Understanding the major challenges and evolving regulatory landscape facing physician groups

Soon after he started working at MGMA back in the 1990s, Robert M. Tennant, MA, was in a staff meeting discussing the recently passed HIPAA law and was charged with looking into the implications for physician practices.

“Little did I know that it would turn out to be a career,” Tennant said during a recent MGMA Insider podcast on the evolution of health IT. “HIPAA has expanded beyond its original intent, and healthcare has been driven by technology.”

In his role today as director for health IT policy on the MGMA Government Affairs team, Tennant spends most of any given day reading through numerous announcements from the government and industry at large, as well as sitting on numerous boards and work groups that track everything from EHRs, privacy/security and administrative standards. But most important, he says, is the role of interacting with MGMA members.

“I get a lot of questions from members on technology policy and those are very important to me to answer,” Tennant said. “Being able to interact with the members is so vital, because it not only helps the member, but it helps me to understand how these technology policies are impacting our members on a day-to-day basis.”

A pulse check on physician groups

In more than 20 years watching the evolution of health IT, Tennant said that two of the major issues facing medical group practices are the pervasive use of EHRs and the ongoing need for administrative simplification for new technologies.

Why? “It boils down to one word: money,” Tennant said, noting an often adversarial relationship between providers and health plans. “[Health plans are] looking for opportunities to improve their revenue streams. Physicians do not like health plans telling them how to practice medicine, whereas health plans say they need to be an overseer to make sure that the monies are distributed fairly and that patients are receiving the appropriate care.”

When it comes to finding common ground, Tennant points to health data and how health plans are beginning to understand how better data translates into improved patient care, “which hopefully will decrease costs for health plans,” he said.

“I think there’s a general agreement on the need for good data, what I call actionable data,” Tennant said, but there remain issues on how practices get that data and who should pay for that movement of data.

Top trends impacting health IT today

Echoing his comments on the pain points between providers and health plans, Tennant noted that the movement toward interoperability of health information is a central focal point for health IT today. “The theory is that the seamless movement of patient data between care settings will result in improved care and decreased costs,” Tennant said, though cautioning that providing too much data can also be a challenge to providers. “With physicians having only limited time with patients, they must be armed with the right data. We can't waste their time by giving them information that is not relevant or actionable.”

Ultimately, Tennant said that improving care coordination via technology is significant given the increasing shift of reimbursement into alternative payment models and risk-based contracts. Practices that have “access to real-time patient data can greatly improve their ability to coordinate care” and keep patients out of ERs, which saves the healthcare system significant amounts of money.

To that end, artificial intelligence (A.I.) and APIs (application programming interfaces), along with real-time benefit transactions, are showing promise in improving care delivery processes and establishing new standards for moving health information for clinical and administrative purposes. FHIR (fast healthcare interoperability resources) leverages API standards — “the backbone of apps that we currently use on our smartphones,” Tennant noted — to move to meet the government’s mandate for EHRs to support apps that permit patients to download their health records and practices to share data more efficiently with other providers and health plans.

Technologies and standards that benefit real-time transactions — such as those now seen in EHRs for prescription medications — hold the key to significantly reducing the time and resources tied up in prior authorizations. “The next stage will be to adopt this type of technology to a broader set of medical services,” Tennant said.

Operational and regulatory challenges

Though Tennant says that it is exciting time for practices, the challenges in keeping up with health IT are many, such as:

• The constant threat of cyberattack
• Searching for return on investment prior to investing in new technology
• Ensuring that new technologies fit within existing workflows and practice culture
• Working toward establishing a national, unique patient identifier.

“You can't have true interoperability if you can't trust the data that is coming into your practice. … There's got to a way to effectively identify patients,” Tennant said.

With any emerging issue in health IT, Tennant said that his role with MGMA Government Affairs is to refocus the conversation on “the real world of healthcare” and how policies affect medical practices of all sizes.

“There's so much data flowing from the government, from the private sector,” Tennant said, and there’s a tendency to look at health IT from the perspective of big organizations that have nearly unlimited budgets for health IT. As one member once told him, the cost of government mandates on physicians often come “right out of the physicians’ children's college funds,” he noted. “There has to be a recognition that any policies have to be effective, lead to better patient care or more efficient delivery of care, and have to be reasonable in terms of costs for practices.”

Additional Resources:

• "Sessions you don't want to miss: Sifting through the noise on health IT" (MGMA Podcast)
• "Insider: Talking tech, privacy and A.I. in healthcare with Robin Farmanfarmaian" (MGMA Podcast)
• "RTLS: Keeping electronic tabs on patients (and staff) can offer major insights into efficiency in care" (MGMA Insight Article)