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MIPS Quality Performance Category – MACRA Monday

Posted on January 23, 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.

It’s time to start diving into more of the details of the MIPS performance categories. For reference, be sure to check out our previous post on the MIPS Performance Category Weightings to see how the Quality performance category fits in with the other MIPS performance categories. The Quality performance category makes up 60% of your MIPS composite score. So, this is a very important category. If you’re looking for a formal course that dives into the nitty gritty details of this category, check out this course taught by Wayne Singer that covers the MIPS Quality Performance Category ($150 off the course if you use this link) in detail.

The Quality performance category is a replacement of the program we now know as PQRS. The program is simplified a little and they have created specialty specific measure sets. This is a valuable resource since the number of measures available in the quality performance category is quite large.

In the Quality performance category you must select 6 measures and at least one measure must be an outcome or high-priority measure. Scoring of these measures will go as follows:

Here’s how you calculate your quality performance category score:

If you’ve been participating in PQRS, this MIPS performance category won’t be a big issue for you. You’ll likely achieve a high score and be well on the road to doing very well with MIPS. If you haven’t been doing PQRS, then you have some work to do. The nice thing is that there are a lot of organizations with experience with PQRS and you can learn from them. Plus, your EHR vendor should be very familiar with PQRS as well and should be able to help.

That’s all for this week’s MACRA Monday. Next week we’ll talk about the new Clinical Practice Improvement Activities (CPIA) Category.

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

Diagnosis And Treatment Of “Epic Finger”

Posted on January 20, 2017 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.

The following is a summary of an “academic” paper written by Andrew P. Ross, M.D., an emergency physician practicing in Savannah, GA. In the paper, Dr. Ross vents about the state of physician EMR issues and repetitive EMR clicking (in quite witty fashion!). Rather than try and elaborate on what he’s said so well, I leave you with his thoughts.

At long last, medical science has identified a subtle but dangerous condition which could harm generations of clinicians. A paper appearing in the Annals of Emergency Medicine this month has described and listed treatment options for “Epic finger,” an occupational injury similar to black lung, phossy jaw and miner’s nystagmus.

Article author Andrew Ross, MD, describes Epic finger, otherwise known as “Ross’s finger” or “the furious finger of clerical rage,” as a progressive repetitive use injury. Symptoms of Epic finger can include chronic-appearing tender and raised deformities, which may be followed by crepitus and locking of the finger. The joint may become enlarged and erythematous, resembling “a boa constrictor after it has eaten a small woodland mammal.”

Patients with Epic finger may experience severe psychiatric and comorbid conditions. Physical complications may include the inability to hail a cab with one’s finger extended, play a musical instrument or hold a pen due to intractable pain.  Meanwhile, job performance may suffer due to the inability to conduct standard tests such as the digital rectal exam and percussion of the abdomen, leading in turn to depression, unhappiness and increased physician burnout.

Dr. Ross notes that plain film imaging may show findings consistent with osteoarthritic changes of the joint space, and that blood work may show a mild leukocytosis and increased nonspecific markers of inflammation. Ultimately, however, this elusive yet disabling condition must be identified by the treating professional.

To treat Epic finger, Dr. Ross recommends anti-inflammatory medication, aluminum finger splinting and massage, as well as “an unwavering faith in the decency of humanity.”  But ultimately, to reverse this condition more is called for, including a sabbatical “in some magnificent locale with terrible wi-fi and a manageable patient load.”

Having identified the syndrome, Dr. Ross calls for recognition of this condition in the ICD-10 manual. Such recognition would help clinicians win acceptance of such a sabbatical by employers and obtain health and disability insurance coverage for treatment, he notes. In his view, the code for Epic finger would fit well in between “sucked into jet engine, subsequent encounter,” “burn due to water skis on fire” and “dependence on enabling machines and devices, not elsewhere classified.”

Meanwhile, hospitals can do their part by training patients to recognize when their healthcare providers are suffering from Epic finger. Patients can “provide appropriate and timely warnings to hospital administrators through critical Press Ganey patient satisfaction scorecards.”

Unfortunately, the prognosis for patients with Epic finger can be poor if it remains untreated. However, if the condition is recognized promptly, treated early, and bundled with time spent in actual patient care, the author believes that this condition can be reversed and perhaps even cured.

To accomplish this result, clinicians need to stand up for themselves, he suggests: “We as a profession need to recognize this condition as an occult manifestation of our own professional malaise,” he writes. “We must heal ourselves to heal others.”

The Digital Health Biography: There’s A New Record In Town

Posted on January 18, 2017 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.

Few of us would argue that using EMRs is not a soul-sucking ordeal for many clinicians. But is there any alternative in sight? Maybe so, according to Robert Graboyes and Dr. Darcy Nikol Bryan, who are touting a new model they’ve named a “digital health biography.”

In a new article published in Real Clear Health, Graboyes, an economist who writes on technology, and Bryan, an OB/GYN, argue that DHBs will be no less than “an essential component of 21st century healthcare.” They then go on to describe the DHB, which has several intriguing features.

Since y’all know what doctors dislike (hate?) about EMRs, I probably don’t need to list the details the pair shares on why they generate such strong feelings. But as they rightly note, EMRs may take away from patient-physician communication, may be unattractively designed and often disrupt physician workflow.

Not only that, they remind us that third parties like insurance companies and healthcare administrators seem to get far more benefits from EMR content than clinicians do. Over time, data analytics efforts may identify factors that improve care, which eventually benefits clinicians, but on a transactional level it’s hard to dispute that many physicians get nothing but aggravation from their systems.

So what makes the DHB model different? Here’s how the authors lay it out:

* Patients own the DHB and data it contains
* Each patient should have only one DHB
* Patient DHBs should incorporate data from all providers, including PCPs, specialists, nurse practitioners, EDs, pharmacists and therapists
* The DHB should incorporate data from wearable telemetry devices like FitBits, insulin pumps and heart monitors
* The DHB should include data entered by patients, including family history, recollections of childhood illness, fears and feelings
* DHB data entry should use natural language rather than structured queries whenever possible
* The DHB should leverage machine learning to extract and organize output specific to specific providers or the patient
* In the DHB model, input and output software are separated into different categories, with vendors competing for both ends separately on functionality and aesthetics
* Common protocols should minimize the difficulty and cost of shifting from one input or output vendor to the other
* The government should not mandate or subsidize any specific vendors or data requirements
* DHB usage should be voluntary, forcing systems to keep proving their worth or risk being dumpted
* Clinical applications shouldn’t be subservient to reimbursement considerations

To summarize, the DHB model calls for a single, patient-controlled, universal record incorporating all available patient health data, including both provider and patient inputs. It differ significantly from existing EMR models in some ways, particularly if it separated data input from output and cut vendors out of the database business.

As described, this model would eliminate the need for separate institutions to own and maintain their own EMRs, which would of course stand existing health IT structures completely on their head. Instead of dumping information into systems owned by providers, the patient would own and control the DHB, perhaps on a server maintained by an independent intermediary.

Unfortunately, it’s hard to imagine a scenario in which providers would be willing to give up control to this great an extent, even if this model was more effective. Still, the article makes some provocative suggestions which are worth discussing. Do you think this approach is viable?

Big Hairy Audacious Goals for Healthcare IT (and some small ones too) – #HITsm Chat Recap and Commentary

Posted on January 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.

As we’ve been doing the past few weeks, we’re excited to do a bit of a recap and commentary on last week’s #HITsm chat. For those who missed it, we talked about 2017 Goals for Healthcare IT. We started off with the famous Big Hairy Audacious Goals (BHAG) idea which made for some interesting conversation. You can find the full #HITsm tanscript for this chat on Symplur.

There was a wide ranging discussion over the hour, but a certain emphasis on more empowered patients. Here’s a look at some of the interesting ideas and our own commentary on what they tweeted.


It’s sad that this is a BHAG, but it certainly is a challenging goal given the disconnected nature of our healthcare system. Not to mention perverse incentives which make sharing healthcare data difficult to achieve.


The last line of this tweet really captured me. It certainly feels like much of healthcare is more beholden to the CFO than to the patient. That’s brutal for me to even type and is far too close to reality. Does anyone see this changing in the near future?


I’m not sure if these classify as BHAGs or not. They sure feel like they won’t happen despite a lot of people interested in them becoming a reality.


Make healthcare easier? Fascinating to think about. I wonder what cost we pay because healthcare is so hard.


This is a definite BHAG. What’s extraordinary is to start thinking about the innovation that could occur if this was a reality.


I’d like to dig into this one more. Greg certainly knows a lot more about CCDA and FHIR than I do. This is a sad sign for the potential of FHIR going forward.


Topic 2 was about smaller goals that healthcare IT could achieve. I like this one from Max. It highlights a real challenge with how most EHR software programs were implemented. They were done in such a rush that most people were just training for competence. Is it any wonder that many EHR users are unsatisfied? I wonder if training them with quality in mind would change their views of EHRs.


I shouldn’t be shocked, but I’m always surprised by how valuable improving communication can be. I think that’s true in every industry and many parts of life. However, Steve’s suggestion for healthcare is a good one and would likely provide tremendous benefit.


I wonder if this goal should have been under the BHAG section of the chat and not the “simple” goals section. The problem with this idea is that in many cases HIT has been part of the problem. We need to fix that and ensure that HIT is a solution for the majority of people who use it.


I don’t see this changing, but I think it’s part of the problem. I’m always torn when I see this big party and ribbon cutting at the opening of a new hospital. Shouldn’t we be sad that they needed more beds? Shouldn’t we be celebrating when health is so improved that hospitals needed to shut down because they didn’t have enough business?


This relates to the tweet above it. We want lower costs, but who wants to get paid less?


This is very true. And I think heatlhcare IT vendors could do more than they’re doing today. Many are just coasting. Plus, all of them have been distracted by so many government regulations. Is it time to just leave health IT vendors alone for a bit to let them innovate?


Should be a fun chat. Always good to get new perspectives on learning and engagement. See you at next week’s #HITsm chat.

MIPS Performance Category Weightings – MACRA Monday

Posted on January 16, 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 going to keep this post short and sweet since it’s a holiday. However, we wanted to keep going with our regular MACRA Monday series. As we start to talk about the details of MIPS, the key change in the MACRA final was removal of the “Cost” category from MIPS. Ok, it wasn’t really removed. It’s still apart of MIPS, but it doesn’t influence the payment adjustment that you’ll receive. For those following along at home, the cost performance category in MIPS was a replacement of the Value Based Reimbursement Modifier.

Here’s the full breakdown of the 4 MIPS Performance Categories and how much weight each category will get in determining your MIPS Composite Score:

As a reminder, the Quality category replaces the old PQRS program. The Improvement Activities category is a new category. The Advancing Care Information category is the meaningful use replacement. We already mentioned that the Cost category is a replacement of the Value Based Reimbursement program.

Looking at the weights above, if you’re participating in PQRS, then MIPS is not going to be an issue for you. If you’ve been doing PQRS and Meaningful Use, then you’re well positioned to get access to the extra incentives available under MIPS. Although, remember that the MIPS incentives are subject to budget neutrality.

That’s the basic overview of the MIPS categories. Next week we’ll start diving into more details on each category.

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

Has the MD Profession Been Irreparably Harmed?

Posted on January 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.

Physician burnout has been a hot topic lately. You see it anywhere you find a physician. Doctors are tired, worn out, and feel like they’re overworked. Many feel like they’ve become data entry clerks and not doctors. Many doctors feel like all these regulation and reimbursement requirements have gotten between them and the patient. Many are pressured by their employer to hit numbers as opposed to caring for patients.

I could keep going, but you get the point. If you’re a doctor, then you’re living many of these challenges. If you’re not, I’d love to hear from you.

Lately when I’ve heard people talking about the damage the meaningful use, EHR, and now MACRA have caused, I hear those people proclaim that the medical profession has been damaged. Many go on to suggest that irreparable harm has been caused to the medical profession. Is that true?

When I ask these people what the solution is, they say that government should get out of the exam room. While that principle is interesting, it’s not very practical. Most of these doctors that want government out of the exam room still want Medicare to cut them a check for seeing Medicare patients. There’s a big disconnect there and it’s not likely to change.

All of this sidesteps the real issue we have in healthcare. Whenever we talk about lowering the cost of healthcare, that means someone is going to get paid less. Who should that be? Yes, there is the pretty rare scenario that you can lower costs while improving care. I’ve seen examples of this, but it’s an extremely challenging thing to make happen.

Going back to the main question. Is the medical profession irreparably harmed by the implementation of EHR software and other regulations? Certainly, it’s had a significant impact, but I don’t think the harm is impossible to repair. We do need to simplify the hoop jumping that we require from physicians. We do need to improve our EHR software so that it makes the physician workflow more efficient and not less. We do need to find better incentives that provide for health data sharing and deeper engagement with patients. All of these things will help repair the medical profession. Doing so will create a whole generation of doctors who can’t imagine what it was like to practice medicine without an EHR.

MACRA and CMS – A #HITsm Chat Summary and Commentary

Posted on January 12, 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.

Note: Join us Friday at Noon ET (9 AM PT) for the latest #HITsm chat.

We had a really unique opportunity to have the Acting Administrator of CMS, Andy Slavitt, join us as host of the #HITsm Twitter chat. His participation in the Twitter chat was a good illustration of how he led things during his time at CMS. We’ll see how things play out with this new administration, but I can personally say that I’m going to miss Andy Slavitt at CMS. He’s brought a fresh engagement from CMS that I hope will continue with his replacement and will continue with the other employees at CMS.

In the #HITsm chat that Andy hosted, we had a wide ranging discussion about MACRA and CMS. The chat was extremely active, so if you missed it live, be sure to read through the whole #HITsm transcript.

Here we’ll just highlight a few of the tweets that we found interesting and add a bit of commentary as well.


I really think this isn’t lip service, but is the culture of many at CMS now. That’s a huge win. There’s still a lot of work to be done and we need more voices willing to talk with CMS so that they hear the right messages, but it’s been a huge step forward.


I think many might think this was the tweet of the chat. There are a lot of pressures in healthcare that are shocking.


I loved this tweet. Many in government aren’t open to changes, but I think many on social media just spout complaints without a plan that will be better than what’s happening today.


All about the patients!


Seriously. If you’re on Twitter and care about healthcare, then you should be following Aisling. And do it for much more than on point emoji sharing.


My feeling is the Advanced APM participants are going to be the happiest group that participates in MACRA. There are good incentives and in many cases they get them for things they were already planning to do.
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E-Patient Update:  The Virtues, And Failings, Of Doctor-Patient Email

Posted on January 10, 2017 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.

Lately, I’ve been thinking about my experiences with emailing my providers. I’m certainly grateful that this channel is now available, as I’ve used it to manage some important health problems. That being said, there’s also some new challenges to address when reaching out to your clinician.

Some of the important benefits I’ve gotten from emailing my doctors include:

  • Cutting out middlemen: If I want to communicate with my PCP outside of a medical visit, I have to call, wait on hold for the receptionist to answer, then wait for a nurse to find out what I want, who might get back to me if she can track down the doctor. Email communication bypasses the whole bureaucracy, which I love.
  • Quick solutions: If a doctor is at all wired, she may be able to shoot quick responses to basic questions (“Do I need to schedule a follow-up?”) far more quickly than if I’m at the end of a voice-message queue. Of course, the more email she has the longer it may take to respond, but responding to my email is still quicker than a phone conversation in most cases.
  • Messaging during off hours: If I want to communicate with a doctor, but the issue isn’t critical, I can write to them anytime I’d like – even while I’m eating a 3AM snack! I don’t have to wait until office hours, when I’m likely to be juggling other workaday issue and forget to reach out.

But there are also disadvantages to emailing my doctors, and they’re significant:

  • Problems with communication: A few times, I’ve been in situations where emailing doctors created confusion rather than clarifying things. For example, one specialist sent me an email suggesting an appointment slot, and though I never confirmed, he still considered the slot booked (and charged me for missing it)! That was a relatively petty problem, but if there was a similar level of misunderstanding about a clinical matter it could have been much worse.
  • Unclear expectations: If you call a medical practice’s service overnight for help with a serious problem, you can be pretty sure the on-call doc will call back. But when you email a doctor, it’s not clear what you can expect. There’s no formal rule – or even best practices guidelines, as far as I know – governing how quickly doctors should answer emails, what issues they’re willing to tackle via this medium or how they should handle email responses when they’re on vacation or ill (ask a colleague or nurse to monitor their inbox?)
  • Lack of context: In most cases, the email messages I’ve gotten from doctors resemble text messages rather than letters. Sometimes that’s enough, but in other cases I wish I could get more context on, say, why they’re recommending a med or suggesting I get screened at an emergency department.

Without a doubt, being able to email doctors is a good thing. However, I think it will work better for both sides if doctors have tools that help them manage multichannel conversations with patients.

Specifically, I believe doctors need access to a secure messaging portal, one which offers not only a unified inbox but also tools for prioritizing messages, perhaps using AI to identify urgent issues, and automates routine tasks. Ideally, it would identify patients by their name or email address, and pop up a patient status summary for those with urgent concerns — and yes, this would probably require EMR integration, but why not? (Feel free to write me at anne@ziegerhealthcare.com if something like this already exists!)

The last thing we need is for patient emails to become one more cause of physician burnout. So let’s give doctors the tools they need to manage the messaging process effectively and stay connected with patients who need them most. In fact, what if we made the messaging so effective that it saved them time over a voicemail message?

Should Physicians “Just Say No” to MACRA? – MACRA Monday

Posted on January 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.

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’d planned to start diving into MIPS this week, but I couldn’t resist commenting on a post I saw on Medical Economics where a physician makes the case that physicians should just say “No” to MACRA. The opening paragraph describes the challenges of MACRA (and its meaningful use predecessor) pretty well:

I can’t recall the exact moment I crossed over from believer in today’s version of the healthcare quality movement to skeptic. Perhaps it was when the office trash would fill with clinical summaries the staff dutifully handed out to patients to satisfy a “meaningless use” measure. Or maybe it was trying to convince a 75-year-old Mrs. Davis that we would really appreciate it if she logged on to our electronic health record (EHR) using the patient portal. To do what, she asked? I stared back at her blankly.

It’s easy to make the case that some of the meaningful use requirements are meaningless. The same could be said for MACRA. That’s particularly true if you look at specialty specific instances where certain requirements made no sense to specific specialties. In other cases, the concept is good, but the execution is poor. For example, the concept of giving patients access to their health information is good, but it was poorly executed. Providing a clinical summary after a visit doesn’t really get us there and yet that’s what doctors were required to do.

Long story short, I understand why many see meaningful use and now MACRA as a distraction and they should just say no to both. In fact, that’s the advice that the author above offers:

My advice to physicians operating in this climate is simple: Don’t participate. MACRA clearly is the law of the land, and while one may hope the implementation from a Trump-Price administration will have a much lighter touch than the Obama-Burwell administration, sustained resistance in the form of non-participation is a small but important message to send to policymakers.

It is true that opting out of MACRA would send a small message to policymakers. If doctors would opt completely out of Medicare to avoid the MACRA penalties, that would send an even stronger message. I hear some doctors talking about this as an option as well. Both actions would send a message if doctors did this in mass. The problem is this isn’t happening and I don’t think it will happen.

While it is easy for a well paid cardiologist to say in a blog post that doctors should just say no to MACRA, my experience is that the MACRA math is much more difficult for general medicine and other specialties that don’t get paid as much and have large Medicare populations. The 4% MACRA penalty is a significant penalty to many doctors and “just saying no” is a very challenging decision for them financially. In fact, I’ve talked to many that just don’t see it as an option.

The same is true for people opting out of Medicare or reducing their Medicare population so the penalties aren’t as damaging. Not only is Medicare a significant source of revenue for many practices, but opting out of Medicare would hurt many patients who would have challenge finding care without them. Indeed, choosing to accept the Medicare penalties is not as easy a decision as some like to make it seem.

If you believe MACRA will fail, then opting out wouldn’t be as hard to handle for a year at a 4 percent penalty. However, I don’t see a scenario where MACRA fails so badly that it goes away. In fact, given the budget neutral nature of the legislation and the MIPS Pick Your Pace changes, it’s easy to see how MACRA is going to be proclaimed as a successful program. It would take some really serious lobbying for MACRA to disappear and I don’t see the will in Washington to make this a reality.

Assuming MACRA sticks around, your initial 4% penalty will grow to 9%. That’s a big hit to the bottom line for many practices. Given the Pick Your Pace options and the fact that most are already doing many pieces of the MIPS program (PQRS and Meaningful Use), why would a practice just take the penalty on the chin when the penalty is easily avoided? Out of honor and principle?

In fact, if you want to minimize MACRA’s impact on your practice it might send a clearer message to Washington if everyone participated at the lowest Pick Your Pace (Test Pace) option as opposed to a few people opting out of MACRA completely. If a few people opt out of MACRA and take the penalties, that will just fuel the incentives of those that participate in MACRA. If the majority of doctors do the minimum required to avoid the penalties, then they’ll avoid the penalties and it will send a message to CMS that they need to continue at a slower pace. Plus, those that participate fully will only get a small increase because there aren’t enough penalties to pay them what MACRA could pay them.

I previously suggested that the best strategy for most practices would be to go and participate as much as possible in MIPS so that a practice doesn’t get behind. I still think getting behind is an important concept to consider when you evaluate your MACRA participation. However, given the budget neutral nature of MACRA and the way it minimizes the incentives for full participants, I’m ok with a practice that chooses to take MACRA slowly. I just think most practices with a reasonably sized Medicare population are a bit crazy to not at least avoid the MACRA penalties.

Feel free to send a small message by just saying no to MACRA, but don’t expect that strategy to achieve the goals you desire. In fact, all it will likely do is damage yourself and put you in a harder position to participate in MACRA in future years. Of course, if you’re a highly paid specialist and/or you have a small Medicare population, then you’re choice doesn’t matter much to you or them anyway.

I agree that we should make an effort to get government regulation out of the EHR world as much as possible. It’s stifled innovation, burnt out doctors, and commoditized EHR software. I dream for the day when doctors love technology because it helps them be better doctors as opposed to better medical billers and government hoop jumpers. However, “just saying no” to MACRA won’t get us there.

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

E-Patient Update: All I Want For 2017

Posted on January 6, 2017 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.

Over the past year, I’ve done a lot of kvetching about the ways in which I think my e-relationships with doctors and hospitals have fallen short. I don’t regret doing so, but I think it’s just as important to focus on the future. So without further ado, here’s a list of ways in which providers could improve their digital interactions with me and my fellow patients during the coming year:

  • Have consistent policies and operations: Over time, I’ve found that many providers don’t seem to keep track of what they say about e-services such as portals and telemedicine visits. Others do little to let you know whether, say, doctors respond to email and how long it may take for them to do so. All of this creates patient confusion. This year, please be consistent in what you do and how you do it.
  • Create channels for patient feedback: As you may recall, I recently trashed a practice that didn’t respond to patient complaints about a broken appointment-making function on its site, and noted that all could have been avoided if patient objections had gotten routed to practice administrators sooner. Let’s make sure this doesn’t happen anymore. This year, make sure your patients don’t face this kind of frustration; create formal channels for patient technical feedback and have a process for escalating their concerns quickly.
  • Give us more access: While patients do have access to some data from their medical records, most of the time we still have to jump through onerous hoops if we need a complete record. Given that it’s all digital these days, this is very hard for us to understand, so fix this process. (And by the way, don’t pile on $2.50 per page charges when you produce a digitally-produced patient record; not only is it insulting and predatory, if that fee doesn’t reflect the costs of sharing the record it may be illegal in many states.)
  • Give us more control: Particularly when, like me, you have more than one chronic condition to manage, it gets very tiring to deal with the policies of multiple institutions when you want the big picture. We want more control of our records!  We’ll be much happier (and possibly healthier) if we have ways to compile complete record sets of our own.
  • Take us seriously: The following is not just an e-patient concern, but it still applies. Too often, when I raised a concern (“Why do you say I don’t have an appointment when I made one online?”) I’ve gotten a blank stare or defensive posturing. This year, providers, please take our digital problems as seriously as other any problems we face in interacting with you. We do!

As I look at this list, I think it’s interesting that I have no temptation to suggest one technology or another (though as your faithful scribe I’ve seen many intriguing options). The truth is, I’d submit, that most providers should get their social and operational ducks in a row before they roll out sophisticated patient engagement platforms or roll out major telehealth initiatives. Just make sure everything works, and everybody cares, and you’ll be off to a better start.