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#MACRA at #HIMSS17 – MACRA Monday

Posted on February 20, 2017 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.

We’re taking this week kind of off from covering MACRA because we’re at the HIMSS 2017 Annual Conference. However, there’s been a lot of discussion about MACRA at the conference. It’s a hot topic and one of great concern for many organizations that stand to lose millions if they get it wrong. Here are just a few of the high level tweets about MACRA that I found interesting.


This is something we have written about before. Whether you like MACRA or don’t, I can’t imagine it’s going away. I think this is part of a long term change and it’s just the start. Where it will go will depend on a lot of factors. The factor we need most is more doctors to give input. And the input of just get rid of it is likely to fall on deaf ears. So, dive a little deeper and use the data to illustrate why and/or how it can be changed so it is effective.


I’m really happy that CMS added these MACRA APIs. I’m still interested to see how effective they are and how people use them, but I think they could streamline things for a lot of companies. What do you think?


This graphic is confusing to me, but I understood the output was improved patient experience and improved outcomes. Do you think MACRA will improve results? I think that’s a bit of stretch. It may get there eventually. Hopefully that’s the long term process that Andy Slavitt mentioned above.


I think we’re seeing a proliferation of tools. Will it be a whole market of tools for MACRA?


I need to chew on this one a bit more. What do you think?


Not really MACRA, but I know many are wondering about CMMI. I hope he’s right.

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

How Do You Keep Up with All the Health IT Innovation?

Posted on February 17, 2017 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.

When I think about doctors, I quickly realize that there’s no easy way for them to keep up with healthcare innovation. I’m a blogger that’s devoted to Healthcare IT and even I can’t keep up with everything that’s happening. I’m always learning about new companies that I’d never heard of before. How can a doctor that’s seeing 10-15 patients a day suppose to keep up?

This really hit home when I saw this graphic shared on Twitter (yes, it’s a bit old, but in this case it’s lucky that Healthcare doesn’t move that fast):

Add this to the fact that there are probably ~1300 vendors exhibiting at the HIMSS Annual Conference next week and it’s no wonders that a lot of doctors just throw up their hands. It’s overwhelming to say the least. Plus, it’s not like there are going to be that many practicing doctors at HIMSS anyway.

How then do doctors keep up with all the innovation that’s happening? Unfortunately, they don’t. Certainly blogs like this one help. Certainly there’s a lot of word of mouth that happens between doctors. However, it’s a challenge without a simple solution. Plus, let’s face the facts. Many aren’t that interested in the next innovation. They’re happy just doing what they’ve been doing for years. That’s what makes doing a tech startup company in healthcare so challenging.

What do you do to keep up with innovation? I’d love to hear in the comments.

“We’re All Patients”

Posted on February 15, 2017 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.

Ever since the first #HITsm Chat of the year, I’ve been rolling around the idea of “We’re All Patients.” It was kicked off by what I think was probably a well-intentioned tweet by Andrey Ostrovsky, MD who asked to hear from patients:

This led someone to say “Aren’t we all patients at some point?” which got this response from Erin Gilmer along with a whole firestorm of other comments:

First, let’s applaud Dr. Ostrovsky for asking for the patient perspective and let’s not let the firestorm of defining patients overwhelm the fact that he wanted to hear from patients. That’s a dramatic shift from the past where patients might have been an afterthought. Dr. Ostrovsky was asking for patient input 11 minutes into a 1 hour chat. That’s a big improvement.

Second, if you look at the literal definition of patient, it says “a person receiving or registered to receive medical treatment.” By pure technical definition, it’s true that we’re all patients. Hard to imagine an adult that hasn’t received medical treatment at some point. However, when we say that “We’re all patients” it misses the point of why I think Erin Gilmer and Carolyn Thomas, who wrote the post that Erin linked to, said that we’re not all patients.

The reality is that even if we’ve all been to a doctor before, it doesn’t mean that we’re talking from our view as a patient. Many times when you go to a conference or are participating on a Twitter chat, you’re not having a discussion from your view as a patient. Often you’re talking from a work perspective or from a provider perspective and not from a patient perspective.

We know this happens a lot because you’ll often hear at conferences “This isn’t what I want personally, but this is my perspective on it.” Just because you have been a patient at one point doesn’t mean you’re speaking from that perspective at a conference, Twitter chat, blog post, etc. That’s true for me too when writing these blog posts. I’ll write from a wide variety of perspectives depending on the topic and post. It’s often not from the patient perspective.

Along with not necessarily speaking from your own patient perspective, it’s fair to say that just because you were a patient for some “injury or episode of illness”, it doesn’t mean you can share the perspective of a patient with a chronic condition. That’s a very different situation and one that largely has to be lived to fully comprehend.

The reality is that we need to involve as many different patient voices in our discussions as possible if we want to create solutions that benefit patients the most. On that, I think almost everyone agrees. Studies have shown that having a wide diversity of viewpoints, opinions, and perspectives provides a much better solution.

At the end of the day, we can all only share our own personal experience. I don’t want chronic patients talking for me. Chronic patients don’t want non-chronic patients talking for them. In fact, many chronic patients don’t want other chronic patients talking for them. etc etc etc

Instead, we should do everything we can to incorporate multiple perspectives into all the work we do. That’s where we’ll get the best results. We shouldn’t be so arrogant that we try to speak for someone else. However, we also shouldn’t demonize someone that tries to show empathy and raises the voice of another’s perspective either. The reality of complex problems is that we can all be right depending on perspective. So, let’s embrace as many perspectives as possible. We are all humans and most of us want healthcare to be better.

UPDATE: In a great discussion on Twitter with Erin Gilmer that was prompted by this post, Erin highlights a point that I didn’t cover well in the above commentary. She pointed out that many chronic patients’ voices have been marginalized in the past. I’d take it even a step further and say they’ve not only been marginalized but often ignored.

The reality is that the “healthy” patients have more voices making sure their (my) needs are heard. Chronic patients are smaller in number and so it’s more challenging to have their voices heard. Not to mention the last thing you want to do when you’re dealing with chronic illness is make your voice heard. However, in an impressive manner, many patients with debilitating illnesses do just that.

Erin also made a good point that we shouldn’t use “We are all patients” as an excuse to not involve expert patients at the table. We should definitely elevate their voices. As an advisor to many health IT startup companies and having written about thousands of companies, the challenge of incorporating all these voices and perspectives into a product is impossible. There are always gives and takes with limited resources. However, far too many don’t even make a sincere effort. That’s what’s sad.

This post is about elevating more patient voices from a wide variety of perspectives. That produces the best outcomes and discussions.

Are the Independent Doctors that Remain the Disruptors, the Tough Ones?

Posted on February 14, 2017 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.

We’ve seen a dramatic shift in healthcare over the past 3-5 years. More and more small group and independent practices have been selling to much larger health systems. Plus, we’ve seen a consolidation of health systems as well. The move to larger and larger health organizations has happened and I’ve heard many predict that we’ll never go back.

While I know there are pressures that indicate this might be the case, I also wonder if the independent doctors and small group practices that remain are the real industry disruptors. Are they the tough ones that survived through the challenging healthcare environment?

With this thought in mind, I looked up the definition of “survival of the fittest”:

the continued existence of organisms that are best adapted to their environment, with the extinction of others, as a concept in the Darwinian theory of evolution.

Sounds a bit like the independent practice to me. Those independent practices that still exist have had to adapt to the changing healthcare world. The ones that remain are likely the most “fit”. We’ve also seen a lot of other independent practices go “extinct.”

Does this give us hope? On the one hand, I can see how those independent practices that remain are strong and can adapt well. I hope that they do it so well that they disrupt the whole healthcare system in a good way. I think that the health system is generally better with more independent practices. There are a certain ownership and patient kinship that happens with independent practices that is often missing in larger health systems that treat doctors like machines that need to produce certain numbers. It’s unfortunate for healthcare that this is being lost.

The thing that scares me most about this trend is that most of the independent doctors seem to be older doctors. Most of the younger doctors I know are just fine going to the large health systems. They don’t want to take on the risk of starting their own practice. If the younger generation isn’t willing to fight the independent practice fight, then independent practices will die.

How many doctors at large health systems have created real disruptive innovation? Not very many. That’s a scary thought that should all have us worried about the future of the independent doctor. Once it’s gone. It will be hard to see how it could come back.

If you don’t think this is a big deal. Think back to the last time you called your cable provider. There’s a reason they’re ranked the lowest in customer service. They have very little competition to force their hand. The loss of independent practices will mean very little competition for the big healthcare organizations. That’s a bad thing for all of us.

What do you think about independent practices? Are the ones that remain the strong ones? Will the independent practices survive in healthcare? I look forward to reading your thoughts on social media and in the comments.

MIPS APMs and MACRA Small Practice Support – MACRA Monday

Posted on February 13, 2017 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 previously, there are some benefits to practices that are participating in an APM, but don’t qualify as an advanced APM. These practices can’t participate in the APM program and they need to participate in the MIPS program or they’ll get the 4% penalty for not participating in MIPS. The good news is that there is a benefit to taking part in what is called a MIPS APM (ie. an APM that doesn’t qualify as an advanced APM).

Here’s the list of MIPS benefits for being in a MIPS APM:

MACRA also has a number of opportunities available to small practices. The first example is that many small practices were excluded from participating in MACRA because of their size. Second, the program itself made MACRA easier with Pick Your Pace and they also created more access to advanced APMs. Finally, they created what they call the Transforming Clinical Practice Initiative.

The Transforming Clinical Practice Initiative seems quite similar to the REC program under meaningful use. This program is a network of support for those participating in MACRA and MIPS. You can see a full interactive chart that shows a view of the various support centers around the country for more details on what’s available in your area.

That’s all for this edition of MACRA Monday. Next week we’ll finish off our overview of MACRA Monday and discuss what we think is the right strategy when it comes to MACRA.

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

Physician EHR Burnout Infographic

Posted on February 9, 2017 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.

Physician burnout is a hot topic and one that’s not likely to go away anytime soon. There are a lot of elements to physician burnout and I was impressed with how well eMedApps captured the issue of physician burnout in the infographic below.

I think the question of the next decade is going to be, “How do we decrease the administrative tasks the doctors perform?” If we don’t find a satisfactory answer, our healthcare system will be permanently damaged. What’s even scarier is that this seems to be trending worse and not better.

What would you propose to help solve the problem of physician burnout?

Physician EHR Burnout and Administration Tasks - eMedApps

Advancing Care Information (ACI) Category – MACRA Monday

Posted on February 6, 2017 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.

Time to continue our journey through the MIPS performance categories. For today’s MACRA Monday we’re going to start talking about the Advancing Care Information (ACI) category. Most of you will know this category better as meaningful use. However, it does have some significant changes to what existed in meaningful use.

Some of the major changes include a shift from the “All or Nothing” approach to the EHR meaningful use program. CPOE and CDS objectives were also eliminated along with some redundant measures. ACI also reduces the number of required public health registries.

As we mentioned previously, ACI makes up 25% of your MIPS Composite Scoring. There is a significant hardship exemption available that will change the ACI weighting to zero and apply the 25% weight to other categories. Here’s a look at how the ACI score will be calculated:

The biggest piece of ACI scoring is the 5 required measures that make up the base score as follows:

Much like meaningful use, in advancing care information (ACI) clinicians are required to use a certified EHR. Which EHR certification you use will determine which ACI objectives and measures you will need to use as follows:

That’s the quick overview of the Advancing Care Information (ACI) category. Next week we’ll take a look at the MIPS APM benefits and MACRA small practice support.

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

The Quality Disconnect in Healthcare

Posted on February 2, 2017 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.

There’s a big problem with the current healthcare model. There’s no real financial incentive to make sure you’re practicing the highest quality care possible. Doctors don’t get paid for quality. Patients don’t select a doctor based on the clinical quality of the doctor since the patient has no way of measuring a doctor’s clinical quality. The clinical quality a doctor provides doesn’t move the needle on her business.

Certainly, I’m not saying that doctors don’t provide quality care. It is also true that over time a doctor could grow a reputation as a poor quality doctor, but those are usually only the extreme cases that end up in court with big medical class action lawsuits.

What’s amazing is that most doctors can’t event evaluate the quality of another doctor. An orthopedic surgeon has no way to evaluate how well an ENT is doing quality wise. Doctors of the same specialty could evaluate a colleague’s clinical quality, but that doesn’t happen in the current system.

In a perfect world, we could create payments based on the quality of care a doctor provides. That makes a lot of sense and it’s what we do in a lot of other industries. We pay people who provide higher quality more than we pay people who provide lower quality. The problem in healthcare is that we don’t have any good way to measure quality.

While I believe there’s no good way to measure quality, that doesn’t mean that it won’t keep organizations from trying. In fact, that’s the basis of much of MACRA and the PQRS program before it. Same goes for Accountable Care Organizations (ACOs). These are all efforts to evaluate the quality of care that’s being given and reimburse based on those quality indicators. Most doctors will tell you, that’s not a very good system if you want quality.

What’s screwed up about these quality measures is that they do nothing to actually lower the cost of healthcare. Poor quality care only represents a small portion of the massive premium we pay for healthcare in the US. The real costs come from outrageous drug pricing, pallative care, medical liability fears, and chronic conditions. Those are the four areas we should really be focusing our efforts on. The problem is that there’s not a lot of will in healthcare to address these challenging issues.

Cost and Clinical Practice Improvement Activities (CPIA) Categories – MACRA Monday

Posted on January 30, 2017 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.

We’re continuing to move through the various MIPS performance categories as we cover the details of MACRA. Today we’re going to cover the Cost and Clinical Practice Improvement Activities (CPIA) Categories.

MIPS Cost Category
We won’t cover much of the Cost (Formerly known as Resource Use) category since it has basically been relegated to future MACRA requirements. For those that missed it, the cost category has a weighting of 0% in 2017, so it basically won’t impact your MACRA payment adjustment at all. In 2017, they’re looking at feedback for this category, but it won’t affect your 2019 payments.

You’ll probably remember that the Cost category was the replacement to the value-based modifier and didn’t require any reporting on the part of the provider. Instead, the cost category is tracked using the Medicare claims data. This means that CMS will still have the data they need to evaluate this category without any additional work from providers.

MIPS Clinical Practice Improvement Activities (CPIA) Category
You’ll remember that the Clinical Practice Improvement Activities (CPIA) category is a new category that was added as part of MACRA. This category will account for 15% of your MIPS score. This category has some small practice exceptions and also special credit for those participating in a patient-centered medical home or other similar medical home model.

Under CPIA providers must choose from 90+ activities in the following 9 subcategories:

CPIA will be scored on a total of 40 points with “Medium” activities scoring 10 points and “High” activities scoring 20 points. These point totals are doubled for small, rural, and underserved practices. That means that small practices only need to do 1-2 activities to get full credit for this category. Larger practices only need to do 2-4.

The Cost and CPIA MIPS categories only make up 15% of your total MIPS score. So, they’re not going to be a significant impact on your MACRA score either way. However, if you do even just 1 improvement activity (CPIA), then you’ll avoid any negative payment adjustment thanks to MIPS pick your pace.

That’s all for this week’s MACRA Monday. Next week we’ll talk Advancing Care Information (ACI) or what most of you call meaningful use.

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

What’s It Take to Be a Great Thought Leader – #HITsm Summary

Posted on January 26, 2017 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.

At last Friday’s #HITsm Chat, we had a lively discussion hosted by Juliana Ruiz from Bryte Box Consulting (@BryteBox) where we talked about Healthcare IT Influencers and Thought Leaders. If you missed the chat, you can read the whole transcript here.

I thought the first question summarized the chat really well as it talked about the key attributes of a thought leader.

Greg Meyer started the chat off nicely with this observation:


Greg was spot on with his comparison to a minion. We want to listen to someone who says something interesting and thoughtful and not just someone who spits out content like a robot.

His comment about thought leaders not being afraid to make mistakes drew some interesting discussion with some agreeing that mistakes are part of thought leadership, but others saying that social media and other things hold it against many leaders who make mistakes. Although, most agreed that mistakes were ok because it was part of growth.

I did argue that it really depends how the thought leader treats mistakes. Humility matters a lot when you make mistakes:

The concept of humility seemed to be an important concept for thought leaders as was illustrated by these tweets from Greg and @hospitalEHR:

Steve Sisko and @WHAMGlobal also chimed in on the importance of thought leaders to be consistent and have a clear voice and style.

Our host wrapped up the discussion of what makes a great thought leader with this insight:

I love these principles, because they apply to individuals and organizations. They apply online and offline. They apply in your work life and your personal life. There are so many opportunities for us to be thought leaders. By doing so we can impact a lot of people for good and help a lot of people. There’s nothing better in life than doing something that helps someone else.

Be sure to join us at next week’s #HITsm chat hosted by Bill Esslinger (@billesslinger) from @FogoDataCenters on the topic of “Key Components of Health IT Strategy and Disaster Recovery“.