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Why Delaying the Transition to 2015 Edition Technology Would Be a Problem for Patients and Families – MACRA Monday

Posted on September 11, 2017 I Written By

The following is a guest blog post by Erin Mackay, Associate Director, Health Information Technology Policy and Programs, National Partnership for Women & Families.  This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

The National Partnership for Women & Families recently weighed in on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule for 2018 updates to the Quality Payment Program (QPP). In our comments, we express concerns that many of the proposed requirements would have a chilling effect on the country’s badly needed transition to a health care system that rewards quality and value over volume. Of particular concern to us is the proposed delay in clinicians’ transition to the 2015 Edition electronic health record (EHR) certification requirements.

Putting off requirements to use more advanced health IT would be a one-two punch to health transformation. First, new models of care that demand high-quality, efficient practices and coordinated care rely on robust health IT. Likewise, these new models only succeed when patients have the information – about their medications, health status, diagnoses and treatment received – they need to participate in their care and make informed decisions with their health care teams.

Here are three ways the proposed rule would delay critical functionalities that are foundational to a patient and family-centered health care system:

1) Delaying Availability of APIs for Consumer Access
It would undermine the commitment to patient engagement to delay the availability of application programming interfaces (APIs) as a way for patients and their caregivers to access, download and share health data. When available, APIs will let consumers choose from a range of apps that pull in health data from various health care providers and hospitals, helping form a comprehensive picture of their health and health care and facilitating information sharing. Gone will be the days when patients and family caregivers struggled to remember passwords for multiple patient portals, or were able to view only one aspect of their medical history at a time.

2) Slowing More Robust Collection of Demographic Data
To enhance health equity, we must first be able to identify disparities by gathering standardized, granular demographic data. Right now, certified EHRs are not designed to distinguish among Chinese, Indian or Vietnamese patients, for instance, instead collapsing these identities into a single “Asian” category. Similarly, EHRs cannot currently store structured information about patients’ sexual orientation or gender identity. In both these examples, this information has clinical relevance and is vital for improving health outcomes. For example, too often transgender individuals do not receive appropriate “gendered” preventive screenings such as Pap tests, mammograms and prostate exams.

3) Failing to Capture Information on Social Determinants of Health
In addition to better demographic information, to best support providers in delivering patient- and family-centered care, EHRs should also capture information about non-clinical factors pertinent to individuals’ health. The 2015 Edition includes a new criterion to capture relevant social, psychological and behavioral data. This includes information on financial resource strain, educational attainment, stress, depression, physical activity, alcohol use, social connection and isolation, and intimate partner violence. At the individual level, this information could help clinicians and care teams determine treatment options that address the unique needs of the patients and families they serve. To improve population health, clinicians, hospitals and community organizations need this information to identify communities that need additional support in order to get and stay healthy.

Conclusion
Overall, the proposed rule for QPP 2018 raises a number of concerns for the National Partnership, particularly the proposed delay of 2015 Edition certified health IT products. We strongly encourage CMS to maintain the current requirements and timeline for clinicians transitioning to the 2015 Edition to provide the necessary infrastructure for the kind of patient- and family-centered health system our country urgently needs.

Fear, Loathing, and Documentation. Why Do Doctors Still Say They Hate EHR?

Posted on August 29, 2017 I Written By

The following is a guest blog post by Daniel Sabido, Director of Product Marketing at CareCloud.

It’s been 10 years since the start of the modern EHR era. Why do doctors still report hating the technology so much? Electronic health records (EHR) have been fairly universally villainized in surveys of physicians. Here’s a recent sampler for you:

  • 54% of physicians reported being unhappy with their EHR system in 2014, according to an American EHR survey.

  • 82% of users in a survey by Peer 60 said they would actively discourage other medical professionals from using one particularly hated EHR vendor.

  • Physicians blame EHR for lost productivity — spending more time on documentation (85%) and seeing fewer patients (66%) in an IDC report on tech dissatisfaction.

What’s happening in healthcare? Is EHR really the most universally despised technology in America? Or is it a scapegoat for other changes in medicine? Let’s take a closer look at a couple of key trends:

A higher standard for EHR

Crucially, not all EHRs have been created equal. For years, the health technology market was swamped with expensive, server-based systems. These antiquated platforms were easily 20 years behind your average first-generation iPhone and looked more like Windows 95 than Mac iOS 10. When Meaningful Use incentives were prescribed under the 2008 economic stimulus plan, it created a surge in adoption for a technology landscape that frankly was not ready for primetime. Medical practices and physicians were right to complain about this rushed technology.

In recent years, we’ve seen a readjustment with a hot rip-and-replace market for EHR technology. Software Advice found that the number of clinicians replacing their EHRs increased 59% between 2014 and 2015. They’re not just upgrading to better systems; these medical groups are seeing the huge advances made in other industries and moving to the cloud. Black Book Rankings reported in 2015 that 7 out of 10 small medical practices were using a cloud-based EHR.

Changing health economics

At the same time that healthcare technology has been getting better, the economic pressure on medical practices and physicians has been getting more intense. The shift to value-based care and other policy changes have increased administrative burden. “About 80% of physician burnout is really due to workflow issues…the electronic medical record has contributed to burnout as one component,” said Steven Strongwater, a rheumatologist and CEO at Atrius Health in a New England Journal of Medicine interview.

It’s not just the recording process, but how much physicians are being asked to record that is interfering with the clinical workflow. There’s an epidemic of “just one more thing” creep in regulatory policy. Asking physicians to record a relatively simple new health marker, such as smoking status, can quickly compound into an extra hour a week of work. EHR systems don’t need to just keep up, they also need to speed ahead of increasing efficiency drag in the practice of medicine.

Perception vs. reality

Health technology has undoubtedly created stress on physicians in the past decade. Research also shows tremendous benefit. Contrary to the common belief that EHR gets in the way of patient experience, research shows that patients prefer it when their physician uses a computer. A whopping 76% of patients said they prefer their doctor to use EHR over paper charts, according to a survey by the Office of the National Coordinator (ONC).

In our 2017 Practice Performance Index, we found that high-performing medical practices were twice as likely to be adopting new health technology compared to practices that were falling behind. In our upcoming Patient Experience Index, a full 85% of patients said that it was important for medical practices they visit to be “modern and up to date.”

What comes next for EHR?

I believe we’re entering a new era of EHR in healthcare. Thanks to the shift to cloud-based systems, there is a faster pace of innovation in the sector. Cloud-based systems can roll out upgrades in a few hours, instead of a few months of costly consultant-driven updates. We’re seeing a new focus on tools that intelligently streamline administrative tasks and that connect what happens inside the exam room with the patient experience outside it. The same kind of technology that helps recommend movies on Netflix and send friendly timely reminders on Runkeeper are coming to healthcare, helping physicians provide a better patient experience and improve overall outcomes.

There are also new risks emerging to this rosy future. Meaningful Use created bad behaviors in the EHR market — the kinds of rote, administrative bulk that led to physicians despising their systems. MACRA could be heading down the same path. Can health technology companies stop history from repeating this time?

At the end of the day, patients want their doctors to be using modern technology, and patient satisfaction is a crucial part of the shift to value-based care economics. Physicians who want to be successful in their practice will need to find a way to love their EHR — or look for one that can keep up with new demands. It’s up to those of us in the health technology sector to meet them halfway.

About Daniel Sabido
Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst.

Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania’s Wharton School with majors in Finance and Operations.

EHR Innovation & Regulation: Friends or Foes?

Posted on August 16, 2017 I Written By

The following is a guest blog post by Stephen Dart, Sr. Director of Product Management at AdvancedMD.

Healthcare insiders often point out how far behind the industry is in taking advantage of technology when compared to industries like retail or finance.

Technology providers get their share of blame for not designing it with a user in mind, a common argument heard in relation to the Electronic Health Record (EHR) ill-fitting place in the physician’s workflow. What is not talked about much is the role regulations play in shaping the technology and its use in healthcare.

Designing for compliance

Regulations are present in every industry and serve an important function of protecting individuals’ privacy and rights. Healthcare is highly regulated compared to many other industries due to the sensitive nature of Protected Health Information.  There is a good deal of additional regulations regarding programs such as MACRA, dedicated to monitoring provider performance and reporting it back to the government for reimbursement. As such, technology for providers must be designed to capture and report such data.

For vendors like AdvancedMD, one of the challenges is not in designing software to address the regulations, but rather in designing it under the ever-evolving guidelines and shifting deadlines. At times, well-meaning standards also fail to function as intended because they are not enforced end-to-end.

As an example, Meaningful Use Stage 2 required the EHR to meet a standard for interfacing with state immunization registries. For certification, technology providers had to produce a standard-format file and transmit it to the state immunization registry. However, every state had its own set of requirements and most states would not accept the format designated as the certification requirement but instead have their own additional or different requirements.

Consider lab results as another example. The EHR has to meet the engineering standard for using a LOINC code when receiving lab results to enable the physician to report metrics for regulatory attestation. Unfortunately, labs are not held to the same standard, and if the lab does not send results using the LOINC code, the physician cannot get credit when reporting or has to manually add a code for it to be considered for meeting the performance metric.

Naturally, there is cost incurred to design compliance features for vendors. At AdvancedMD, it has a significant impact on our research and development (R&D) budget. It also influences the other two R&D categories that have a direct impact on the end-user experience – keeping the technology on the cutting edge and innovation.

Integrating compliance into workflow

If regulations require physicians to report more data, vendors have a choice of designing compliance features to either ask the physician to input that information manually or to capture it automatically for reporting.

At AdvancedMD, a lot of effort goes into automating the regulatory requirements and integrating the necessary data collection naturally into providers’ existing workflow. If software identifies that the physician has just written an electronic prescription, there is no reason to ask him or her to go into a separate system and attest manually to having done so. This regulatory tracker can be natively built into the platform.

All roads lead to innovation

There is a lot of pressure on everyone in healthcare today and the industry is undergoing constant changes. Patients expect more as they pay more under high-deductible plans.  They increasingly rely on wearables to tell them how well they sleep and how many steps they need to take as part of a larger trend of taking command of their own health. Doctors and patients alike will benefit from this data being integrated into patient records.  If this patient-captured data can be merged into the patient chart, machine learning and analytics algorithms can in some cases predict what an independent practice needs to do next. This next step could be to streamline administrative processes for outreach messaging and improve care through electronic follow-up, leading to increased profitability and better care. Importantly, the EHR, practice management and all other technologies designed for providers need to liberate them to focus on patient care, not distract from it.

All these advanced features are the next frontier in healthcare and require vendors to dedicate a lot more effort and budget to innovation. While healthcare technology can’t be expected to catch up with an Apple or Facebook overnight with regard to user experience, there is much that can be done to close the gap. The industry as a whole will get there much faster when regulations and technology align to advance that goal.

Incremental regulatory steps in areas where standards can be controlled and enforced cradle-to-the-grave will benefit all parties. Vendors can plan their engineering budgets in advance and design fully functional compliance features. The industry will benefit from designing with the user in mind, furthering the role regulations play in shaping technology and its use in healthcare. Ultimately, regulations should allow providers to focus on care and to engage more meaningfully with their patients, thus optimizing the EHR’s role in the physician’s workflow.

Getting Buy-in For Your Second (Or More) EMR Purchase

Posted on August 15, 2017 I Written By

The following is a guest blog post by Michael Shearer is VP of Marketing for SelectHub.

Remember when you rolled out your first EMR?  Many of your doctors were uncertain, frustrated or angry, insurers were rejecting claims left and right and revenue fell as providers struggled to use the new system. Ah, those were lovely days.

Thankfully, in time everyone finally adapted. Through a combination of one-on-one coaching, group training, peer-to-peer mentoring and daily practice, clinicians got used to the system. Your patient volumes returned to normal. Some, though probably not all, of them got comfortable with the EMR, and a few even developed an interest in the technology itself.

Unfortunately, over time you’ve realized that your existing EMR isn’t cutting it. Maybe you want a system with an integrated practice management system. Perhaps your vendor isn’t giving you enough support or plans to jack up prices for future upgrades.  It could be that after working with it for a year or two, your EMR still doesn’t do what you wanted it to do. Whatever your reasons, it’s time to move on and find a system that fits better.

Given how painful the previous rollout was, buying a new EMR could be pretty disruptive and could easily stir up resentments and fears that had previously been laid to rest. But if you handle the process well, you might find that getting EMR buy-in is easier the second (or more) time around. Below are some strategies for getting clinicians on board.

Learn from your mistakes

Before you begin searching for an EMR, make sure that you’ve learned from your past mistakes. Consider taking the following steps:

  • Conduct thorough research on how clinicians (and staff if relevant) see your existing system. This could include a survey posing questions such as:
    • How usable is the EMR?
    • What impact does the EMR have on patient care, and why?
    • Does the EMR meet the needs of their specialty?
    • What features does the existing EMR lack?
    • Are EMR templates helping with documentation?
    • What are the great features of your existing EHR?
  • Compile a list of technical problems you’ve experienced with the system
  • Evaluate your relationship with the EMR vendor, and make note of any problems you’ve experienced
  • Consider whether your purchasing model (perpetual license vs. online subscription) is a good fit

Put clinicians in charge

When you bought your first EMR, you may have been on uncharted ground. You weren’t sure what you wanted to buy or how much to spend, and clinicians were at a loss as well.  Perhaps in the absence of detailed clinical feedback, you moved ahead on your own in an effort to keep the buying process moving.

This time around, though, clinicians will have plenty to say, and you should take their input very seriously. If they’re like their peers, their critiques of the existing EMR may include that:

  • It made documentation harder and/or more time-consuming
  • It wasn’t intuitive to use
  • It got in the way of their relationship with patients
  • It forced them to change their workflow
  • It didn’t present information effectively

These are just a few examples of the problems clinicians have had with their first EMR – you’ll probably hear a lot more. Ignoring these concerns could doom your next EMR rollout.

To avoid such problems, put clinicians in charge of the EMR purchasing process. By this point, they probably know what features they want, how documentation should work, what breaks their workflow, what supports their process and how the system should present patient data.

This will only work if you take your hands off of the wheel and let them drive the EMR selection process. Giving them a chance for token input but buying whatever administrators choose can only breed hostility and distrust.

Look to the future

When EMRs first showed up in medical practice, no one was sure what impact they’d have on patient care. Administrators knew that digitizing medical records would help them produce cleaner claims and shoot down denials, but few if any could explain why that would help their providers offer better care. In some cases, these first-line systems did nothing whatsoever for clinicians while weighing them down with extra work.

Over time, however, providers have begun using pooled EMR data to make good things happen, such as improving the health of entire populations, identifying how genetics can dictate responses to medication and predicting whether a patient is likely to develop a specific health condition. These are goals that will inspire most clinicians. While they may not care what happens in the business office, they care what happens to patients.

These days, in fact, using EMR data to improve care has become almost mandatory. Even if they didn’t bother before, practices are now buying systems better designed to help providers deliver care and improve outcomes. If your clinicians are still unhappy about their first experience, they may have trouble believing this. But make sure that they do.

The truth is, there will always be someone who doesn’t like technology, or refuses to take part in the buying process, and it’s unlikely you’ll win them over. But if your EMR actually enhances their ability to provide care, most will be happy to use it, and even evangelize the system to their colleagues. That’s the kind of buy-in you can expect if you deliver a system that meets their needs.

Michael Shearer is VP of Marketing for SelectHub, which offers selection tools for EMRs and practice management systems.

 

Patients Frustrated with Poor Practice Logistics

Posted on August 9, 2017 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

A new study shows that patients have just about had it with poor practice logistics—things like communication, scheduling, and accessibility. There have certainly been signs this was coming for quite some time, but now the data shows patients really are getting fed up with not having some of the same basic tools they have in service and retail interactions.

The Patient-Provider Relationship Study, which was conducted by Solutionreach, surveyed over 2,000 patients about their recent experiences with different types of providers. Over 500 of those who responded had seen a primary care provider in the past year and were asked questions about that interaction. The questions focused on satisfaction with the provider, their staff, and the practice in general as well as likelihood of switching providers and preferences around communication and accessibility.

The results were pretty stunning. Only 35 percent of patients were completely satisfied with their primary care provider and thirty-four percent of patients said they were considering switching primary care providers in the next couple of years. In addition, 12 percent had switched in the past year. And, quite a few left for reasons other than things like changing insurance or moving. Just under 40 percent of those who had switched said they left because of customer service and experience issues. The problems they listed included:

  • Feeling more like a number than a person
  • Trouble getting appointments
  • Poor communication with/from the staff
  • The staff were not friendly
  • Not satisfied with the staff (other than the provider)

These are very fixable issues. We’re talking almost entirely about the personal perceptions of patients about their interactions with staff, with just a couple exceptions. And those exceptions have largely to do with communication and access, which are also pretty manageable things to change.

You can improve communication and appointment scheduling, and with the right technology, you can do it in a way that feels more personal as well. Not surprisingly many patients want to schedule appointments online and they want options for email and text for communications like reminders. In fact, 79 percent of patients said they wanted text messages from their primary care providers.

It’s important to note that these things don’t just improve the patient experience outside the practice, they save time for staff, which means a better experience when patients are in the practice. So why are providers so hesitant to invest in tools that can fix this problem?

To some degree, it appears to be about fears that these investments won’t pay off—in added reimbursement or return on investment (ROI) from savings. In a study conducted by HIMSS in 2015, providers cited time constraints and lack of reimbursement as barriers to improving patient engagement. The truth is many of the things that fall under “engagement” can also be seen as “customer service,” and patients want better customer service. In another study conducted by MicKinsey, patients said they had similar expectations of service from healthcare providers and non-healthcare companies.

While there will never be added reimbursement for smiling or greeting patients by name, there are some clear areas of ROI that can make up for that. Email and text reminders have been shown to reduce no-shows by 30 to 50 percent, saving the average primary care practice about $40,000 a year. Online appointment scheduling not only saves the practice on scheduling calls, which generally take four to eight minutes, but it can also help patients find earlier appointments, shortening wait times.

For providers who worry that texting with patients will suck up more time with no reimbursement, there is hope as well. Texts take only about four seconds on average while the average call is more like two or more. Also, texts can be responded to at the convenience of providers and staff. There is no need to play phone tag, which is a waste of time for everyone.

When it comes to reimbursement for engagement and service activities, it’s time to think bigger picture. Reimbursement can be time saved. It can be patients retained. It can be increased compliance or fewer phone calls. There are a lot of ways a better patient experience can translate into a better bottom line.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff. Learn more about the Patient-Provider relationship survey here.

The Health Plans’ Role in Meeting MACRA Requirements – MACRA Monday

Posted on July 17, 2017 I Written By

The following is a guest blog post by Karen Way, Health Plan Analytics and Consulting Practice Lead at NTT DATA Services. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

When the Medicare Access and CHIP Reauthorization Act (MACRA) became an official federal ruling for the healthcare industry in 2015, the act replaced the previous Medicare reimbursement schedule with a new pay-for-performance program focused on quality, value and accountability. In short, the legislation rewards healthcare providers for quality of care, not quantity.

While many discuss the impact on providers, what is the health plans’ role in aiding health systems and physicians to meet MACRA requirements?

MACRA provides multiple opportunities for health plans to increase and improve collaboration with provider networks. Recommendations on how health plans can accomplish this include sharing information and services, creating new partnerships and bringing about financial awareness as the legislation continues to take effect.

Sharing Data

One of the requirements under MACRA is for providers to enhance clinical measures and data analytics to strengthen members’ experiences. Health plans can assist by recognizing where providers lack expertise in data-related facts to offer input and support where it’s most beneficial.

For example, a provider may not have as much knowledge on advanced data science, but health plans can share their predictive models and tools to strengthen analytics. Sharing advanced technical infrastructure to facilitate data exchange will enable providers to access a more complete picture of members’ profiles. In return, the picture will provide a higher quality service to individual members, as well as opportunities for health plans to continue offering tailored consulting and data support.

At its best, sharing data to improve clinical measures is a win-win scenario. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Just as HEDIS calls for measurement, MACRA also encourages health plans to aid providers with reporting standards. Under these rules, health plans are required to record a wealth of information on members, and when shared with providers, the tide lifts all boats.

Partnering to Manage Risk

Some of the changes under MACRA are reminders for providers to be highly aware of risk management. Providers will seek strong partners with the necessary skills, experience and knowledge to ensure they do not take on risk greater than they can support. To assist, health plans should enter into risk-sharing relationships, such as value-based contracts, with high-performing providers.

Health plans should actively strive to be strong partners by enabling robust data analytics that support quantitative action plans in the areas of quality and clinical care gaps, medical cost and trend analysis, population health, as well as member-risk management. As health plans partner with providers, they should also stay flexible on potential changes to provider payments as the pay-for-performance model(s) mature over time.

Financial Awareness

Health plans also need to be aware of the financial considerations that result from increased value-based contracting for small and large providers.

Under MACRA, smaller providers and individual physicians are more likely to be exposed to potential increase in costs, which may result in additional provider considerations. As Medicare payments shrink, these providers will look to shift costs to other payers, making contract negotiations more difficult and potentially increasing unit costs for some services. Large physician groups, or those located in markets with progressive healthcare systems, will look to negotiate even higher reimbursement rates due to the potential for increased competition.

Health plans should also be aware of potential impacts beyond Medicare fee-for-service (FFS), which is the initial focus of the MACRA legislation. Pay-for-performance is likely to extend beyond Medicare FFS into other health plan lines of business, such as Medicaid or commercial plans. For example, under MACRA, Centers for Medicare and Medicaid Services stated it would consider permitting Medicaid Medical Homes to count as an alternative payment model if participating practices would risk at least four percent of their revenue in 2019 and five percent in 2020.

Why This Matters

Overall, MACRA creates a tall order as it aims to increase pay-for-performance and decrease care based on quantity. This notion is an altruistic adjustment for the health system and each party has a specific role to play to achieve the dream. But the backbone of this goal is collaboration between health plans and providers. Collaboration will result in shared clinical measures, awareness and management of risk, lower healthcare costs and, most importantly, improved patient outcomes.

The Top Three Hidden Impacts of MIPS – MACRA Monday

Posted on July 10, 2017 I Written By

The following is a guest blog post by Tom S. Lee, PhD, CEO & Founder, SA Ignite. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

While most providers know the Merit-based Incentive Payment System (MIPS) will have escalating financial impacts, there are additional strategic and operational concerns that go along with managing MIPS participation. The MIPS score will impact areas beyond just clinicians’ Medicare reimbursement, including public reputation, clinician recruiting and compensation, and reporting for participants in alternative payment models (APMs).

  1. Public Reputation

Clinicians participating in MIPS and most Medicare accountable care organizations (ACOs) will have a MIPS score that determines their Medicare Part B reimbursement. The same score can impact public reputation because CMS will publish the scores on the Physician Compare website and make the data freely available to the public. Companies like Google, Healthgrades, Consumer Reports, Yelp, and others can use that data to incorporate the MIPS score into its clinician ratings and review systems. If an organization chooses to do just the minimum in 2017 to avoid the penalty, it means its clinicians could have a public performance score as low as 3 out of 100, while competitors who fully perform and report could have much higher publicly reported scores.

MIPS scores become a permanent part of each clinician’s resume because CMS binds the annual score to the clinician’s unique national provider identifier (NPI). So even if a clinician switches organizations, the historical score, along with the reimbursement or penalty, will follow the clinician, with the new organization absorbing the financial impact earned by the clinician up to two years prior at a different organization.

Estimates indicate that the revenue impact of consumers swayed by MIPS scores can be significantly larger than just the direct reimbursement impacts of MIPS. According to this article, a 1-star increase on Yelp leads to 5 to 9 percent increase in a business’ revenue. Using CMS’ data on Medicare Part B payments by specialty, this could mean an increase ranging from $4,468 to $8,042 per year per clinician for an internal medicine doctor and up to $10,705 to $19,269 per year per clinician for a cardiologist.

And, it may be much harder to convince a consumer who did not select a clinician based on an unfavorable MIPS score to re-evaluate that clinician in the future, even if the clinician’s score ultimately increases.

  1. Clinician Recruiting and Compensation

Understanding a clinician’s historical MIPS scores will be important to an organization properly evaluating and contracting with that clinician. When recruiting new clinicians or acquiring practices, healthcare organizations are mindful that they can inherit poor scores from other organizations’ program decisions. Conversely, clinicians will increasingly seek to join organizations with a good track record enabling its clinicians to achieve high MIPS scores, which positively impacts the resumes of all those clinicians.

In addition, organizations are seeking to align clinician compensation with MIPS financial and reputational impacts so look for an increasing number of compensation plan designs to directly incorporate MIPS scores and category scores as key performance indicators.

  1. Reporting Obligations of APM Participants

Although a healthcare organization may make a strategic decision to join an Alternative Payment Model (APM), such as a Medicare Shared Savings Program Accountable Care Organization (ACO), clinicians who are part of that organization are not necessarily exempt from MIPS. For example, if a clinician joins the organization after the final August 31st CMS determination of APM participation, then those clinicians will still need to fully report for MIPS or face a penalty. This is true for late-joining clinicians in both MIPS APMs as well as Advanced APMs, which typically qualify for a MIPS exemption.

Regardless of when clinicians join a Medicare Shared Savings Program (MSSP) Track 1 ACO, the ACO must manage MIPS eligibility, performance, and reporting for all clinicians, in addition to its ACO program obligations. This stems from the fact that MSSP Track 1 ACOs are not Advanced APMs.

How to Engage Clinicians Regarding MIPS

Beyond educating clinicians and leadership about the hidden impacts of MIPS, much of the important work to be successful under MIPS involves engaging clinicians in taking ownership of their responsibilities under the program. Some best practices:

  1. Recognize the importance of patient and clinician satisfaction
    • Reinvigorate support from leadership on the importance of both pillars
  2. Collaborate with clinicians
    • Let their voices be heard regarding both the explicit and hidden impacts of MIPS
  3. Provide feedback loop to clinicians and staff teams
    • Clinicians want to understand how they are being scored and where they have the best opportunities to improve
  4. Provide transparency
    • Communicating successful as well as failed efforts and the learnings accrued builds trust

Independent Primary Care Practice Success and MACRA – MACRA Monday

Posted on July 3, 2017 I Written By

The following is a guest blog post by Christina Scannapiego who currently writes the technical documentation and educational content for HealthFusion MediTouch. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Can participating in a PCMH and programs like Chronic Care Management improve your MIPS total score?

The shift to fee-for-value healthcare may feel like discouraging, foreign territory. However, if you’re already participating in value-based models like a patient centered medical home or chronic care management, your practice is more poised for success during this transition.

Chronic Care Management

The Centers for Medicare and Medicaid Services (CMS) have increased reimbursement for Chronic Care Management (CCM) services. Now, a provider has the potential to earn more than $50,000 per year under the CCM program. Patient-centered care, patient engagement and better care coordination are the core objectives of CMS. Participation in CCM could weigh heavily on your total MIPS score. CCM helps patients by extending care support beyond face-to-face appointments. Participation in this program will help you move the needle in four performance categories by extending care between office visits, controlling costs, increasing care coordination, enhancing doctor-patient relationships to help improve patient outcomes.

CCM and MACRA overlap across several MIPS components:

  • Advancing Care Information: Previously Meaningful Use, meant to achieve patient engagement and promote the electronic exchange of information, practice analytics and reporting capabilities using an EHR.
  • Quality measures: At least 30 measures including many high priority items are common to the CCM program.
  • Clinical Practice Improvement Activities: Patient engagement is one of the main objectives of both CCM and MACRA. Providing 24/7 access to clinicians and coordinating care across provider settings plays an integral part in the CCM objectives and will boost your score in this performance category.
  • Cost: Although providers aren’t responsible for reporting data in this performance category, participating in CCM can lower costs due to preventable hospitalizations from poor medication adherence and care transitions to other providers. Patients with multiple chronic conditions can often pose the highest costs in healthcare. Effectively managing the care of patients will ultimately benefit their overall well-being and the health of your practice.

Patient Centered Medical Home

The PCMH model was established to help deliver patient-centered care through care coordination, preventative services, population health management and extended access to care services. This model thrives from robust patient engagement, which is one of MACRA’s most important goals. MIPS scoring methods favor those participating in PCMH by automatically scoring providers with 100% in the Advancing Care Information performance category. PCMH recognized practices will also likely get credit in the Advancing Care Information performance category because of their experience with NCQA standards.

The importance of both CCM and PCMHs in the new healthcare regime have placed primary care physicians in a unique and opportune position; one in which the independent provider stands to find success amidst change. The impact of MACRA on healthcare is “monumental” and “herculean,” said the Director of Provider Innovation Strategies at DST Health Solutions in her presentation, “The Role of PCMH Under MACRA.” MACRA isn’t a momentary, passing legislation — it’s had bipartisan support from the beginning and it’s here to stay. Luckily for PCHM and CCM participators, this new legislation and enormous impact becomes more manageable.

About the Christina Scannapiego:
Christina Scannapiego has been a technical, health and lifestyle writer for more than 10 years. Christina currently writes the technical documentation and educational content for HealthFusion MediTouch, an Electronic Health Records software platform. HealthFusion and its MediToch cloud software suite is a subsidiary of Quality Systems/next Gen. MediTouch is comprised of a range of web-based software solutions for physicians, medical practices and billing services.

2018 QPP Proposed Rule: What it Means for MIPS & Quantifying the Impact on Specialty Practices – MACRA Monday

Posted on June 26, 2017 I Written By

The following is a guest blog post by Justin Barnes, Board Advisor at iHealth Innovations. This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

The Centers for Medicare and Medicaid Services (CMS) recently released a Proposed Rule highlighting recommended updates to the 2018 reporting period of the Quality Payment Program (QPP). Like flexibilities extended in 2017, the proposal seeks to further reduce reporting burdens on small practices and rural providers in the program’s second-year reporting period.

Merit-based Incentive Payment System (MIPS) reporting track updates include:

  • Increased low-volume exemption thresholds (<200 patients or <$90,000 in payments)
  • New virtual group options for solo practitioners and groups with 10 or fewer Eligible Clinicians
  • Extending “pick your pace” flexibilities into 2018
  • Postponing introduction of the Cost category to MIPS composite scores
  • Factoring MIPS performance improvements into quality scores
  • Permissions for facility-based providers to report through the facility where they do most of their work instead of the practice
  • Permitting the use of 2014 CEHRT in 2018 reporting

The Rule introduces new MIPS bonus point opportunities for:

  • The use of 2015 CEHRT
  • The care of complex patients

Recommendations also extend small practice relief including:

  • Up to 5 bonus points for practices with 15 or fewer Eligible Clinicians
  • Hardship exemption for Advancing Care Information category measures
  • Additional points on Quality measures that don’t meet completeness requirements

Comments on the Proposed Rule are due by August 21, 2017. Physicians have until October 2, 2017, to begin collecting performance data for the inaugural 2017 MIPS reporting period.

Calculating MIPS: The Financial Impact on Specialty Practices

Results from a crowdsourced survey fielded by Black Book Research among nearly 9,000 physician practices from February through April of 2017 reveal that 94 percent of physician participants were unaware or unsure of how to predict their 2017 MIPS performance scores. Seventy-seven percent of practices with three or more clinicians reported intentions to purchase MIPS compliance technology solutions by the fourth quarter of this year, largely driven by an inability to independently determine earning potential under MACRA.

Orthopedics, cardiology and radiology are among the highest incentivized specialties under MIPS. To help specialty practices quantify the fiscal impact MIPS poses, we evaluated average Medicare earnings by specialty to establish the MIPS calculations below. These estimates are based on bare minimum earnings and losses that could be greater for practices with larger Medicare patient populations and/or more physicians. (Calculations are strictly illustrative estimates.)

Cardiology Practices
Estimated average payment adjustment for a 5-clinician cardiology practice in 2019 alone: $43,601
Number of cardiology-specific QPP measures: 20

Orthopedics Practices
Estimated average payment adjustment for a 6-clinician orthopedics practice in 2019 alone: $34,603
Number of orthopedics-specific QPP measures: 21

Radiology Practices
Estimated average payment adjustment for a 6-clinician radiology practice in 2019 alone: $30,117
Number of radiology-specific QPP measures: 22

Note: The above projections assume the full incentive and penalty will be paid out as outlined in the MACRA law. However, the positive and negative payment adjustments will be scaled so the program is budget neutral. This means that the positive payment adjustments will have to be offset by penalties.

Navigating the Transition to MIPS
As clinicians prepare for reporting under MIPS, establishing specialty-specific expertise on financial, clinical and technical objectives can help practices thrive rather than just survive.

Tips as you for prepare for MIPS:

  • Know your reporting options and pick your path.
  • Choose measures that play to the strengths of your specific specialty practice. Review your current billing codes and Quality and Resource Use Report to help determine these areas.
  • Do a technology asset inventory to make sure you can track the required CQMs.
  • Customize your EHR for track your selected measures or ID an outsource vendor to assist.
  • Work towards minimum reporting requirements to avoid a penalty with a stretch goal to report on the full required measures to maximize positive adjustment earnings potential.

Additional resources:
QPP website
An overview and support documentation is available at the CMS QPP website here.

MIPS EDU Program
A new “Quality Payment Program in 2017: Pick Your Pace Web-Based Training” course with Continuing Education Credit is available through the Learning Management System. Learn more here.

2017 CMS-Approved Qualified Clinical Data Registries
Additional specialty-specific measures are available via approved 2017 QCDRs to meet MIPS reporting requirements. Options for cardiology, radiology and orthopedic practices are included. Learn more here.

About the Author:
Justin Barnes is a nationally recognized business and policy advisor who serves as Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. As Board Advisor with iHealth, Justin assists providers with optimizing revenue sources and transitioning to value-based payment and care delivery models. Justin has formally addressed Congress and the last three Presidential Administrations on more than twenty occasions on the topics of MACRA, value-based medicine, accountable care, interoperability, consumerism and more. He is also host of the weekly syndicated radio show “This Just In.” Justin can be found on Twitter at @HITAdvisor.

Embracing Quality: What’s Next in the Shift to Value-Based Care, and How to Prepare

Posted on June 13, 2017 I Written By

The following is a guest blog post by Brad Hill, Chief Revenue Officer at RemitDATA.

Whatever the future holds for the Affordable Care Act (ACA), the shift to value-based care is likely here to stay. The number of providers and payers implementing value-based reimbursement contracts has grown steadily over the past few years. A survey of 465 payers and hospitals conducted in 2016 by ORC International and McKesson revealed that 58 percent are moving forward with incorporating value-based reimbursement protocols. The study, “Journey to Value: The State of Value-Based Reimbursements in 2016” further revealed that as healthcare continues to adopt full value-based reimbursement, bundled payments are the fastest growing with projections that they will continue to grow the fastest over the next five years, and that network strategies are changing, becoming narrower and more selective, creating challenges among many payers and hospitals as they struggle to scale these complex strategies.

Given the growth of adoption of value-based care, there are certainly many hurdles to clear in the near future as policymakers decide on how they plan to repeal and replace the ACA. A January 2017 report by the Urban Institute funded by the Robert Wood Johnson Foundation revealed that some of the top concerns with some potential scenarios being floated by policymakers include concerns over an immediate repeal of the individual mandate with delayed repeal of financial subsidies; delayed repeal of the ACA without its concurrent replacement; and a cutoff of cost-sharing subsidies in 2017.

With the assumption that value-based healthcare is here to stay, what steps can you take to continue to prepare for value-based payments? The best advice would be to continue on with a “business as usual” mindset, stay focused and ensure all business processes are ready for this shift by continuing to:

  1. Help providers establish baselines and understand their true cost of conducting business as a baseline for assuming risk.
  2. Analyze your revenue cycle. Look at the big picture for your practice to analyze service costs and reimbursements for each – determine if margins are in-line with peers.  Identify internal staff processing time and turnaround times by payer. Evaluate whether there are any glaring issues or problems that need to be addressed to reduce A/R days and improve reimbursement rates.
  3. Determine whether there are reimbursement issues for specific payers or if the problem is broader in nature. Are your peers experiencing the same issues with the same payers?
  4. Capture data analysis for practice improvement. With emerging payment models, hospitals and practices will need expertise in evaluating data and knowledge in how to make business adjustments to keep the organization profitable.
  5. Determine how you can scale and grow specific payment models. Consider, for example, a provider group that maintains 4 different payment models and 10 different payers. The provider group will need to determine whether this system is sustainable once payment models shift.
  6. Break down department silos in determining cost allocation rules. Providers need a cost accounting system that can help determine exact costs needed to provide care and to identify highest cost areas. Cost accounting systems are typically managed by the finance team. There needs to be clinical and operational input from all departments to make a difference. Collaborate across all departments to determine costs, and design rules and methodologies that take each into account.
  7. Compare your financial health to that of your peers. Comparative analytics can help by giving you insights and data to determine your practice’s operational health. Determine whether you are taking longer to submit claims than your peers, have a higher percentage of denied claims for a specific service, percentage of billed to allowed amounts and more.

Though change is a part of the healthcare industry’s DNA, ensuring business processes are in line, and leveraging data to do so will help organizations adapt to anything that comes their way.