The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)’s attempt to move the Medicare program away from payments based on volume of services delivered and towards payments based on the quality and efficiency of services delivered has led to significant anxiety across the provider community, since the volume-based reimbursement system in the United States is deeply entrenched. It forms the basis of healthcare payments across almost every type of payer and provider.
The volume-based system, however, is deeply flawed. With each service individually paid for regardless of quality, providers have a natural incentive to deliver more and more services, a vastly expensive proposition for payers. Providers also lack financial incentive to improve the quality of care: to avoid duplication of services, to coordinate with a patient’s other providers, to choose the lowest-cost intervention, to prevent errors, and many more desirable activities. In short, the provider’s healthy bottom line is poorly aligned with a healthy patient.
Making the transition
Success in this new value-based reimbursement paradigm will require significant investment in new tools and infrastructure: care management, information technology, data analytics, workforce redevelopment, care teams, ambulatory practices, and so much more. Can biometric tools be part of this suite of innovations?
First, as providers begin to take on more financial risk for the patients they see, they are rapidly consolidating. These larger, more comprehensive systems seek to capture more patients, spreading the system’s financial risk over a wider pool. But integrating the health records of disparate organizations is a steep challenge, one fraught with inefficiency and error. Biometric patient identification creates a single, unique identifier for every patient, which may be used across multiple records systems and clinical sites, making it a key tool in efforts to reconcile disparate patient records during consolidations.
In addition to broadening the risk pool, a consolidated health system offers the opportunity to service most or all of a patient’s needs within the system. This can offer important clinical advantages: coordinated care teams, integrated care management plans, comprehensive data records, and a patient-friendlier experience. From a risk perspective, it also allows the system to control the patient’s care, preventing unmanaged and potentially costly visits to providers outside their purview.
These out-of-network visits, however, happen all the time, particularly in highly-competitive and dense urban areas. Biometric patient identification could be a key tool for network leakage, so critical to effective risk management, as part of an integrated technology and partnership infrastructure. It could allow real-time signaling of emergency room or urgent care use, and triggering of a patient’s usual care team to coordinate the needed services.
Even under its own umbrella, patient care coordination and error avoidance is critical for a health system trying to deliver high-quality, high-value care in a risk-based environment. Biometric patient identification can also be a critical tool in this area, consistently linking the correct patient to the correct record, even in instances where patients are unconscious or otherwise unable to communicate. Use of biometric identification has been proven to reduce duplicate records, ensuring that a patient’s comprehensive history is available to clinicians at critical moments of care.
Accuracy and efficiency of patient records
Lastly, as providers take on more financial risk, it is critical that they keep meticulous records to ensure appropriate billing and cost accounting. Hospitals have struggled with tracking of internal costs, likely given the fact that they have not born the risk of their services for so long. Patient misidentification can lead to duplicate records and/or inaccurate records. This can mean denied claims from insurance companies or internal miscalculations of costs against premium revenues. Biometric identification can help mitigate against these risks.
Preparing for MACRA changes
To learn more about the New Medicare Card initiative and to understand potential impacts on patient identification, download our whitepaper, The challenges of MACRA – and how biometric patient identification can help, or watch our on demand webinar, Overcoming MACRA obstacles with positive patient identification