Case Exchange – a closer look at the market drivers and restraints

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In my last blog I compared Image exchange vs. case exchange. There is a growing need and importance among healthcare providers for case exchange. Today let us look at some of the key market forces that are shaping the adoption of case exchange solutions.

  • Meeting the needs and alignment with new and emerging care delivery models

In the US, the healthcare reform guidelines – specifically Meaningful Use Stage 2 and 3 – are incentivizing organizations to deploy solutions and systems that will enable access to patients images and data. (Read the requirements for electronic access to patient’s data here). In addition, the establishment of ACOs promotes a highly collaborative and integrated care model where primary care providers, specialists, referrers and payers come together and share financial responsibility to enhance the quality of patient care. Shifts in reimbursement models are also notable. Trends are from fee for service to fee for performance. This further underscores the importance of patient experience and satisfaction for services provided by the healthcare enterprise.

  • Declining reimbursements and economic volatility increasing cost pressures and pushing for higher levels of efficiency

In the US, starting with the Deficit Reduction Act in 2006, Imaging reimbursements have experienced continuous cuts year over year. Medical reimbursements declined by 21% between 2007 and 20101. These cost pressures directly impacting both public and private healthcare systems have heightened price sensitivity. This resulted in cost-cut measures and in turn put the onus on the vendors to provide solutions which can increase efficiency and help organizations reduce the total cost of ownership in a sustainable fashion.

  • Growing Shortage of clinicians and specialists

The United States alone may face a shortage of more than 90,000 doctors in the next decade2. According to the AAMC’s Center for Workforce Studies, there will be 45,000 too few primary care physicians – and a shortage of 46,000 surgeons and medical specialists – in the next decade. While the incidence of chronic diseases is growing, the shortage of physicians and specialists intensifies the pressure to provide high levels of accuracy for diagnosis and efficiency in managing patient care. Globally, the shortage of physicians is more critical in rural areas. Whereas nearly half of the world population lives in rural areas, only 38 per cent of the world’s nurses and less than 25 per cent of doctors work in rural areas³. In this environment it is important that technology rapidly evolves to provide remote diagnostic and treatment tools to improve patient/specialist accessibility.

At the same time, there are limitations for widespread adoption of case exchange as well. Based on information from the Advisory Board, if a case exchange for a patient transfer is happening among sites within the same healthcare system, the professional component may be denied reimbursement for a second read. Even if it goes through successfully, the Multiple Procedure Payment Reduction clause means reimbursement will often be cut by 25%4. If sites are different hospitals or providers, there may be a chance for reimbursement of the second read, but still a high possibility the payer will reject it. For this reason, many providers may offer second-read or second opinion services at an out-of-pocket cost to the patient. If a patient is referred to a specialist for consultation, the specialist may get the reimbursement, not the primary care physician.

This may change in an ACO model where ACO arrangements such as bundled payments make all the physicians and providers responsible for a patient’s episode are reimbursed a lump sum to share. The more the number of reads or exams performed for that patient the more are the costs which do not contribute to any more reimbursement for those involved in the patient’s care. Therefore the incentives to share patient’s existing exams, history, and prevent any duplication and redundancies are enhanced.

In summary, the drivers of case exchange are clearly outweighing the limitations to ultimately ensure faster and accurate delivery of care. To maintain continuity of care for the patients, it is imperative that the data frees up from systemic silos and is available at point of care, anytime, anywhere.

But of course this is my point of view – I’d love to hear what you think of the ‘case’ for case exchange.  Feel free to respond to continue the dialogue!

 


[1] Analyses at the Neiman Health Policy Institute using data from the Medicare Physician/Supplier Procedure Summary (PSPS) annual master files 2003 to 2010; the enrollment data from CMS, Medicare & Medicaid Research Review; and the 2011 Statistical Supplement. Article published in ACR (Medical Imaging: Is the Growth Boom Over?)

[2] http://www.un.org/esa/population/publications/popfacts/popfacts_2010-2rev.pdf

[3] https://www.aamc.org/download/286592/data/


[4] Source : http://www.advisory.com/research/imaging-performance-partnership/the-reading-room/2013/07/proposed-hopps-2014-rule-slashes-ct-and-mr-how-to-guard-your-revenue-stream


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