Physician Data Analytics and 2014 Challenges – Part 1

Last year, I wrote several blogs on physician data analytics – basic framework, questions to ask, why do it, key problems, support for a new payment model, where to start, benefits, relationship to meaningful use (MU), population health, patient health, mobile health, stages of progress and what it can mean for your practice.



As 2014 begins, I read a recent article on the “Top 10 Challenges Facing Physicians in 2014,” by J. Bendix, D.R. Verdon, A. Ritchie, D. Marbury, in Medical Economics, 12/15/13. Over the next few months, I will share these challenges with you and discuss them related to physician data analytics. As authors point out, these challenges may seem daunting for smaller physician practices, but there may be some large upsides over the long-term.

The Year of Government Mandates
The year 2014 will be when many government mandates come together and create a major challenge for physician practices. The 2014 mandates are creating the “perfect storm” for the supporting IT systems. These include: 1) Affordable Care Act (ACA) financial changes (to be discussed next month), 2) Meaningful Use, 3) ICD-10, 4) new HIPAA rules; and 5) Physician Quality Reporting System (PQRS).

Participation in the Centers for Medicare and Medicaid Services (CMS) Meaningful Use (MU) incentive program, whether a practice is meeting MU Stage 1 or Stage 2 requirements, will require the electronic health record (EHR) system to be “2014 Certified” by the Office of the National Coordinator for Health Information Technology (ONC). The year 2014 is also the last in which a physician can attest to MU to avoid financial penalties that start next year.

In October of 2014, the new ICD-10 coding system for reimbursement begins. ICD-10 has thousands of new codes and will require physicians and staff to be trained to use the codes. Without training, the practice could suffer a financial lose due to lack of effective coding.

Additional HIPAA rules also begin in 2014. The new rules will require practices to conduct risk analysis of their PHI and develop a risk mitigation plan. Also, the CMS MU incentive program will require an annual Security Risk Assessment (SRA), which incorporates all the new HIPAA and security requirements, as well as a risk mitigation plan. The North Texas Regional Extension Center (NTREC) has consultants who can perform the annual SRA for physician practice groups.

Finally, PQRS rewards practices for successfully reporting on 138 outcome quality measures. The PQRS financial rewards turn into a financial penalty beginning in 2015. However, physicians’ participation in PQRS has been low, so this may not have too much of an impact on your practice.

As you can see, one key theme in the federal mandates is that your EHR system must be updated to a new product that can handle ACA mandated changes, ICD-10, MU, HIPAA and PQRS. Many software vendors supporting physician offices today will not be able to upgrade to meet these requirements and, therefore, may drop out of the business. The 2014 software upgrades will need to be accomplished early in the year because of the timing of these mandates. As you do these upgrades, make sure your new software will support physician data analytics.