Document Type

Report

Publication Date

4-13-2015

Publisher

George Washington University Milken Institute School of Public Health Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Series

Policy Research Brief # 41

Keywords

Electronic Health Record; Health Information Exchange; Community Health Centers; Medical Billing and Coding

Abstract

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably develop new rate setting approaches or evaluate existing rates as they might be applied to community health centers. Specifically, key findings include: 

  • Use of internal, center-specific codes (for example, in CPT fields) complicates the translation into relative value units (RVUs) and the aggregation of comparable data across health centers.
  • Enabling services are difficult to quantify.
  • Vague and inconsistent position titles lead to potential inaccuracies in the allocation of expenses.
  • The current funding environment deters capture of new information.

This study raises fundamental questions about how to quantify (let alone how to reimburse) the true value associated with the community health center model of care. The study recommends tailoring EHR products to better capture the unique services provided by health centers and their effective management of high-risk patients. Fully moving to value-based reimbursement models will likely require that health centers adapt workflow to ensure that additional critical information (e.g., social determinants of health) is properly entered as structured data and not merely as scanned notes and other documentation

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Peer Reviewed

1

Open Access

1