act, suggest that the balance of supply and demand will result in further stress to the healthcare delivery system. Providers face challenges related to cuts in reim- bursement. They are also challenged with meeting pay-for-performance objectives, CMS core measures and The Joint Commission’s quality indicators. Addi- tionally, the HITECH Act adds a little complexity to the equation by requiring specifi c interoperability capabili- ties, including communication with health information exchanges, state departments of health, personal health records and other external agencies. Interoperability is absolutely necessary to success in these endeavors. Further, providers are challenged with being able to prove that they meet meaningful-use criteria, pay-for- performance goals, core measures, and quality indica- tors. The ability to quickly and easily monitor these metrics, and consequently manage the appropriate clini- cal processes, will be critically important. Business and diagnostic intelligence solutions that enable real-time analytics will become increasingly important.
Justin Barnes For provider organizations, the biggest challenge – which we’re already seeing – will be the ongoing evolu- tion of adapting to payer and/or payment models and having the functionality in hand to do so. As traditional fee-for-service (FFS) models are beginning to give way to pay for performance, physician quality reporting ini- tiative (PQRI) and a host of quality-reporting measures from private and public payers, such as the emergence of accountable-care organizations and the patient-centered medical home, the ability to maintain and enhance profi tability will always be where provider organizations need to focus. Factor in the meaningful-use model, and provider organizations will have to continue to make sound and sometimes complex decisions based on their community-care model, practice model and patient population. For CIOs, interoperability will factor right in with choosing future payer and/or payment models in terms of the ability to offer digital quality reporting and enhanced patient outcomes. CIOs will need fl ex- ible, customizable and innovative technologies that can share information within practices and hospitals, through referrals, with patients and with public health agencies. As standards-based interoperability becomes even more institutionalized, I think the challenges will be competently overcome.
Betty Otter-Nickerson The migration from quantity-based to quality-based reimbursement creates the greatest challenge for the provider organization over the next 10 years. Work
fl ows and systems designed to maximize productivity and reimbursement must now be re-engineered based on best practices for demonstrating best outcomes. We are already seeing the next hospital integration wave, and it is likely that the defi nition of “independent” will change for practices choosing to remain independent. HIT infrastructure needs to be readjusted in tandem to support collaboration between providers across the care community and within accountable-care organiza- tions. The focus will move from administrative/fi nancial systems with clinical components to clinical decision support and EHR systems with an administrative/ fi nancial aspect.
The biggest challenge for providers will be the move- ment toward outcomes-based reimbursement. Pay for performance is the tip of the iceberg in terms of where the industry will eventually head, and integrated systems are a necessary prerequisite. It will likely take 10 years before signifi cantly different reimbursement models can fully take hold for hospitals, but it is my belief that we are headed that way. When the govern- ment has access to real-time data in large quantities regarding hospital and physician performance, it will be in a position to pay according to which organizations deliver the best care at the lowest cost.
Steve Emery Providers’ issues include capacity, cost and reim- bursement. If they are losing money serving one patient; they will lose 10 times as much serving 10 new patients. Providers and CIOs will need to accommodate an increasingly granular set of patient controls for access and sharing of health records, where the technology will struggle to keep abreast of regulations and our society’s evolving understanding of privacy rights.
Doug Bilbrey Without a doubt, the conversion to ICD-10 will be the biggest challenge our industry has ever faced. This will make Y2K and X12 look like a walk in the park. IT will play a role in ensuring that existing or legacy systems are upgraded to handle both the 5010 imple- mentation as well as the ICD-10 conversion shortly thereafter. Further, IT will need to ensure that the providers have systems that enable them to correctly code with ICD-10 and ensure that the payments from payers are accurate in the new ICD-10 world. Lastly, it’s too early to anticipate what regulatory requirements are going to come from healthcare re- form, but you can bet that there will be many new mandates that will require new solutions or updates to existing solutions.
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