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How do gaps in care affect providers?
When gaps in care exist, you miss opportunities to provide essential services to patients and receive reimbursement for them. Gaps in care may also contribute to poor performance in meeting quality measures, leading to financial penalties or reduced reimbursements.
Additionally, treating preventable complications, managing advanced disease stages, or providing emergency interventions can be more expensive than providing timely and preventive care. You may incur additional expenses in the form of extended hospital stays, specialized treatments, or costly procedures. Identifying and closing gaps in care leads to improved scores under Medicare, P4P (pay for performance) and other quality improvement programs
Closing Gaps
Closing gaps in care not only transforms patient health outcomes, it is also financially advantageous for healthcare practices. Eliminating care gaps improves quality scores and increases reimbursements and quality improvement programs. However, identifying and closing gaps in care requires intensive effort and resources.
Closing gaps in care extends beyond preventative measures to patients currently managing chronic conditions as well. For example, patients with diabetes should be receiving A1C testing anywhere from twice a year to every three months, depending on the severity of their condition. These tests are essential for monitoring the efficacy of diabetes treatment plans. When these are missed, healthcare providers do not have the necessary data to evaluate the success of the treatment programs.
Why it’s important to identify gaps in care
Identifying gaps in care is crucial to facilitating positive clinical outcomes for patients and enhancing quality scores for your practice. Healthcare providers cannot manage conditions that have not been identified. When the window for early diagnosis is missed, so is the opportunity for implementing proactive treatment and maintenance plans.
Identifying gaps in care allow patients to be ideally positioned to treat their chronic conditions early and effectively, leading to improved quality of life and lower healthcare costs.
Increase CMS Reimbursements
Higher Pay for your Practice
Improving HEDIS Scores
Close more “care gaps”
Crease member satisfaction for higher Star ratings
What Are Gaps in Care
A “gap in care” is created when the care provided to a patient is inconsistent with the recommended best practices in healthcare. For example, if a patient is in a high-risk category for breast cancer and has not received an annual mammogram, this lack of insight into their cancer status presents a gap in the patient’s record. Their primary care provider cannot manage or take action on what has not been measured.
When patients fail to follow through on recommended screenings, diagnoses can be missed. This presents an obvious gap in care that can have a deleterious impact on the patient’s health. Early detection of disease leads to proactive treatment plans that can mitigate patient suffering and increase quality of life. Therefore, it is vital for patients in at-risk groups to comply with recommended health screenings.
Gaps in care manifest in a wide variety of ways. Missed screenings, failure to reschedule wellness visits, improper medication adherence, and inability to find in-network specialists can all interrupt a patient’s journey toward optimal care. The risk of undetected conditions developing into serious health concerns heightens the longer these care gaps go unresolved.
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