the opportunity to speak with you directly to answer any questions you may have about the IECI Program or PECAA Membership. Please fill out an inquiry form here and a representative will be in touch with you soon. Or, simply e-mail PECAA at info@pecaa.com or by calling 503.670.9200.

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