Patients’ health coverage

In this era of Accountable Care Organizations (ACOs) and bundled payments, it might be wise to know how your patients are covered. Some physicians may see all fee-for-service patients, but many are likely to begin seeing new kinds of payment types creeping into their systems. “You want to understand what type of patients fall within different types of coverage and see if that volume is growing or shrinking,” Gaston said. “It would help you monitor the fundamental shift from fee-for-service to an ACO-type of payment model.”

Understanding how to use data can also help to negotiate with the different insurers who are, or will be, writing you checks. If you are going to be negotiating a fee for bundled payments, it is imperative to know how much you need for the services you provide. Your billing system can provide information related to collection for services, the amounts being charged, and how frequently you provide treatment.

“Armed with data, you can work with payers and have a stronger negotiation point for what you want to be paid,” Evenson said. “Financial information is an effective vehicle to have, and you will have a different discussion than if you went in empty handed (to talk to a payer).”


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You can also use data that is available online showing operating expenditures and health IT costs to negotiate with vendors. Evenson said MGMA publishes data on professional liability costs that can be used to compare with peers and negotiate with insurance carriers.

“Whoever owns a practice, it is in their best interest and ultimately their responsibility to understand what the business drivers are around that practice,” Gaston said. “It is an investment they have made and it is their job to know their risk is minimized.”

Lisa Brooks Taylor, director of health information management practice excellence at the American Health Information Management Association, said improving quality through data will take time and effort, but the insights gained from understanding a practice are “beneficial and actionable.”

She hears a lot of physicians say documenting and using EMRs interrupts their workflow. If this is the case, she recommends really pushing vendors to improve the systems.

“I encourage physicians to work with their EMR vendors,” she said. “If they don’t like the way it works, they need to work with EMR vendors to get documentation that flows with their workflow process.”