Observation Deck

The Journey to True Interoperability

HME businesses that connect their IT systems with other health providers build a bigger presence.

• By Dave Cormack
• Mar 01, 2016

“Interoperability.” You’ve likely heard this term, and you may even understand what it means, but what is the potential impact on HME providers?

Interoperability is the extent to which systems can seamlessly exchange data, interpret, and act on that shared data. In our industry, this means being able to share electronic information between referral sources, payors, manufacturers, distributors, and others in order to improve efficiencies, and deliver better outcomes and patient care.

For HME providers that embrace interoperability, the business impact will be dramatic, leading to exponentially more referrals and increased relevancy within the post-acute healthcare continuum.

To put the importance of interoperability into perspective for the HME industry, look no further than the acute and ambulatory healthcare markets, where significant strides have already been made to digitize and begin sharing health information. The post-acute market, including HME, will be required to have this interoperability capability soon, and those who embrace interoperability early will see significant upside.

History of Interoperability

Driven primarily by payors and our government, interoperability is aimed at improving patient care and controlling skyrocketing healthcare costs through an outcomes-based reimbursement model.

In order to quickly drive the adoption of health information technology by hospitals and physicians, incentives were put in place. The first program was the Meaningful Use program, led by CMS and the Office of the National Coordinator for Health Information Technology (ONC). Meaningful Use is a phased approach, that grants an incentive payment to eligible healthcare professionals and hospitals who demonstrate that they have engaged with certified Electronic Health Records (EHR) technology. As the initiative evolved, the program became cumbersome and physicians pushed back as comprehending and complying with the program took time away from their patients.

Last year, The Medicare Reform Law and CHIP Reauthorization Act of 2015 (MACRA) was passed. MACRA expands upon Meaningful Use, but considers quality, cost, and clinical practice improvement activities in calculating how reimbursements are determined; MACRA also measures physicians on their meaningful use of certified EHR technology. As this shift in model occurs, CMS and ONC have made it clear that a key goal for the new program will be to aggressively drive interoperability across the healthcare ecosystem that they paid to digitize.

Impact on HME Providers

In the HME industry, building and servicing referral sources has always been critical. But now, interoperability is beginning to have a major impact on the referral process. More and more referral sources are rapidly moving towards transmitting electronic referrals (eReferrals) through their EHR system. The benefits of this trend for the HME provider are realized when the provider can receive referrals and related documentation electronically into their own system. These modern connections streamline the referral process for both the referral source and the provider, which reduces errors, decreases order entry times, and most importantly, strengthens referral relationships.

Although the percentage of electronic referrals to HMEs is small today, it is expected to rise significantly over the next few years. This presents an opportunity for HME providers who quickly embrace interoperability now to gain market share as the transition to eReferrals takes off in a big way.

Moving from Baked Goods to Interoperability

It used to be that nurturing your referral sources might involve dropping off some fresh cookies or doughnuts. While that remains a nice personal touch, the benefits of electronic collaboration are sure to do even more to keep you locked in with your referral sources. As the physician EMR market is evolving, HMEs are increasingly expected to do the same to communicate electronically and bi-directionally with referral sources. Traditional labor-intensive efforts to stay in touch with referring partners — such as sending employees to wait and collect signed documentation, or making endless phone calls — will become even more of a nuisance. The HMEs that develop strong relationships with physicians through interoperable platforms will significantly increase sales and market share, ensuring future business prosperity.

In the end, it comes down to physicians choosing where to send referrals. In the new interoperable world, the choice will depend on which provider will be equipped to accept eReferrals, request eSignatures, and automatically share patient data and outcomes with the referral source easily and thoroughly. By becoming interoperable, an HME will be viewed more as a partner and less as a commodity.

Get Connected, or You’ll Be Disconnected

As important as interoperability will become to your HME business over the next few years, it is paramount that you select a technology partner who can deliver the most robust software and communications architecture. Also, the technology partner is only as strong as the connections it offers to your referral sources, payors, manufacturers, distributors, and others so that you are connected where you need to be to share data seamlessly across your care continuum. From a technology perspective, a cloud-based SaaS platform where the connectivity is automatically managed will enable providers to easily share information, leading to reduced costs and improved care coordination.

Additionally, the technology vendor should be leveraging emerging interoperability standards. Brightree is the first post-acute care member of the CommonWell Health Alliance, the industry’s leading initiative focused on solving the problem of interoperability, and our solutions will leverage the emerging CommonWell standards. The day is coming where a provider will receive a referral electronically, automatically send forms to the physician for eSignature, and deliver HME product with reduced or no risk of denials. The fully electronic HME world is cresting the horizon. Will you be ready?

The Future is Now

Embracing interoperability is not an option. It is imperative to the future of your business. As a provider, you must have a clear understanding of how your business fits into the dynamic healthcare ecosystem, and you must use a strong technology platform to succeed in this new interconnected world. The HMEs who act now will succeed, reaping the rewards that early adopters enjoy. Those that continue to operate in ‘business as usual’ mode will be left behind or put out of business. It’s time to get busy!

This article originally appeared in the March 2016 issue of HME Business.