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Leveraging New Age Technology to Overcome MACRA Challenges – MACRA Monday

Posted on August 21, 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.

The following is a guest blog post by Dr. David A. Goldman, CEO and founder, Goldman Eye and Ophthalmology Team Lead, Anterior Segment at Modernizing Medicine.  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.

MACRA and the Quality Payment Program (QPP) were implemented by the Centers for Medicare & Medicaid Services (CMS) to improve healthcare by focusing on the quality of care provided to patients. There are two paths under the QPP: the Merit-based Incentive Payment System (MIPS) track which covers most clinicians, and the Advanced Alternate Payment Models (APMs) track which applies to providers who have taken on some risk related to patient outcomes (Medicare Shared Savings 2,3 and Next Gen ACO participants for example).

MACRA and MIPS are intended to advance quality based care by implementing outcome-based payment adjustments. Providers will be measured across a number of different performance categories and will be paid on a curve. By 2022, physicians who outperform their peers may receive up to a 9 percent positive payment adjustment on their Medicare reimbursements based on their performance in 2020. Those who report poor performance may receive up to a 9 percent negative payment adjustment on their Medicare reimbursements in 2022.

Specialtyspecific Measures & Bonus Points

As previously mentioned, if you perform better than your peers when it comes to MIPS, you can substantially increase your Medicare reimbursements. Conversely, reporting a score below the performance threshold could prevent you from receiving a positive payment adjustment on your Medicare reimbursements, and not reporting on MIPS could cause you to be penalized.

Some MIPS categories will be the same across all specialties such as Advancing Care Information and Improvement Activities, whereas others can be geared towards a specialty, like Quality. Quality accounts for 60 percent of your total MIPS score in 2017. As an Eligible Clinician (EC), you should select six measures, including one Outcome Measure or if an Outcome Measure is not available, a High Priority Measure. After your first Outcome or High Priority Measure, any additional ones you report will count towards your bonus points (up to six points). In addition, an EC can earn another six points by doing end-to-end reporting. More information on the measure specifications can be found here.

Under the Advancing Care Information (ACI) category, ECs have the option to earn 5 bonus points by being in active engagement with a specialized registry, which are typically specialty-specific. The third category of MIPS is called Improvement Activities (IAs) which has over 90 activities to choose from. ECs, regardless of specialty, can choose activities that apply to their practice size and way of practicing like expanded practice access and closing the referral loop. Depending on the IA selected, ECs can also earn a 10 point bonus under the ACI category.

How can we turn this change into an opportunity?

A major factor in succeeding in MIPS is the use of today’s latest technology. Innovative electronic health record (EHR) systems, which can collect and organize clinical data in a structured format, empower doctors to extract meaningful insights at the patient and population levels. Instead of relying on any one physician’s narrative assessment or unstructured data for a diagnosis or treatment, physicians who have access to an interoperable platform can reference relative findings from their peers while eliminating redundancies, automating communications and improving patient outcomes.

How Do You Track Your Performance

The answer is certainly not using pen and paper. Look for a certified EHR vendor that has technology which provides services and products that can track data in real time and provide analytics to show your progress and outcomes. You want MIPS intelligence directly built-in to your EHR system.

Modernizing Medicine offers a specialty-specific suite of products and services that gives physicians added support. modmed Ophthalmology™ helps ophthalmologists transition to MIPS by providing them with quality data and reporting capabilities with the products and services they provide. Included within the suite is the company’s flagship EHR system, EMA™. EMA provides functionality for automated quality data capture, population health registries, real patient engagement and analytical tools, plus the ability to submit MIPS right to CMS.

I have been utilizing EMA for the past few years and am also a team lead on Modernizing Medicine’s ophthalmology team. As a practicing ophthalmologist, I have gone through the process of spending countless hours documenting patient reporting following a long day in the office. Couple that with ensuring my compliance measures are in check – it adds up. Now, my measures are completed efficiently, accurately and securely, ready to be submitted to CMS at the end of my reporting period. I even led a webinar on the topic of MIPS, if you want to see it in action.

EHR System Checklist for MIPS

From my unique perspective of working for an EHR vendor and utilizing the certified technology in my practice, I’ve shared a few qualities to look for in an EHR to support your reporting needs:

  • 2014 / 2015 ONC Certified
  • Integrated MIPS intelligence
  • Built in Improvement Activities
  • Qualified MIPS Registry
  • Automated data capturing and reporting
  • Built-in, real-time analytics reporting for Quality, Resource Use, Advancing Care Information and Improvement Activities
  • A vendor with an all-in on solution, including the ability to submit MIPS right to CMS
  • Advisory services and consultation during MIPS transition and reporting

While there is much work to be done in terms of keeping up with and understanding today’s fast-paced healthcare landscape, one thing is for certain – the proper use of specialty-specific technology can help alleviate hours of extra work, stress and physician burnout. As noted above, there are certain aspects of MACRA that apply across all specialties, whereas others are specialty-specific and working with a vendor that can guide you along this MIPS journey can be crucial to your financial success.

David A. Goldman, M.D. is the Ophthalmology Team Lead, Anterior Segment at Modernizing Medicine and founder of Goldman Eye in Palm Beach Gardens, Fla.

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.

ONC To Farm Out Certification Testing To Private Sector – MACRA Monday

Posted on August 14, 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.

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.

EHR certification has been a big part of the meaningful use program and is now part of MACRA as well. After several years of using health IT certification testing tools developed by government organizations, the ONC has announced plans to turn the development of these tools over to the private sector.

Since its inception, ONC has managed its health IT’s education program internally, developing automated tools designed to measure health IT can compliance with certification requirements in partnership with the CDC, CMS and NIST. However, in a new blog post, Office of Standards and Technology director Steven Posnack just announced that ONC would be transitioning development of these tools to private industry over the next five years.

In the post, Posnack said that farming out tool development would bring diversity to certification effort and help it perform optimally. “We have set a goal…to include as many industry-developed and maintained testing tools as possible in lieu of taxpayer financed testing tools,” Posnack wrote. “Achieving this goal will enable the Program to more efficiently focus its testing resources and better aligned with industry-developed testing tools.”

Readers, I don’t have any insider information on this, but I have to think this transition was spurred (or at least sped up) by the eClinicalWorks certification debacle.  As we reported earlier this year, eCW settled a whistleblower lawsuit for $155 million a few months ago;  in the suit, the federal government asserted that the vendor had gotten its EHR certified by faking its capabilities. Of course the potential cuts to ONC’s budget could have spurred this as well.

I have no reason to believe that eCW was able to beat the system because ONC’s certification testing tools were inadequate. As we all know, any tool can be tricked if you throw the right people at the problem. On the other hand, it can’t hurt to turn tool development over to the private sector. Of course, I’m not suggesting that government coders are less skilled than private industry folks (and after all, lots of government technology work is done by private contractors), but perhaps the rhythms of private industry are better suited to this task.

It’s worth noting that this change is not just cosmetic. Poznack notes that with private industry at the helm, vendors may need to enter into new business arrangements and assume new fees depending on who has invested in the testing tools, what it costs to administer them and how the tools are used.

However, I’d be surprised if private sector companies that develop certification arrangements will stay tremendously far from the existing model. Health IT vendors may want to get their products certified, but they’re likely to push back hard if private companies jack up the price for being evaluated or create business structures that don’t work.

Honestly, I’d like to see the ONC stay on this path. I think it works best as a sort of think tank focused on finding best practices health IT companies across government and private industry, rather than sweating the smaller stuff as it has in recent times. Otherwise, it’s going to stay bogged down in detail and lose whatever thought leadership position it may have.

The MACRA (QPP) API – MACRA Monday

Posted on August 7, 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 (QPP) and related topics.

When the MACRA program was announced, CMS also announced a new API for MACRA as well. In that announcement, CMS really just mentioned that the MACRA API would give developers access to the complete list of Advancing Care Information (ACI), Improvement Activities (IA), and quality measures for QPP 2017 (now called the QPP Measures Data Repository). While it was nice of them to offer this API, it really didn’t seem that useful.

Since then, CMS has launched what they call the QPP Submissions APIs which allow developers to submit MACRA data to CMS. This is much more useful and something that I believe will be adopted by many EHR vendors, data registries, etc.

Here’s a quick look at what these MACRA APIs can do:

  • Submissions API
    • Submit data as a single file or a set of smaller files throughout the reporting period, using QRDA-III or a new, streamlined QPP data format
    • Submit, update or delete ACI, IA and quality measures data during the reporting period
    • Receive feedback on the content and accuracy of a submission
    • Receive the preliminary score for a submission, based on the finalized policy
  • CMS Web Interface API
    • If you are registered for the CMS Web Interface, download your group’s beneficiary sample, modify it and submit it to the CMS Web Interface
    • Receive feedback on the content and accuracy of a submission
    • Receive a real-time composite score for a submission

For those that prefer a picture explanation of how the API works, you’ll enjoy this diagram of the current process and how the API works:

It’s great to see CMS really embracing APIs as part of MACRA. Now if we could just get the rest of healthcare and EHR vendors to implement high quality APIs.

MACRA Twitter Roundup – MACRA Monday

Posted on July 31, 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 and related topics.

There’s always a lot of activity on Twitter that’s relevant and interesting and this is particularly true for MACRA. So, I thought it would be fun for this MACRA Monday to do a roundup of some of the recent tweets providing resources, information and perspective on MACRA.


This is an important list to know about if you’re participating in MACRA. Make sure you’re using an approved registry (QCDR for those following along at home). I wish it wasn’t a pdf, but it is CMS.


This is a great side by side comparison for those preparing for what’s coming in MACRA 2018. I also found it interesting to see that it outlines MACRA’s main goals as:

  • Improve Health Outcomes
  • Spend Wisely
  • Minimize Burden of Participation
  • Be Fair and Transparent

I think if those are the goals, they might have the wrong program.


This is many doctors views of MACRA. Although, Kris Held, MD is very vocal about it. Her Twitter profile even says she has a mission to get government out of medicine. I don’t think enough doctors are going to follow her lead and opt out, but we’ll see very soon.


This tweet just made me laugh. I guess there’s a Miss Macra. I’m not sure what the Miss Macra Festival is, but I find it hilarious when terms overlap like this. Not really the point of MACRA Monday, but I thought you might enjoy the laugh that I got from the odd overlap.

The Positive Impacts of EHRs and MACRA on Patient Care – #KareoChat

Posted on July 26, 2017 I Written By

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

If you were to look at the Twittersphere or read a lot of the healthcare IT publications out there, you might think that nothing good has come from EHRs or MACRA. While there are plenty of points of criticism that are worthy of discussion about both of these things, I think the negative discussion overwhelms many of the positive things that have come out of EHRs and MACRA (and it’s predecessor meaningful use).

With this in mind, I recently did a blog post for Kareo which looked at some of the ways EHRs and MACRA can improve patient care. The intro to the post summarizes what’s happening well:

When healthcare pundits talk about MACRA they often offer a basic analysis of how the move to value-based reimbursement will be a good thing for healthcare, since then we are only spending money on care that provides value. Many doctors disagree and suggest that value-based reimbursement won’t create the value it purports to create. Either of these analyses overlooks many of the benefits that MACRA and the move to EHR software offer healthcare. The reality is that many of the most exciting initiatives in healthcare would not be happening today and would not even be possible if it weren’t for programs like MACRA and the implementation of EHR software. Let’s take a look at some of these improvements.

Be sure to check out the full blog post to read about a number of ways we’re benefiting from EHRs and MACRA.

This idea became a theme for me this month and so when Kareo asked me to host their weekly #KareoChat I thought it would be a great topic of conversation for the larger healthcare IT Community as well. I’m sure many of you can offer a lot of great perspectives on how patient care has been improved sthanks to these programs and technology. If you’d like to join the discussion, I’ll be hosting the #KareoChat on Thursday, July 27th at 9 AM PT. Just hop on Twitter and join in!

During the #KareoChat we’ll be discussing the topic of “The Positive Impacts of EHRs and MACRA on Patient Care.” Here are the 5 questions that will serve as the framework for the discussion:

1. Are you planning to participate in MACRA? At what pace? And why or why not?

2. Where do you see MACRA having a positive impact on patient care?

3. What are the short term benefits to patient care from having an EHR?

4. What are the long term benefits to patient care from having an EHR?

5. What other things beyond MACRA and EHR can we do to improve patient care?

I have a feeling that this chat is going to be a challenge for many. It’s so easy for us to see the negative. It takes much more work to see the positives. I think that’s largely because we start to take the positives for granted. Hopefully, during this chat we’ll take a step back and realize all the positives of EHRs and MACRA.

Full Disclosure: Kareo is a sponsor of Healthcare Scene.

HHS Office of Inspector General Plans To Review $1.6 Billion In Incentive Payments – MACRA Monday

Posted on July 24, 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.

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

The HHS Office of Inspector General has announced plans to review the appropriateness of a walloping $14.6 billion of incentive payments made to providers over a five-year period.  The upcoming report, which follows on a GAO study naming improperly issued incentive checks as the biggest threat to the Medicare EHR incentive program, addresses payments made between by CMS between January 2011 and December 2016.

The OIG’s current audit plans follow on research it previously conducted which estimated that the incentive program had wrongfully paid out $729 million incentive payments between just May 2011 and June 2014.

To conduct that review, the OIG sampled incentive payment records for 100 eligible providers, then used the level of erroneous payments found among them to extrapolate the total amount paid out wrongly by CMS during those three years.

This time around, the watchdog organization plans to audit all payments made during the entire past life of the incentive program, an exercise which could generate some even more dramatic numbers. If the prior research is any indication, the OIG could conclude that roughly 10 % to 12% of the entire $14.6 billion in incentive payments it issued shouldn’t have been made in the first place.

Of course, looked at one way this effort could be seen as closing the incentive door after the horses have left. Meaningful Use, by all accounts, is giving way to incentives under MACRA, which will apply distinctive criteria to its incentive payment formulas. Also, while I’m no numbers whiz, seems to me that you can’t really model the entire meaningful use program effectively using just 100 sample cases.

That being said, it does seem likely that the audit will find more situations in which physicians hadn’t submitted he right self-attestation data or couldn’t prove what they asserted, and if the federal auditor has any role to play, this research is probably a good idea

Sure, nobody wants to be audited, particularly when your healthcare organization has jumped through many hoops to comply with meaningful use rules. Even if you can afford to pay back your incentive money, why would you want to do so? And particularly if you’ve already played by the rules, you certainly wouldn’t want to prove it again. But since the audit is going to happen anyway, perhaps it’s best to get any possible pain it may generate out of the way.

To date, I haven’t read anything suggesting that CMS has immediate plans to claw back incentive payments from providers. My assumption, though, is that they will eventually do so. Governments need money to get their job done, and audits theoretically offer the added benefit of tightening up important initiatives like this one.

As someone who has worked exclusively in the civilian world, I have often made fun of the plodding pace at which federal and state government agencies operate. In this case, though, a slow, deliberate process — such as a gradually-widening payment review — is likely get the job done most effectively. Let’s establish carefully which incentive payments may have been issued inappropriately and clear the decks for MACRA.

eClinicalWorks Settlement Raises Question Of Customer Liability

Posted on July 19, 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.

Not much ago, my colleague John Lynn shared the news that EMR vendor eClinicalWorks had settled a whistleblower lawsuit for $155 million. The U.S. Department of Justice found that the vendor had skirted many EMR certification requirements, which in turn had caused providers using its software to file false claims for Meaningful Use incentives.

Today, I read an interesting follow-up by Becker’s Hospital Review addressing the issue of whether eCW users faced any liability for the vendor’s failure to meet certification standards.  The Becker’s writer, who reached out to CMS to find out its policy on the matter, found that while eCW’s customers technically submitted false claims for MU reimbursement, the agency won’t be asking any them to return any of the money.

If anyone has calculated how much CMS paid them, I haven’t seen the figures, but I’m sure it’s a pretty substantial sum of money. It’s good to see that the feds aren’t putting the squeeze on these customers, who presumably weren’t aware of eCW’s apparent skullduggery.

The thing is, I find it hard to believe that eCW is the only vendor who fudged things to get certified for the MU program. In fact, I’d guess that virtually every vendor in the industry has skirted if not crossed the line when it comes to EMR certification. That’s the way it goes, realistically, when you’re dealing with federal oversight.

After all, doesn’t every company work to save as much on taxes as they can? Yes, some are very conservative and only take whatever deductions they see as clearly legal, but others push harder. A goodly number of firms are willing to adopt strategies a tax lawyer might call “aggressive” – which don’t clearly violate the law but may raise a few eyebrows – in an effort to maximize their profits.

The big question here is whether an EMR customers could be on the hook for incentives paid wrongly due to an invalid vendor certification. If vendors are coloring outside the lines, it’s likely some will be caught, and if so, I’m betting that CMS will eventually get tough with their customers.

In the absence of clear evidence of customer wrongdoing, CMS might let customers keep their incentive payments. But I imagine that under some circumstances, the agency might wonder if they knew they what was going on and decided to take, say, a price cut in exchange for keeping its mouth shut.

Also, particularly if other vendors are hit with whistleblower suits, CMS might decide that customers should have validated that the EMR they were using actually had a legitimate certification. I don’t know how (or if) EMR customers would do this, but I can imagine a scenario under which CMS might take this tack.

Bottom line, we’d all better hope that CMS doesn’t decide to audit every vendor’s EMR certification filings. As I see it, their customers could easily be caught in the backlash.

Did Meaningful Use Really Turn EMRs Into A Commodity?

Posted on July 12, 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.

Not long ago, I had a nice email exchange with a sales manager with one of the top ambulatory EMR vendors.  He had written to comment on “The EMR Vendor’s Dilemma,” a piece I wrote about the difficult choices such vendors face in staying just slightly ahead of the market.

In our correspondence, he argued that Meaningful Use (MU) had led customers to see EMRs as commodities. I think he meant that MU sucked the innovation out of EMR development.

After reflecting on his comments, I realized that I didn’t quite agree that EMRs had become a commodity item. Though the MU program obviously relied on the use of commoditized, certified EMR technology, I’d argue that the industry has simply grown around that obstacle.

If anything, I’d argue that MU has actually sparked greater innovation in EMR development. Follow me for a minute here.

Consider the early stages of the EMR market. At the outset, say, in the 50s, there were a few innovators who figured out that medical processes could be automated, and built out versions of their ideas. However, there was essentially no market for such systems, so those who developed them had no incentive to keep reinventing them.

Over time, a few select healthcare providers developed platforms which had the general outline EMRs would later have, and vendors like Epic began selling packaged EMR systems. These emerging systems began to leverage powerful databases and connect with increasingly powerful front-end systems available to clinicians. The design for overall EMR architecture was still up for grabs, but some consensus was building on what its core was.

Eventually, the feds decided that it was time for mass EMR adoption, the Meaningful Use program came along. MU certification set some baselines standards for EMR vendors, leaving little practical debate as to what an EMR’s working parts were. Sure, at least at first, these requirements bled a lot of experimentation out of the market, and certainly discouraged wide-ranging innovation to a degree. But it also set the stage for an explosion of ideas.

Because the truth is, having a dull, standardized baseline that defines a product can be liberating. Having a basic outline to work with frees up energy and resources for use in innovating at the edges. Who wants to keep figuring out what the product is? There’s far more upside in, say, creating modules that help providers tackle their unique problems.

In other words, while commoditization solves one (less interesting) set of problems, it also lets vendors focus on the high-level solutions that arguably have the most potential to help providers.

That’s certainly been the case when an industry agrees on a technology specification set such as, say, the 802.11 and 802.11x standards for wireless LANs. I doubt Wi-Fi tech would be ubiquitous today if the IEEE hadn’t codified these standards. Yes, working from technical specs is different than building complex systems to meet multi-layered requirements, but I’d argue that the principle still stands.

All told, I think the feds did EMR vendors a favor when they created Meaningful Use EMR certification standards. I doubt the vendors could have found common ground any other way.

A Health Reform We Can All Support

Posted on July 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.

If you’re like most Americans, you have a pretty strong idea of where you stand in the debate over healthcare reform. This has always been a hot button issue, but now attempts to repeal or remake the terms of the Affordable Care Act have heated things up further.

Is there any strategy that can generate a bipartisan agreement on these issues? Well, maybe. Buried in a Washington Post article on bipartisan reform, there’s an idea you’ll probably like. Bear with me for a moment and I’ll explain.

The piece, which was written by Harvard economist David Cutler, notes that there’s a few industry problems that nearly everyone recognizes, including the need to address the opioid epidemic, the importance of trimming medical pricing and costs and adopting strategies to slash healthcare’s high levels of administrative spending.

Not to dis a Harvard professor too much, but most of his piece lacks specifics. OK, great, we get that you’ve identified some overarching problems the healthcare industry must address. That’s fine. What about doing something other than saying “This house is on fire. Get a bucket of water!”?

Such vague pronouncements are part of why reform is so difficult; few experts seem to be willing to get down in the weeds and explain just how execute on their proposals. The pundit-ocracy and professors and think tanks are looking at reform issues from the 10,000-foot level – and there’s merit in what they do. But providers are on the battlefield fighting for their lives, and theories don’t help them much.

Nonetheless, Cutler did list one cost-cutting measure that could actually be practical. He argues that developing uniform quality metrics all providers and health plans can use, as the current explosion of quality data demands is unsustainable.

Cutler argues that a government entity should manage the process of consolidating metrics, and even write regulations demanding that providers use the resulting standards. I, for one, think that this isn’t going to work, as the federal government doesn’t have a great track record in building consensus on health IT issues.

Still, if there’s a reasonable way to do so,  most providers would love, love, love to see somebody rid them of the hundreds of quality measures they must address and simplify the requirements to only those that actually impact quality. Who wants to deal with MACRA, Meaningful Use and its descendants, the Physician Quality Reporting System plus dozens of other data requirements? Hospitals and doctors are being quality-measured to death.

I know, I know, it seems unlikely that anyone could slash their way through thousands of standards and pick a winner. After all, the reason there are so many approaches is that no one is sure which one is best.

Can we at least agree that scaling back demands is critical? Yes? That’s progress. I’m not suggesting that there’s anything wrong with complaining non-stop about the quality metrics problem; in fact, given the burden these requirements impose, you’d be crazy not to protest. But it’s time to get real and figure out exactly what you want to do about the problem. Are you ready to demand change?