In today’s ever-changing world, where healthcare providers’ margins are tighter than ever, Rural Health Clinics (RHC) need advanced reporting to help leverage data analytics for regulatory compliance while providing insights that improve their overall clinical, operational and financial performance.
Data analytics converts raw data into actionable, insightful information. It comprises tools, technologies, and processes to find trends, monitor performance and solve problems. From improved decision-making to automating business processes, data analytics can help RHCs thrive on multiple fronts:
- Accurately tracking RHC-qualified visits and other vital stats per clinician
- Effectively managing the complex billing and collections processes
- Improved Clinical Outcomes through Gaps in Care and Chronic Care Management
The benefits extend beyond compliance: Harnessing the power of data can help providers lower costs while improving the quality of care and patient experience. RHCs don’t have the luxury of throwing money at a problem, hoping it improves quality and leads to compliance. Instead, they need viable solutions that save costs and improve the quality of the patient experience and the quality of care.
The Centers for Medicare & Medicaid Services (CMS) requires RHCs to file annual cost reports to determine payment rates and reconcile interim payments. If RHCs do not submit a timely report, Medicare will stop payments and demand Medicare monies paid to the RHC during the fiscal year be paid back to Medicare.
The Cost Report is extensive and includes information about revenues, expenses, visit statistics, productivity and vaccinations. Accurately tracking and properly reporting visit stats alone can be challenging for RHCs. That’s where Analytics comes in.
Tracking RHC-qualified visits
CMS publishes procedure codes that qualify or count toward the RHC’s visit count statistics, making compliance a constant challenge for practices. Administrators often rely on time-intensive manual approaches by running multiple granular reports followed by manual grouping and counting procedures.
This potentially erroneous process is exacerbated by the fact that each clinician, for each location, will require a unique count of qualified visits, plus the visits need to be further broken out by patients from different CMS programs, including Medicare, Medicaid or Title V.
A comprehensive EHR solution with an advanced reporting and analytics platform can generate a predesigned report with the relevant data grouping logic in one click. With analytic reporting tools, relying on manual compilations and counts is a thing of the past.
Effectively managing Billing and Collections
RHCs have unique billing challenges, such as bundling and claim splitting. Medicare and Medicaid require the biller to “know” what services get bundled into the qualified visit and which services must get split into a separate claim. Analytics can deliver RHC claim splitting and procedure bundling reports that help streamline the billing process for Independent and Provider-Based RHCs.
Additionally, RHCs must provide detailed expense and reimbursement information for cost reporting relating to graduate medical education payments and bad debt. RHCs must track specific expenses around influenza, pneumococcal and COVID-19 vaccines and cover monoclonal antibody products used as pre-exposure prophylaxis prevention of COVID-19 and their administration.
Without analytics and advanced reporting capabilities, this data must again be tracked and compiled manually, which is extremely time-consuming, error-prone and generally inefficient.
Improved Clinical Outcomes through Gaps in Care and Chronic Care Management
Healthcare in the U.S. has been shifting from a volume-based Fee-For-Service Care model to a quality-focused, Value-Based Care model and a shift to more preventive medicine.
The next steps are being driven by leveraging clinical data with Analytics and soon with AI. Data empowers providers to be more focused on getting patients into the practice so they can more actively manage chronic illnesses like diabetes or hypertension.
CMS’s priority is for RHC clinics to see each patient at least annually for a wellness visit. Visits are key to the early diagnosis of chronic illnesses and setting an appropriate care plan. The wellness exams provide an opportunity to address gaps in care, such as depression screenings, vaccinations, or routine cancer screenings that may be due.
Providers must comply with the aftercare of exam results — whether hypertension or another diagnosis. Similarly, when it comes to cancer screenings, such as mammograms and colonoscopies, providers might consider a specific test for those patients who meet certain criteria. Without an analytics tool to mine that data, it is cumbersome or impossible to manually assess what tests or treatments are missing.
To track and measure the quality of clinical initiatives, RHC Clinics must monitor performance using Clinical Quality Data Measures or CQMs approved by CMS. These CQMs are built to read volumes of historical data and can easily identify what screenings a patient needs and how their care plan is progressing.
Analytics calculates the extensive details behind the scenes. It displays only final results vs. goals or targets per clinician. It eliminates the need to manually track complex patient demographics, medical history, and current clinical findings data for every patient seen daily.
What’s on the horizon? More data!
Remote Patient Monitoring (RPM), the ability to monitor certain aspects of a patient’s health via a mobile device from their home, will play a significant role in the year ahead. RPM gained popularity by allowing providers to better manage acute and chronic conditions and save costs while reducing patient infection risk.
Roughly 30 million Americans will have used an RPM device by 2024, including blood pressure or heart rate monitors, glucose meters and blood oxygen level monitors. Medicare or Medicaid patients with chronic conditions are usually eligible for RPM devices and services.
Modernized EHR systems will ingest the data from the RPM Devices and automatically update the patient’s chart. Analytics will continue to take over from there to alert clinicians and help ensure the best possible care plans are brought to the forefront for every patient.
RHCs must keep the doors open while running tight margins and barely covering costs. However, with the right tools and technology, delivering the next level of patient care is well within providers’ reach — whether they’re major urban providers or rural clinics focused on underserved populations.
Jose Valero, CMQP
Jose Valero has over 25 years of experience in healthcare software and product development, analytics, financial and clinical management. As the founder and CEO of dashboardMD, an industry leader in advanced analytics, Mr. Valero has worked with numerous hospitals, large academic medical facilities, RHC clinics and physician groups of all sizes and specialties. Mr. Valero helps these organizations implement effective performance management and improvement initiatives to streamline operations and improve workflows, patient outcomes, and revenues.
