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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.

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.

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.

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 Cost Category and 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.

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.

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.
Read more..

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.

MACRA is Required by Law to Be Budget Neutral – What’s The Impact? – MACRA Monday

Posted on January 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.

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

In my last post on MIPS benefits and the “Pick Your Pace” options, I published an old slide which highlighted the potential positive and negative payment adjustments under MIPS. Thanks to Lynn Scheps from SRSsoft (she also wrote our previous Meaningful Use Monday series of blog posts), it was pointed out to me that there’s one big caveat to how much positive payment adjustment you’d receive under MIPS. I don’t know how I missed it on page 1282-1286 of the final rule. It was such an important point, that I wanted to dive into all the details in a MACRA Monday post of its own.

This all gets pretty technical, pretty quickly, but we’ll try to make this as simple to understand as possible. The core issue at hand is that the MACRA program has to be budget neutral. This means that the MACRA penalties have to offset any MACRA benefits that are paid to participants. Since Pick Your Pace has made it so very few practices will receive the 4% MACRA penalty, that means that there won’t be as big of a pool of incentives available to those who do participate in MACRA.

The math gets pretty complicated, but this chart illustrates how the adjustments you receive could be effected by the need to make the program budget neutral:

This chart is illustrative, but I also believe that it’s a decent representation of what’s likely to happen given the lack of MIPS penalties that will be assessed. If the chart is accurate, most MIPS participants will receive less than a 1% incentive and exceptional performers will be less then 2.4%. That’s quite a big difference between the 4% that was originally discussed.

Now remember that CMS was stuck in a tough position. They had a legal requirement to make it budget neutral. They could have continued with the 4% positive payment adjustment, but that would mean that a whole bunch of practices would get a 4% negative payment adjustment. Instead, they chose to do Pick Your Pace to give people a chance to avoid the penalties. Now those people are happy, but exceptional performers pay the price because there’s no budget to reward the exceptional performers.

At least this is how I read the legalese. If anyone has any other nuances I missed, please let us know in the comments. Next week we’ll start diving into more of the MIPS Categories and changes to the MIPS Composite Score.

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