From the September 2017 issue of HealthCare Business News magazine

While the focus of all value-based care programs is to improve the quality of patient care and reduce costs, shifting from reimbursement that is based on quantity to quality, let’s focus on a couple of specific programs and their requirements.

Starting with the Hospital Readmission Reduction (HRR) Program, CMS indicates that “there are many things hospitals are doing to lower the rate of readmissions, including:
• Focusing on better coordination of care and communications between providers, and patients and their caregivers.
• Improving discharge planning, education and follow-up for discharged patients.
• Using electronic medical records to share information and provide continuity of care.



MIPS states that eligible clinicians (EC) who choose to participate “earn a performance-based payment adjustment to Medicare payments.” ECs must show high-quality, efficient care, using technology in these areas: quality; improvement activities; advancing care; and cost. Data in support of these four areas are to be collected and submitted Jan. 1, 2017, through Oct. 2, 2017. Payment adjustments begin Jan. 1, 2019, and are based on performance and the amount of data submitted in 2017.

These programs dictate an exchange of accurate, correct and timely information that is readily available and is protected. Discharge planning and follow-up to ensure patient compliance requires a formalized process to accomplish the exchange between EC and patient, as well as documented results. The use of electronic medical (health) records needs to be governed to ensure that the information collected is accurate and meaningful and is readily available in a useable format for making patient care decisions. This is why the information governance competencies of enterprise information management (EIM) and IT are critical to ensuring that all enterprise-wide information and technology is in place to provide the best care and follow-up, and to reduce unnecessary readmissions.

As shown through these examples, MIPS requires reporting data on key measures in support of the quality of patient care, activities to improve patient engagement, technology use and reducing costs. Likewise, providers must ensure that the data and information captured and reported is complete, accurate and timely. Only through reported data and information can results be adequately measured. Therefore, information governance in the new world of value-based care is imperative.


About the author: Ann Meehan, RHIA, is the director of information governance at AHIMA IGAdvisors.

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