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The American Hospital Association reports the average community hospital spends over $7.5 million every year on regulatory compliance. Healthcare organizations need a data-driven approach to measure the value of the care they deliver and while working to maintain compliance and avoid financial penalties.

Healthcare providers and administrators typically view regulatory measures as ever-changing, making it difficult to implement effective strategies and solutions to meet them. Additionally, many healthcare organizations feel a heavy reporting burden because they lack the infrastructure to automatically calculate, track, or submit data.

Although regulatory measures can be hard to understand and feel daunting to providers, they play an important role in keeping patients safe, holding health systems accountable, and promoting quality care. With comprehensive data and supporting infrastructure, organizations can deliver patient-centered care and increase profit margins while meeting these rigorous standards of care.

Healthcare Regulatory Measures Infrastructure Supports Optimal Compliance Performance

Organizations should invest in regulatory measures infrastructure to more easily meet healthcare regulatory measure requirements. One common reason for regulatory measure underperformance—or falling short of these high standards of care—is that organizations don’t know their actual performance or how it compares to other providers or local and national benchmarks. Organizations that manually collect and report regulatory measures performance data often miss relevant information and base conclusions on incomplete data sets.

A comprehensive healthcare regulatory measures solution will aggregate claims and clinical data from multiple sources and provide a comprehensive view of regulatory performance. This would allow healthcare organizations to easily identify areas where they don’t reach compliance targets and then track improvements. Real-time insights on performance can help to optimize reimbursements, and in turn profit margins.

Aligning Healthcare Regulatory Measures with Value-Based Care

As healthcare continues to shift toward value-based care, quality measures keep patients at the center. Efforts like the Meaningful Measures Initiative identify “high priority areas for quality measurement and improvement to improve outcomes for patients, their families, and providers while also reducing burden on clinicians and providers.” For instance, eliminating duplicate regulatory measures across programs will reduce the reporting burden on providers. Less time spent on administrative tasks means more one-on-one face time with patients. The Initiative gathers patient and provider feedback throughout the care process to help guide regulatory organizations and health systems as they create and/or comply with performance measures that focus on areas with the biggest impacts on improving patient outcomes and lowering costs.

Healthcare providers have historically lost money when caring for Medicare populations due to lower reimbursement rates. And, as Centre for Medicare and Medicaid Serivces (CMS) estimates that Medicare spending will keep rising, these lower reimbursement rates ultimately limit profits. To survive in this new value-based world and increase earnings via value-based care programs, organizations need accurate data to ensure they are delivering value rather than volume. Regulatory measures, and the data that provides a high-level view of a system’s measures performance, act as a safeguard for health systems on the road to value-based care by identifying areas in which systems fall short of quality performance and expectations.

To meet healthcare regulatory measures and increase profits, healthcare organizations must accomplish the following:

  • Aggregate and analyze data from multiple sources to reveal continual opportunities to improve care and prevent poor health outcomes.
  • Align financial incentives between payers and providers to allow providers to receive financial rewards for the quality—and not volume—of care.
  • Increase patient engagement in behavior or lifestyle modifications to increase the likelihood of an intervention’s success.
  • Garner support from clinicians and encourage them to lead the shift to VBC to set the example for other clinicians and team members.
Boosting Profit Margins and Patient Health

Meeting regulatory measures is an integral part of the healthcare process because payers, such as CMS, use them to evaluate health system and provider performance, measure value, and then determine reimbursement rates. Therefore, health systems should proactively prepare to meet these rigorous standards rather than reacting to them, risking financial consequences. A robust measures engine, a renewed focus on putting patients first, and a more strategic approach to VBC allows organizations to more easily meet these healthcare regulatory measures, improve patient outcomes, and increase profit margins.

 

In an industry already shifting toward increased transparency and data sharing, the pandemic and vaccine rollout have given motivation and momentum to the push for interoperability. In our latest ZipRadio podcast, a panel of seasoned HealthTech experts discuss the persisting challenges to interoperability, expected impacts of Covid-19 on recent efforts, and interoperability solution innovations.  

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