Starting a post-acute palliative care practice: 5 points to consider
Many home health and hospice agencies are expanding into palliative care to ensure their patients receive the care they need by offering better symptom management which can reduce hospitalizations, and keep the patient at home where they’re most comfortable. If your agency is thinking about making the move into palliative care, here are five points to consider.
1: Choose a care setting
Palliative care can be provided in a hospital, physician clinic, or in the patient’s home. Each setting has different requirements and different access to the patient’s health records. For example, palliative care staff who work with hospitals generally see the patient in the hospital before discharge and document the visit in the hospital’s EHR.
However, a home- or clinic-based practice might want to consider a fully functional EHR, which would allow them to send information between their practice and referral partners, such as home health or hospice agencies, for easier sharing of important clinical information.
2: Features to evaluate for a palliative care EHR
If your practice is hospital or clinic-based, you may be documenting in an existing system, which means that although you may not need clinical content, you will need the ability to easily integrate data between the hospital or clinic and your home health and hospice EHR to receive visit notes electronically and bill claims.
Home-based practices need clinical content that is specific to palliative care. In this setting, users need to document multiple HCPCS codes for a single encounter, such as evaluation and management of care, and advanced care planning. The ability to e-prescribe and to transition palliative care patients to a home health or hospice setting should also be considered.
3: The big question: Do you need a certified EHR system?
The requirement for using a certified EHR is based on the Medicare quality payment program, which has two tracks: the merit-based incentive payment system (MIPS), and the alternative payment model (APM).
MIPS is required if a practice bills more than $90,000 for Part B covered services and has provided more than 200 services to more than 200 Part B patients. (A practice must meet all three of these requirements over two sequential determination periods to quality for MIPS.)
If your palliative care practice is just getting off the ground, you may not need a certified EHR yet. It may take several determination periods to reach the threshold for MIPS, which could mean years. But it is important to track the threshold requirements as your practice grows to make sure you have the EHR system you need if you choose to participate in MIPS or APM.
4: Conduct a cost analysis
One way to determine whether your organization should purchase a certified EHR is by doing a cost analysis. Here’s an example:
A small palliative care practice has five nurse practitioners who each see four patients per day. This adds up to 1,500 patients per year. Assuming an average encounter reimbursement of $150, the practice would bill approximately $250,000 in Part B claims. This would exceed the low volume threshold for MIPS if it happened two years in a row.
This practice has two options. If they decide not to use a certified EHR, they will be penalized 9% of their Part B claims, or about $22,500.
If this practice considers buying a certified EHR, there are two key points to evaluate. First, does the EHR require a minimum number of users? If the practice does not meet that minimum, the EHR cost could increase significantly. If there is no minimum and the practice pays only for the number of providers it has, that is more favorable financially.
Second, what is the rate of referrals to home health or hospice? Any cost analysis should evaluate the benefits of your palliative care program compared to the costs.
5: Identify the features you need
Using this example, it’s possible that the practice may decide that a certified EHR is not worth the expense, and they may prefer to keep all information in a single software application.
If that is the decision, the practice should identify which EHR features it needs to be successful. Easy transitions to hospice, mobile point of care with palliative-specific content, and the ability to document multiple codes will be important. The ability to bill Medicare Part B and other insurances, direct secure messaging, and interoperability will be vital as the practice works with hospitals or other providers. Interoperability gives a practice a consistent method for sending documentation from other providers into your non-certified EHR.
MatrixCare is part of the CommonWell Health Alliance. This means that when you take on a new patient, your MatrixCare EHR will be able to search for and pull in documentation from previous care settings that are also part of CommonWell. In addition, direct secure messaging allows users to attach documents, including continuity of care and transition of care documents, and have information auto-populate the corresponding EHR fields. These features save time and help ensure patient data is complete and accurate.
MatrixCare was recently awarded Best in KLAS for home health and hospice software for the second year in a row. This annual award is based not only on our product, but also on phone and web customer support, implementation, our relationships with customers and vendors, and other measures.
Whether you’re just setting up a palliative care practice, or your practice has grown and you need a certified EHR, MatrixCare can help.