Health systems faced major headwinds in 2022: ongoing clinician burnout, soaring staffing shortages, and plummeting financial margins. Fortunately, the healthcare industry has been actively restructuring its landscape and building new momentum in reimbursement, value-based care, and patient engagement. With all the fundamental shifts to come in 2023, health systems have the most to gain… and the most to lose if they don’t take prompt action.
Here are the most pressing changes health systems can expect – and should immediately prepare for:
New CMS rulemaking on remote therapeutic monitoring is more practical for health systems
The Centers for Medicare & Medicaid Services (CMS) announced significant updates to the existing rules for remote therapeutic monitoring (RTM) services.1 Effective January 2023, any RTM service may be furnished under general supervision as opposed to direct supervision – a monumental adjustment for some healthcare providers. Lifting restrictions on supervision will make remote monitoring more practical for providers by allowing clinical staff and auxiliary personnel the opportunity to practice at the top of their licenses, helping ease mounting physician burnout. Providers with centralized remote monitoring departments will be able to seek reimbursement for the coordinated provision of RTM services across their organization.
“It can be really difficult for providers to own every aspect of remote monitoring. Reaching out to beneficiaries, analyzing data, coordinating and managing care, plus clinical and medical decision making are just a few of the tasks on their plates,” said Robert Jarrin, J.D., Strategic Advisor on Digital Health and Medicine at ResMed. “As a result of this change, some of that work can now be performed by clinical staff, thereby alleviating the provider from duties that can be shared.”
Learn more about the 2023 CMS final ruling in an interview with Robert Jarrin, J.D., and gain insights on how to best prepare for reimbursement in the year ahead.
Health equity is no longer optional after updated Joint Commission standards
Three new Joint Commission measures will require that health systems execute more focused and structured approaches to attaining health equity.2 Beginning January 2023, organizations will be obliged to:
1. Appoint an individual to lead activities aimed at reducing health care disparities
2. Assess patients’ health-related social needs, then provide information on community resources and support services
3. Identify health care disparities within their patient population by stratifying quality and safety data based on patients’ sociodemographic characteristics
“These Joint Commission standards are necessary steps toward advancing population health at scale, and more importantly, achieving equitable healthcare,” says Meredith Barrett, VP of Population Health Research at Propeller Health. “Digital health solutions can play a role in driving real change and improvement by enabling a better understanding of where health care disparities exist within health systems and communities, and addressing those gaps with a connected approach.”
Focus on ACOs and value-based care revived through ACO REACH and MSSP updates
Following several years of growth, ACO memberships began to plateau during the peak of the pandemic when health systems were forced to reprioritize basic care over expanding alternative payment models. As we approach the third year of our “new normal”, healthcare will see a renewed focus on ACOs over the next few years.
Historically, providers serving rural and underserved populations lacked the essential infrastructure necessary for excelling in risk-based contracts. CMS’ updates to the Medicare Shared Savings Program (MSSP) fee schedule will provide advanced investment payments to low-revenue Accountable Care Organizations (ACO) that have yet to participate in the program.3 This new ruling will accelerate and expand the number of beneficiaries assigned to an ACO in the program, ultimately encouraging a broader focus on health equity and value-based care.
In addition to the anticipated MSSP updates, a new CMS program – the ACO Realizing Equity, Access and Community Health Model (ACO REACH) – kicks off in 2023 and will incentivize greater nation-wide participation in value-based care agreements.4 ACO REACH provides an alternative to the MSSP and will replace direct contracting, offering the highest level of risk and reward for the total cost of care in Medicare fee-for-service models.
“With population health initiatives shifting to the forefront again, the MSSP and new ACO REACH models provide valuable opportunities for organizations to seek increased levels of risk and reward,” said Chris Fickle, SVP of Healthcare Partnerships at Propeller Health. “When we are able to offer high quality care at a lower total cost, everyone wins including patients, health systems, and payers.”
EHR-compatible digital health solutions become critical for addressing administrative burden and reducing security risks
Health systems continue to struggle with diminishing rosters and limited clinical resources. Organizations are losing great talent at unprecedented rates, with 47% of physicians reporting feeling burnt out.5 On top of that, security breaches remain a constant threat, with healthcare incidents being the most costly of all industries – exceeding an average cost of $10 million.6 More than ever, health systems are in dire need – and will be in search – of solutions that can not only enhance patient care and improve operational efficiencies, but can also seamlessly integrate with their organization’s EHR platforms and minimize security risks.
“It’s just not practical nor feasible to expect providers to learn multiple systems,” said Carlos M. Nunez, M.D., Chief Medical Officer of ResMed. “Working within a single, integrated platform reduces overall privacy and security risks for the organization. Soon enough, the complete integration of digital health solutions into mainstream EHR platforms such as Cerner and Epic will be non-negotiable.”
Health systems partner with digital health companies to drive patient engagement to new heights
Throughout the pandemic, we saw physician and health system adoption of digital health solutions soar, resulting in overwhelmingly positive, lasting impressions on all users. In 2022, the American Medical Association reported 93% of physicians felt that digital health was advantageous for patient care.7 And even as the pandemic winds down, we’re still seeing consumer demand for digital solutions strengthen – 73% of users desire to continue or increase reliance on telemedicine.8 Health systems looking to meet this staggering physician and patient demand will need to partner closely with digital health companies to expand their digital portfolios – or risk faltering patient enrollment and engagement.
“Although digital health solutions have been proven to benefit patients, hardware and software alone are not enough,” said Susa Monacelli,” General Manager of Propeller Health. “Driving real behavior change requires an integrated approach with provider support, and tailored experiences that address individual needs.”
1 Centers for Medicare & Medicaid Services (CMS), November 2022. Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule.
2 The Joint Commission, 2022. R3 Report, New Requirements to Reduce Health Care Disparities.
3 CMS, November 2022. Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule – Medicare Shared Savings Program
4 CMS, 2022. ACO REACH, CMS Innovation Center.
5 Medscape, 2022. Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger.
6 IBM, 2022. Cost of a Data Breach Report 2022.
7 American Medical Association, 2022. AMA Digital Health Care 2022 Study Findings.
8 Rock Health, 2021. Consumer Adoption of Telemedicine in 2021.