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Care Gap Management and Navigating Toward Better Patient Care

Navigating toward better patient care is at the core of every practice’s mission. While there are numerous ways to progress toward better patient care, one that is easier to address is the issue of care gaps. In addition to improving care, gap closing will also help improve performance for practices participating in incentive-based programs with insurance providers and/or government agencies.

A care gap refers to the discrepancy between the care a patient gets and the recommended best practice for that patient “type”. These gaps occur when a provider or practice fails to meet target outcomes with an initial patient visit of the year.  For example, making sure a patient has received a flu shot, been screened for depression, breast cancer screening or has been briefly counseled towards quitting if they are a known tobacco user.  An open care gap results when these events go unaddressed during care visits, much to the detriment of patients and providers. It is well documented that preventative care saves patient lives and reduces costs in the long run.  Making sure you have a system that can track care gaps and help your practice address such issues is paramount to long-term patient care management success.

This article will discuss how to close the gaps that are currently open and provide some way to try to prevent them from occurring through documentation changes within the practice’s EHR system.

ReportingMD can help close those care gaps by providing a measure specific financial analysis to understand where your time is best spent to maximize your performance and increase patient outcomes.

Regarding the insurance and government incentive programs the purpose of closing care gaps is threefold:

  • Find the number of performance gaps per measure to increase score and the financial impact of the change in score.
    1. Without insight into the nature of the issue, it is difficult to find a solution. ReportingMD can help by providing in-depth analysis and identify which patients have care gaps going unaddressed for each measure through our Total Outcomes Management (TOM) platform
  • To understand the return on investment in closing performance gaps
    1. ReportingMD provides a financial analysis that accompanies the in-depth patient identification to help align practice priorities
  • To prioritize the measures to target in end of year effort
    1. By combining the patient identification along with the financial analysis ReportingMD gives practices unique insights into gap closure and the direct revenue impact of potential gap closures moving forward

Within the financial analysis there are two general ways to go about closing care gaps – through patient chasing and chart chasing. 

Patient chasing occurs earlier in the year or before year’s end and only applies to once-per performance period measures or outcomes.  The goal is to follow-up with patients on their next visit within the calendar year and making sure any open care gaps are addressed with the patient in that time or potentially to schedule them in for a follow-up if an urgent gap exists.

The alternative is chart chasing, which applies to all measurements. This entails reviewing targeted charts to ensure all possible data elements are captured for gaps (notes, paper charts, discrete data fields, attachments, etc.) Also, this will help clear any claims backlog that may have occurred over the course of the year. Sometimes claims data can become outdated as it takes time for a claim to be submitted and processed.

How can a practice go about preventing care gaps from occurring in the first place?  Making sure the practice’s EHR is best suited for the practice’s purposes is key.  Ensuring that discrete data fields are plentiful, easily identifiable, and easy to understand. This makes for faster documentation and higher staff compliance, allowing documentation within the chart to be retrieved easily. Time spent doing deep-dives into the notes section for such information as LVEF or BP readings eases the administrative burden on all clinical staff. Also catering the EHR to your practice’s abilities such as having reminders in place indicating that a patient is due for a screening, instead of researching their chart to find their last colonoscopy also assists to close gaps that might occur.

Care gaps are a frustrating aspect of medicine that all practices encounter. Fortunately, there are ways to identify and address these care gaps and ReportingMD’s Total Outcome Management (TOM) platform is here is help.

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