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The Waiting Room – A Patient’s First Impression

Posted on September 23, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is sponsored by Samsung Business. All thoughts and opinions are my own.

We’ve all heard about the importance of first impressions. They last a long time and happen very quickly. The same is true for a medical practice. Patients’ first impression of a medical practice is the waiting room and that impression can last a very long time. What have you done to improve your patients’ experience in the waiting room?

Instead of doing a bunch of small things in your waiting room, I suggest you focus on creating one specific WOW! factor that patients will remember. In many cases people are turning to digital signage to provide this wow factor. Combine amazing content with some amazing digital signage like a curved TV, 3D TV, or massive screen and you can quickly implement the WOW! factor in your waiting room.

These type of memorable experiences for patients in your waiting room are the fuel that feeds social media and physician rating services today. If you want patients to share their experience at your office on social media or rate you highly on the various physician rating websites, start by WOWing them in your waiting room. Almost all of your patients now arrive with a phone in their pocket which they can use while they wait to provide your practice a quality rating. Leverage that as an asset.

I’ve heard some people argue that digital signage isn’t valuable anymore in the exam room because patients all show up with their own smartphones and tablets. They argue that patients have their heads buried in their phones and so they never see the digital signage you put in the exam room. This couldn’t be further from the truth.

The reality is that most of us with smartphones have become quite habituated to what people call the second screen experience. More and more people are watching TV while playing on their smartphone. It’s normal for us to be processing what’s on a TV while keeping an eye on our smartphone at the same time. The same thing happens in the waiting room when you provide a compelling digital experience. We consume both the TV and our smartphone.

Leveraging a high-quality digital experience in your waiting room provides a better patient experience overall. What’s the worst part of a waiting room? You have to wait. What’s the solution? We all have experienced a long flight or car ride that felt like it was much shorter thanks to some sort of digital media experience. This same experience can be had by patients if you invest in the right digital signage and content. Shorter wait times lead to better physician ratings in ambulatory practices and better HCAHPS scores in hospitals.

How have you approached your waiting room? Is there something unique or interesting you’ve done that’s made the patient experience better? What kind of first impression are you making on your patients?

For more content like this, follow Samsung on Insights, Twitter, LinkedIn , YouTube and SlideShare.

How To Choose Tools For Physician-Patient Engagement

Posted on September 22, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

To transition from fee-for-service reimbursement to value-based care, it’s pretty much a given that we have to do a better job of getting patients engaged with their physicians and overall plan of care. However, despite the array of intriguing digital health and mobile technologies we have available to get the job done, it’s still not clear exactly how to do it.

But according to one health IT exec, it all boils down to understanding how the various tools and technologies work and integrating them into your practice. Dr. Ali Hussam, CEO of outcomes data collection firm OBERD, suggests that the following tools are particularly important. I’ve listed his suggestions, and added some thoughts of my own:

  • Educational technologies: Physicians can use these tools to make sure patients are prepared to have an intelligent discussion of their health status, he notes. My take: It’s hard to argue that this makes sense; in fact, this concept is so important that I’m surprised it isn’t mentioned more often as part of the broader patient engagement picture.  
  • Electronic questionnaires: Hussam argues that since value-based care calls for quantifiable outcome measurements, it’s smart to use electronic questionnaires, which are more appealing, efficient and sophisticated than paper tools. My response to this is that while it’s a good idea, it will be important that the questionnaires be based on well-defined measures which the provider organization trusts, and these may not be easy to come by at first.
  • Wearables: Patients may already be using wearables to monitor their own health metrics, but it’s time to make better use of their presence, Hussam suggest. Physicians can step up their value by using the information to improve the quality of health discussions and intervene in response to the data if needed.  It’s hard to argue that he’s right about the potential uses of wearables. However, there’s a lot of doubt about their accuracy, so my sense is that many physicians are still reluctant to make use of them given the clinical accuracy questions which still bedeviled these devices.

Along with recommending these approaches to engagement, Hussam offers some tips for implementing patient engagement technology, including:

  • Focus on patient outcome: Hussam recommends sending a patient-determined outcome as the focus of care, and explaining to patients how engagement technology can help them meet this goal. Plain and simple, this sounds like an excellent idea, as patients are more likely to succeed at meeting goals they have embraced.
  • Solicit feedback: Effective engagement tools “should offer patients a sense of individual attention and intimacy by soliciting feedback about individual patients’ entire healthcare experience,” along with offering care data. He argues, I think compellingly, that this exchange of information could help providers succeed under merit-based incentive payment programs.
  • Encourage responses to questionnaires: As Hussam noted previously, providers must collect data to succeed at outcome-based payment models. But he also notes correctly that these questionnaires and help patients achieve their desired health outcomes by tracking what’s going on with their health. No matter how you couch things, however, patients may need additional encouragement to fill out forms. Perhaps it would make sense to have med techs go through the questionnaires with patients prior to their physician encounter, at least at first.

As Hussam’s analysis suggests, engaging patients isn’t just a matter of presenting them with shiny new technologies. It’s critical to align patient use of the technologies with goals they hope to meet, and to explain how the tools can get them there.

Otherwise, both patients and providers will see little benefit from throwing engagement tools into the mix.

Yet Another Study Says EMRs Contribute to Physician Burnout

Posted on September 21, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A Mayo Clinic study recently concluded that – surprise, surprise – that physicians who used EMRs were less likely to be satisfied with the amount of time spent on clerical tasks. But from where I sit, while the story certainly deserves attention, it’s also worth considering how this fits into the problem of physician burnout on the whole.

First, let’s review the study itself. To conduct the study, which appeared in the Mayo Clinic Proceedings, researchers connected with 6,375 physicians in active practice, 5,389 of which (84.5%) reported using EMRs. Meanwhile, of 5,892 physicians who said that CPOE was relevant to their practice specialty, 4,858 (82.5%) said they used CPOE technology.

Researchers concluded that physicians who use EMRs and CPOE had lower satisfaction with time spent in clerical tasks and higher rates of burnout, including when the data was adjusted for age, sex, specialty, practice setting and hours worked per week. The bottom line, researchers said, was that this large national study demonstrated that satisfaction with EMRs and CPOE was generally low.

Now let’s take a look at the big picture on physician burnout. One comprehensive take comes from the American Academy of Family Physicians, whose position paper on the subject includes the following definition of burnout: “A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feeling of cynicism (depersonalization), and a low sense of personal accomplishment.”

The AAFP paper, which points out that the phenomenon has been studied for decades, notes that 45.8% physicians are considered to be experiencing at least one symptom of burnout. According to a recent broad-based study, that there is currently a 35.2% overall burnout rate among U.S. physicians.

According to research cited by the AAFP, there’s still no definitive data on what causes physician burnout, but notes that common drivers of family physician burnout include paperwork, feeling undervalued, frustration referral networks, difficult patients, medicolegal issues, and challenges in finding work-life balance.

While I don’t want to minimize the impact that a badly-designed EMR can have a negative impact on a physician’s practice, or underplay the findings of the Mayo study cited above, I think it’s worth noting that the group doesn’t cite EMRs as a specific cause of burnout.

Clearly, physicians don’t like using EMRs for administrative work — and it even appears that they would rather use paper to handle such chores. However, let’s not kid ourselves into thinking that doctors loved documenting on paper either. Complaints about not wanting to finish their charts were common in the paper world too.

And the truth is, as EMRs have gradually shifted from being vehicles to support billing to richer clinical documentation and support tools, it may very well have become harder to use them for routine administrative tasks. Vendors probably need to reconsider yet again the balance between clinical and administrative features, and how effective both are.

That being said, I think it’s important not to forget that physicians are facing many, many challenges, most of which began grinding away at their independence and self-respect well before EMRs became an established part of the picture.

Unfortunately, it’s likely that for some physicians, feeling forced to adopt an EMR has proven to be the straw that broke the camel’s back. And they certainly deserve a hearing. But if in the process, we allow ourselves to lose sight of the countless other problems physicians are struggling with, we are doing them a disservice. Addressing physicians’ EMR issues won’t fix everything that’s broken here.

E-Patient Update:  Keeping Data From Patients Has Consequences

Posted on September 20, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Given who I am – an analyst and editor who’s waist-deep in the health IT world – I am primed to stay on top of my health data, including physician notes, lab reports, test results and imaging studies. Not only does it help me talk to my doctors, it gives me a feeling of control which I value.

The thing is, I’m not convinced that most physicians support me in this. Time and again, I run into situations where I can’t see my own health information via a portal until a physician “approves” the data. I’ve written about this phenomenon previously, mostly to wring my hands at the foolishness of it all, but I see the need to revisit the issue.

Having given the matter more thought, I’ve come to believe that withholding such data isn’t just unfortunate, it’s harmful. Not only does it hamper patients’ efforts to manage their own care effectively, it reveals attitudes which are likely to hold back the entire process of transforming the health system.

An Example of Delayed Health Data
Take the following example, from my own care. I was treated in the emergency department for swelling and pain which I feared might be related to a blood clot in my leg. The ED staff did a battery of tests, including an MRI, which concluded that I was actually suffering from lumbar spine issues.

Given that the spinal issue was painful and disabling, I made an appointment for follow up with a spine specialist for one week after the ED visit. But despite having signed up with the hospital’s portal, I was unable to retrieve the radiologist’s report until an hour before the spine specialist visit. And without that report the specialist would not have been able to act immediately to assist me.

I don’t know why I was unable to access the records for several days after my visit, but I can’t think of a reason why it would have made sense to deprive me of information I needed urgently for continued care. My previous experience, however, suggests that I probably had to wait until a physician reviewed the records and released them for my use.

Defeating the Purpose
To my way of looking at things, holding back records defeats the purpose of having portals in the first place. Ideally, patients don’t use portals as passive record repositories; instead, they visit them regularly and review key information generated by their clinical encounters, particularly if they suffer from chronic illnesses.

It’d be a real shame if conservative attitudes about sharing unvetted tests, imaging or procedure data undercut the benefits of portals. While it’s still not entirely clear how we’re going to engage patients further in managing their health – individually or across a population – portals are emerging as one of the more effective tools we’ve got. Bottom line, patients use them, and that’s a pretty big deal.

I’m not saying that patients have never overreacted to what looked like a scary result and called their doctor a million times in a panic. (That seems to be the scenario doctors fear, from conversations I’ve had over time.) But my guess is that it’s far less common than they think.

And in their attempts to head off a minor problem, they’re discouraging patients from getting involved with their care, which is what they need patients to do as value-based care models emerge. Seems like everyone loses.

Sure, patients may struggle to understand care data and notes at first, but what we need to do is educate them on what it means. We can’t afford to keep patients ignorant just to protect turf and salve egos.

Details for 3 MIPS Performance Categories – MACRA Monday

Posted on September 19, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Last week we got a bit side tracked on MACRA Monday as we covered the news about modifications to the MACRA timeline. That seems to be a welcome change. As we mentioned at the end of our post on the MIPS performance categories and MIPS composite score, now we’re going to start diving into the details of those performance categories starting with: Quality Performance, Resource Use (Cost), and the new Clinical Practice Improvement Activities Category.

Quality Performance Category
This category is a replacement for PQRS, but is a reduction from 9 to only 6 measures. Plus, there is no longer a domain requirement. MIPS also expands the program to include close to 300 measures. To combat this explosion of options, they’ll also be offering specialty specific measure sets so that each specialty can more easily identify the measures that might be best for their specialty.

The Quality Performance category makes up 50% of the MIPS composite score.

Resource Use (Cost) Category
The resource use category is also often called the cost category and is a replacement of the value based modifier. The great part of the resource use category is that there is no data submission required to report your work in this category. Instead, this MIPS category will be calculated based on your Medicare claims. MACRA will add 40+ episodic specific measures so providers have more options to participate in this category.

The Resource Use (Cost) category makes up 10% of the MIPS composite score.

Clinical Practice Improvement Activities Category
The CPIA (Clinical Practice Improvement Activies) category that is the new category created as part of MACRA. It will include 90+ activities to choose from and you must participate in a minimum of one activity. Small practices (ie. 15 or fewer professionals) can participate in 2 activities and receive full credit for CPIA. Practices participating as a Patient Centered Medical Home (PCMH) also receive full credit for this category. Participation in an APM gives you 50% credit.

The Clinical Practice Improvement Activities category makes up 15% of the MIPS Composite Score.

That’s the general overview for these three MIPS performance categories. We’ll cover the Advancing Care Information category next week since it’s a bit more complicated.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Doctor Car Disparity

Posted on September 16, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My doctor friend recently sent me this great picture which highlighted the disparity in physician compensation as illustrated by the cars they drive:
doctor-perception-issues-and-car-disparity

Just to be clear, my friend is the one driving the Honda and not the BMW or Audi. I bet you could do a pretty great post comparing various physicians to various types of cars, but I digress. No doubt there’s a disparity in the cars doctors drive, but also between physician specialties as well.

The reason this picture really resonated with me is that I’ve regularly commented that doctors don’t do themselves any favors by driving super expensive, luxury cars. For the record, anyone is welcome to drive whatever car they want, but you can’t later be upset when people don’t believe you when you say that physicians don’t get paid well enough. There’s a massive disconnect when you’re able to drive such an expensive car and then claim you don’t get paid enough.

Take a look at the physician parking at your local hospital. After looking at it, it’s hard to argue that physicians aren’t getting paid enough even if it’s likely true for many specialties (starting with primary care). This picture seemed to illustrate that principle really well.

MGMA Blames Rise in HIT Costs on Fed’s Regs

Posted on September 15, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

MGMA’s released a study of 850 member’s practices showing HIT costs up by more than 45 percent in the last six years. MGMA puts much of the blame on federal regulations. It’s concerned that:

Too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing better patient care. Unless we see significant changes in the final MIPS/APM rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.

There may be a good case that the HITECH act is responsible for the lion’s share of HIT growth for these and other providers, but MGMA study doesn’t make the case – not by far.

What the study does do is track the rise in HIT costs since 2011 for physician owned, multispecialty practices. For example, MGMA’s press release notes that IT costs have gone up by almost 47 percent since 2009.

In fairness, MGMA also notes that costs may have also gone up do to other costs, such as patient portals, etc. However, the release emphasizes that regulations are at great fault.

Here’s why MGMA’s case falls flat:

  • Seeing Behind the Paywall. If you want to examine the study, it’ll cost you $655 to read it. Many similar studies that charge, provide a good synopsis and spell out their methodology. MGMA doesn’t do either.
  • Identifying the Issue. It’s one thing to complain about regulations. It’s quite another to identify which ones specifically harm productivity without compensating benefit. MGMA cites regulations without so much as an example.
  • Lacking Comparables. MGMA’s press release notes that total HIT costs were $32,000 per practitioner. However, this does not look at non HIT support costs, nor does it address comparable support costs from other professions.
  • Breaking Down Costs. The study offers comparable information to practitioners by specialty types, etc. However, all IT costs are lumped together and called HIT.
  • Ignoring Backgrounds. MGMA notes that HIT costs rose most dramatically between 2010 and 2011, which marked MU1’s advent. It doesn’t address these practices’ IT state in 2009. It would be good to know how many were ready to install an EHR and how many had to make basic IT improvements?
  • Finessing Productivity. Other than mentioning patient portals, MGMA ignores any productivity changes due to HIT. For example, how long did it take and what did it cost to do a refill request before HIT and now? This and similar productivity measures could give a good view of HIT’s impact.

It’s popular to beat up on HITs in general and EHRs in general. Lord knows, EHRs have their problems, but many of the ills laid at their doorstep are just so much piling on. Or, as is this case, are used to make a connection for the sake of political argument.

Studies that want to get at the effect HIE and EHRs have had on the practice of medicine need to be carefully done. They need to look at how things were done, what they could accomplish and what costs were before and after HIT changes. Otherwise, the study’s data are fitted to the conclusions not the other way around.

MGMA’s a major and important player with a record of service to its members. In this case, it’s using its access to important practice information in support of an antiregulatory policy goal rather than to help determine HIT’s real status.

Physician Practices Lack Good Models For EMR Adoption

Posted on September 14, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

“All happy families are alike; each unhappy family is unhappy in its own way.”
― Leo TolstoyAnna Karenina

When hospitals roll out an EMR, they go through complex and rich information-gathering process. Health IT leaders tackle problems of scale, systems integration and feature development with support from multiple leaders in other departments. There are best practices to consider and vendor selection processes to observe, references and case studies to collect, and user group meetings they can attend to fine tune their EMR rollout and answer questions.

But when it comes to physician practices, particularly the smaller ones that dominate the medical landscape, the way is not as clear. Often without even a full-time IT staff member to assist them in their selection process, EMR adoption by physician groups is far less structured. Sure, physicians may check references like their hospital colleagues do, explore customer case studies and participate in software demos, but in most cases their process is far less systematic and informed than that of a hospital.

What’s more, if their EMR implementation runs into trouble, smaller medical groups may have far less support than hospital IT leaders. After all, not only are they less likely to get much help in selecting an EMR, they probably don’t have a robust network of peers who can answer questions in context. Like any small business, they make their idiosyncrasies work for them, but when they get into trouble with IT they are unhappy in their own unique way.

Standardizing Physician EMR Adoption
Of course, practice leaders who are struggling with their EMR investment can turn to the vendor that sold them the system, but that can backfire pretty easily. While the vendor is obviously the last word on how the contract is structured, they may or may not have a strong incentive to address gripes and concerns, even if they are obligated to address outright failures of the system.

If the vendor offers a fairly open support model, practices may get some help as they evolve. But if their vendor charges by the hour for support, it’s unlikely many practices be willing to pay for the time to address anything but major problems. That may cut practices off from the knowledge and context they need.

Given these concerns, I’d argue that we need to develop a generalizable, reproducible model for physician EMR adoption and rollout. As I envision it, it should include:

  1. A standardized form smaller practices can use to identify their key needs, allowing them to pick and weight their priorities from an evidence-based list of key selection criteria
  2. A frequently-updated database, maintained by a third party, which collects physician ratings on how a given vendor meets these well-articulated needs
  3. A post-implementation form, once again drawn from research evidence, helping them identify and weight their EMR’s performance based on objective criteria

The idea behind all of this is to standardize physician groups’ EMR selection and rollout, and turn what can be a groping, uneven process into an evidence-based one. Not only will this help physicians from the outset, it allows for building a knowledge base which cuts across vendors, geographies, practice sizes and technical sophistication levels. If physicians had such tools, their process of learning would become iterative and collaborative in a far more effective way.

Don’t get me wrong, I know that virtually any software selection process will address issues that don’t make it into a model like the above.  But if you offer practices a more structured way to adopt an EMR, they are more likely to be happy with their overall results. This is going to become even more and more important as small practices switch EHR software due to EHR consolidation and other factors.

In The Trenches: Primary Care Practice Saves With EMR Transition

Posted on September 13, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This is the first in an occasional series of stories I’m writing on how medical practices – particularly smaller groups – are handling their health IT challenges. If you have suggestions for future columns please feel free to write to me at anne@ziegerhealthcare.com.

It only took six months for Clem Surak to realize that his current EMR system wasn’t going to cut it. Surak, who bought Wilmington, NC-based primary care practice Health Partners in 2011 with his wife, didn’t originally come from the healthcare business, but he quickly saw that his IT platforms weren’t cost-effective.

The systems he inherited to run the practice, an Allscripts EHR sprawling across three servers and a companion practice management platform called Tiger, were “very proprietary” and tech support wasn’t easy to access. And they cost $20K per year to support two doctors.

Worse, the product wasn’t very current. “Meaningful Use had to be downloaded as a separate module,” said Surak.

Not surprisingly, Surak began looking for other options. After consulting with his local Regional Extension Center, he went with a new system from Amazing Charts (full disclosure: a former client of your editor). The new system, which went live in June 2012, offered some important benefits, including:

* Savings:  It cost Health Partners $5,400/month to license the integrated Amazing Charts EHR, a $14,600 savings over the Allscripts systems.

* Maintenance: Because the new solution is cloud-based, the practice doesn’t need to maintain the software or cope with technical breakdowns directly.

* Rollout: Implemented over the course of three months, with no slowdown or reduction in physician hours needed. “We kept our normal pace,” Surak says.

* Data transfer: To bring patient demographic data over from Allscripts to the new system, all the practice had to do was export Allscripts data into an Excel spreadsheet, then run an Amazing Charts wizard which imported it.

Of course, the practice faced some challenges as well, largely around adjusting workflow and phasing out the old system:

* Running in parallel:  For the first few years after the transition to Amazing Charts, Health Partners had to keep the Allscripts system running alongside the new system.

* Practice management lag:  Amazing Charts didn’t offer a practice management module at the time Health Partners acquired the EMR. Until mid-2015, when a practice management module became available, it had to keep doing patient scheduling and accounting in the Allscripts system.

Ultimately, despite some transitional hassles, Surak is glad he made the shift to a set of systems that work effectively in tandem. Putting a new EMR and practice management system in place hasn’t just saved money, it’s helped Surak keep efficiency high, running the practice with just a couple of support staffers.

“Most offices this size would have five to seven support staffers, but we don’t have to,” he says. “And keeping overhead down is the key to remaining independent.”

Modifications to the MACRA 2017 Reporting Period #PickYourPace – MACRA Monday

Posted on September 12, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

As we mentioned near the start of the MACRA Monday series, many were predicting a delay or at least a modification to the MACRA timeline. While we’re still waiting for the MACRA final rule to come out with the official changes, Andy Slavitt, Acting Administrator of CMS, has announced some of the changes that will be in the MACRA final rule. Here’s the introduction to why they’re making these changes to MACRA (or the Quality Payment Program as they like to call it now):

We heard from physicians and other clinicians on how technology can help with patient care and how excessive reporting can distract from patient care; how new programs like medical homes can be encouraged; and the unique issues facing small and rural non-hospital-based physicians. We will address these areas and the many other comments we received when we release the final rule by November 1, 2016.

It’s comforting to many to know that they hear doctors pleas for help with all the reporting. We’ll see if the changes in the MACRA final rule will be enough.

As part of the announcement, Andy Slavitt said that the MACRA and MIPS program will still begin on January 1, 2017 with payment adjustments (ie. incentives or penalties) being paid in 2019 like we’d noted before. However, CMS now plans to provide multiple options to eligible physicians and other clinicians to avoid the negative payment adjustments in 2019.

There will now be 4 options available:

Option 1 – Test the Quality Payment Program.
For this option, you just have to submit “some data” to the Quality Payment Program and you’ll avoid the negative payment adjustment. Basically, CMS just wants to make sure you’re connected and ready to participate in future years. While you won’t get a negative payment adjustment, you always won’t get a positive adjustment either. It will be interesting to see what the final rule defines as “some data.” I expect it will be pretty minimal.

Option 2 – Participate for part of the calendar year.
This option allows you to submit information for a reduced number of days in 2017. In other words, your performance period could start after January 1, 2017 and you could just do MIPS reporting for part of the year. This would qualify you for a small positive payment adjustment. I’ll be interested to see the details in the MACRA final rule which outlines how much smaller the payment adjustment will be and how it will be calculated.

Option 3 – Participate for the full calendar year.
This option is basically what’s in the MACRA proposed rule. You can take part for the full 2017 calendar year and potentially qualify for a modest positive payment adjustment. CMS suggests that many will be ready for this. We’ll see if that’s the case given the compressed timeline from when the final rule is published and the release cycles of EHR software companies.

Option 4 – Participate in an Advanced Alternative Payment Model in 2017.
It seems that participation in an Advanced APM is the same as the proposed rule. Of course, if you’re participating in an Advanced APM, then you avoid the penalties and don’t have to worry about MIPS. Nothing new there.

It’s no surprise that fewer penalties and looser requirements has been applauded by many in the healthcare community. It’s pretty rare that people complain about a loosening of government regulation and wish they would require more. Personally, I think the changes are a good thing. CMS will still be able to get data from organizations that participate for the full year. Hopefully, they’ll use that to guide any modifications for future years. However, they also aren’t penalizing those organizations who won’t be fully ready in 2017 because of the short timelines.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.