Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

MIPS Penalties Include Medicare Part B Drugs – MACRA Monday

Posted on November 13, 2017 I Written By

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.

I’m sure most regular readers can tell that we’re pretty worn out and tired of MACRA, MIPS, and related government regulation. No doubt you’ll see us posting fewer MACRA Mondays going forward, but we’ll still try to cover major MACRA events as they occur. We just won’t be publishing MACRA Monday every Monday like we’ve been doing.

Jim Tate recently posted about the Real MIPS Timeline which included:

  • Phase 1 – Denial
  • Phase 2 – Shock/Anger
  • Phase 3 – Acceptance

You should read his full writeup, but he’s right. There’s a lot of denial that’s going to lead to shock and anger until the majority of healthcare have to finally accept that MIPS and MACA aren’t going anywhere.

Jim Tate also wrote another important piece related to the MIPS penalties and Medicare Part B drugs. You can read the full details of the change, but for those too lazy to click over, here’s the summary:

  • Many organizations argued that Medicare Part B Drug Costs Shouldn’t be Included in the MIPS Penalties (I mean…payment adjustments)
  • The MACRA Final rule still includes Medicare Part B drug costs (for the majority of people) in the MIPS reimbursement and eligibility calculations

If you’re a practice with a high volume of part B drugs, you better start figuring out your MIPS strategy now! Otherwise, that payment adjustment is going to hit pretty hard.

Thanks Jim for the great insights into MACRA and MIPS. If you need help with MIPS, be sure to check out Jim’s company MIPS Consulting.

MACRA Twitter Roundup – MACRA Monday

Posted on October 30, 2017 I Written By

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.

We took last week off from our MACRA Monday series of blog posts. It seems like we’re in a kind of lull period for the program. Either you’ve started collecting the data you’ve needed or you haven’t. Plus, we’re kind of waiting for the next MACRA Final rule to drop for more details.

With that in mind, I did want to see what some of the latest things that were being shared on Twitter when it comes to MACRA. I found a lot of strong opinions about the program, some good resources, and some forward-looking thoughts on what could be coming in the next MACRA final rule.


It’s hard to argue with John. Not just because he’s a smart guy, but because he’s right that it’s hard to imagine a path forward that’s fee for service and doesn’t include a shift to value based care in some form or fashion. At least given the current market dynamics.


This caution from Workflow Chuck should have us all nervous about the shift. I see a lot of healthcare organizations going after the target as opposed to the goal of value based care.


MACRA is going to impact your biz. I liked the way Kelly broke it out into 4 areas. No doubt some of these things could be argued both ways.


This is still how most doctors I know feel about MACRA and even meaningful use before it. They feel like they’ve been thrown under the bus.

Here are two forward looking resources that look at what we might get from the MACRA Final Rule:

What else are you hearing about MACRA? Would love to hear your thoughts, insights, questions, perspectives, rants, etc in the comments.

Optimizing Your EHR for MIPS and Other Quality Payment Programs – MACRA Monday

Posted on October 9, 2017 I Written By

The following is a guest blog post by Meena Ande currently acts as Director of Implementation for Advantum Health. 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.

As quality reporting requirements ramp up under value-based payment programs like MIPS, healthcare organizations are busy retrofitting their EHRs to make way for new measures. In some settings, not much has changed by way of tech utilization since initial EHR investments were made. Many outpatient settings still lack the internal expertise needed to optimize their implementations.

The truth is many EHRs have the functionality providers need for quality reporting, but many providers don’t know that due to limited exposure to the system. Couple that stunted tech knowledge with the well documented lack of familiarity with MACRA and the recent rise of the service model in healthcare is no surprise. Many practice administrators are relying on their EHR vendor or engaging outside experts to help lead the charge on system reconfiguration to meet Quality Payment Program demands.

There are several EMR capabilities providers can take advantage of to support QPP reporting efforts. Here are a few tips to keep in mind as you customize your EHR for MIPS and other value-based models.

Don’t boil the ocean when selecting CQMs.

Most EHRs give the option of tracking more than what is required for quality reporting. Initially, track applicable measures that exceed reporting requirements. After three to four weeks you’ll know which are your strong areas. Pick the best of the litter and proceed.

Providers can be overwhelmed by too many measures, particularly in multi-specialty practice settings. While it can be difficult to find overlap in measures between specialties, taking advantage of shared metrics whenever possible can reduce reporting burdens. Sit down as early as possible and develop an EHR configuration that works for your practice’s various clinicians.

Case in Point:

A gastroenterologist and a cardiologist may work in the same multi-specialty organization and on the same EHR, but the clinical quality measures they care about differ. There is no reason to give the gastroenterologist access to the cardiology problem list in the EHR. Specialty views improve ease-of-use and support more complete documentation.

Most EHRs offer role-based and specialty-based customization. Administrators can enable or disable EHR features related to some quality measures at the practice level and sometimes at the individual provider level. Clinical quality measures are based on details about the patient, but what is captured at each point of care should be tailored to the specific provider role.

Consider the roles impacted by different CQMs.

Keep the role of the person who may be responsible for different quality measures and Advancing Care Information workflows in mind when selecting and carving out space for CQMs in your EHR. Select measures that spread reporting work across multiple roles to relieve clinicians of unnecessary burdens.         

Case in Point:

The insurance eligibility verification required under Meaningful Use is managed by the front office. Front-office staff members should be made aware of the processes they need to complete before a patient checks in, and where to document that task in the EHR.

Control what is included in MIPS denominators.

Like Meaningful Use, patient encounter volume is important under MIPS. The size of the patient pool under any given quality measure directly impacts your adherence percentage. While most primary care encounters do meet patient visit requirements under MACRA, that is not always the case in specialty settings. Clinicians can exercise some control in determining what is included in patient denominators when reporting under MIPS.

Case in point:

Some primary care visits can be omitted. Let’s say a two-physician practice sees 50 patients a day. Only 15 of those patients might be seen by a physician. The rest of the patients may be there for a simple procedure like a blood pressure screening, stress test, or echocardiogram, where quality reporting elements are not verified. Such visits should be excluded.

Evaluate your reporting paths.

MIPS offers both EHR-based and registry-based reporting paths. Most specialties can submit CQM data via their EHR while others will have to rely on paid registry reporting. Additional reporting options might include submitting through associations that member clinicians are affiliated with, or through registries created by large hospital affiliates to help related providers.

Another hurdle for clinicians is deciding whether to submit data as a group or independently. Groups interested in participating in MIPS via the CMS web interface or administering the CAHPS for MIPS survey had until June 30, 2017, to register. Beyond that, clinicians have until the March 31, 2018, MIPS submission deadline to decide whether to report independently or as a group.

Case in point:

Big groups with different levels of EHR proficiency among providers may be better suited reporting at an individual level. Individual reporting takes more time for attestation, but the advantage is that higher-performing clinicians can avoid a penalty if the group doesn’t collectively meet reporting criteria.

Each month, sample 10 percent of EHR CQM data, including instances where criteria have been met and where it has not. Catch outliers with trouble following through on processes and extend targeted training to the team members bringing numbers down.

Conclusion

Optimizing the EHR and other tech resources providers have in place can be a huge MIPS enablement factor. Up-front customization work helps providers meet reporting requirements and save time over the long run. EHR optimization also enables future value-based care initiatives and lays the groundwork for population health management programs. Gains made in EHR use benefit the life of the practice through increased efficiency and, at the end of the day, better patient care.

About Meena Ande
Meena Ande currently acts as Director of Implementation for Advantum Health where she manages Implementation of services along with EHR optimization, with emphasis on workflow management for value-based reporting.

MACRA Preparation, Are You Ready? – MACRA Monday

Posted on October 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 (QPP) and related topics.

I’ll admit that the timing of this week’s MACRA Monday is a bit rough for me given the tragedy that’s occurred in my town, Las Vegas. Instead of dwelling on the tragedy and the person who could do such an awful thing, it’s been amazing even in these early hours to see how many people in Las Vegas and around the world want to and are supporting the victims of this tragedy.

We heard that there was a need for blood and thought we could help. Turns out that hundreds of others had the same idea and the blood banks have their schedules full through Wednesday. We’ll go after that to replenish the blood banks that no doubt will take a while to replenish their supply.

Thanks to everyone on Facebook, Twitter, and other social media that have reached out to myself and the rest of us that live in Las Vegas. We’re in a bit of shock and it doesn’t feel real.

To keep with our tradition of MACRA Monday, I thought I could at least share this infographic from Integra Connect on how prepared specialty practices are for MACRA:

No doubt there are a lot of healthcare organizations that aren’t ready for MACRA and they are confused on how they should be ready. Hopefully, those who have read our weekly MACRA Monday posts feel better prepared than most. MACRA is upon us whether you’re ready or not. However, MACRA certainly seems much less important on this day of mourning in Las Vegas.

On this tragic day, it’s worth noting all the incredible stories I’ve heard about Las Vegas healthcare professionals that were prepared and ready for a tragedy like this. I read stories of UMC, a major Las Vegas hospital that was so full of victims that they asked to stop bringing people to UMC that didn’t have life-threatening injuries. I read of EMS people who were at home and went into the danger to help transport victims. No doubt there will be hundreds of other stories of heroism by healthcare professionals. Many that likely won’t be heard or seen, but saved people’s lives. We thank them for their preparation, care, and work that no doubt has saved hundreds of people’s lives.

A big thank you from Vegas to each of you for all of your support.

New EHR Certification Rules Including Self-Declaration – MACRA Monday

Posted on September 25, 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.

Elise Sweeney Anthony and Steven Posnack recently announced on the ONC Health IT Blog two major changes to the EHR certification program. In some ways, it shows a maturity of the EHR certification program, but in other ways, it’s ONC kind of taking a more hands off approach to EHR certification.

Here are the two big changes they made:

  1. Approving more than 50% of test procedures to be self-declaration; and
  2. Exercising discretion for randomized surveillance of certified health IT products.

The first one is really fascinating since they’re making 30 out of the 55 certification criteria as “self-declaration only.” That basically means that EHR vendors will just have to claim they meet the requirements. The ONC-ACBs won’t be certifying those 30 test procedures. In many ways, it reminds me of the meaningful use self-attestation. Does that mean that ONC-ACBs will cut their costs in half? Don’t be holding your breath on that one.

Let’s just hope that most EHR vendors don’t self-certify the way eCW approached EHR certification. Although, the eCW EHR certification issues are the perfect example of why a company self certifying their EHR software or the ONC-ACB certifying the EHR software is just about the same. I haven’t seen which test procedures will be self-declared, but my guess is that it was the ones that the ONC-ACBs weren’t really doing much to test and certify anyway. Ideally, this will free up the ONC-ACBs to dive deeper into the 25 test procedures they’ll still complete so they can avoid another eCW like incident.

Some might wonder why we don’t just take the self-declared EHR certification tests altogether if there’s no one that’s going to be checking them. What those people miss is that the self-declaration still keeps the EHR vendors on the hook for properly implementing the EHR certification criteria. If it’s discovered that they claimed to be compliant but aren’t, then the government can go after the EHR vendor for false claims.

The second change has me a little more puzzled. I’m not sure why they would want to release ONC-ACBs from the requirement to randomly audit EHR certifications. Maybe they didn’t discover any issues during their random audits and so they didn’t see a need to continue them. Or maybe the ONC-ACBs said they were going to pull out as certifying bodies if the government didn’t lighten the EHR Certification load. This is all conjecture, but they could be some of the reasons why ONC decided to make this change. They did offer the following insight into their reasoning:

This exercise of enforcement discretion will permit ONC-ACBs to prioritize complaint driven, or reactive, surveillance and allow them to devote their resources to certifying health IT to the 2015 Edition.

I wonder how many complaints the ONC-ACBs have gotten about the EHR software they’ve certified. Have they just been so overwhelmed with complaints that they need more time to deal with those complaints and so audits aren’t needed? I’d be surprised if this was the case. At this point I imagine most people with EHR certification issues will be calling the whistle blower attorneys, but I could be wrong.

All in all, I don’t think these EHR certification changes are a huge deal. It’s largely a maturing of the EHR certification program and does little to help the EHR certification burden on software vendors. Maybe the ONC-ACBs will charge a little less for their certification, but that’s always been a negligible cost compared to the development costs to become a certified EHR. I’m sure the ONC-ACBs are happy with these changes though.

What do you think of these changes? Any other impacts I haven’t described above that we should consider?

Mental Health EMRs And MIPS – MACRA Monday

Posted on September 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.

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.

Recently, I began researching the mental health EMR market on behalf of a client. I had expected to find it dwindling as a) the big EMR players have always insisted that an all-purpose EMR could be adapted to serve mental health providers effectively and b) more importantly because mental health professionals weren’t eligible for Meaningful Use payments, which presumably made them lousy sales targets for vendors.

However, my research concluded that there’s roughly a dozen mental health EMRs out there and kicking and that at least two large medical EMR vendors had bought into the mental health technology niche. (Allscripts bought a stake in NetSmart Technologies last year, and Cerner acquired Anasazi outright in 2012). With their investments, the two vendors effectively admitted that supporting mental health providers wasn’t as easy as they’d suggested.

Now, with MIPS imposing new demands on clinicians, mental health providers are likely to expect even more from mental health IT vendors, said Bob Ring, a consultant with Mica Information Systems.

Right now, few mental health EMRs defining themselves as “therapy specific” are CEHRT technology, which could become an issue if MDs on staff in a mental health setting want to meet MIPS requirements, Ring notes.

Under MIPS, psychiatrists must provide a wide range of mental health-specific data, some of which calls for specialty-related technology. For example, one category under the Clinical Practice Improvement Activity Performance Category calls for enhancements to an EMR to capture added data on behavioral health populations and use that data for additional decision-making.

But uncertified EMRs are likely to stay that way, Ring says. “Because these therapy-specific [EMRs] are generally priced very low, and it is expensive to go through the ONC certification process, it’s questionable whether many of them ever will be,” he concludes.

Not only that, things could get even trickier for both mental health clinicians and mental health EMR vendors in the future, if CMS follows through on its threat to hold therapists to the same standards as MDs beginning in 2019.

This could create chaos, however, according to my colleague John Lynn, who contends that putting mental health therapy EMRs under MIPS would be “a disaster.” Instead, mental health should not piggyback MU or MIPS, but instead, focus on incentives for mental health focused EHR incentives.

“The relationship between a mental health provider and a client is totally different than the relationship between a medical provider and their patient,” said John, whose first EMR implementation came when he rolled out a medical EMR in a health and counseling center. “Their methods of documentation are different. Their methods of billing are different. Their approach to care is different. We made it work, but it took a lot of duct tape and jerry rigging to fit it in.”

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

Posted on August 29, 2017 I Written By

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

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

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

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

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

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

A higher standard for EHR

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

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

Changing health economics

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

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

Perception vs. reality

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

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

What comes next for EHR?

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

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

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

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

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

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.

Will New Doctors Hate EMRs the Way Older Doctors Do?

Posted on March 22, 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.

Oh! Just the idiocy of it all!

That’s a quote from an email I got from an older doctor in response to a discussion about EHR software and in particular programs like meaningful use and now MACRA. This is a doctor who I’ve exchanged many emails with over multiple years. Needless to say, he’s not happy with what’s happening with EHR software and sees it as an awful thing for medicine. I think this is the view of most older doctors.

While most older doctors feel this way, I wonder if the next generations of doctors will feel the same. I’ll never forget my med school friend who said he hated rounding at a doctor’s office that didn’t have an EHR because he types faster than he writes. Or the middle-aged doctor that’s been a friend of my family since I was a kid that’s been on EHR so long that he once told me “I’ve never really known anything but an EHR, so I can’t imagine practicing medicine without it.”

I understand the doctors who complain about EHRs and more importantly complain about the regulations which are reflected in the features EHR software companies push out. EHR was a massive change for many of them and that can be brutal. Plus, there are plenty of issues with many EHR software and EHR implementations out there. Some that can be resolved and some that can’t. Not to mention that many regulation requirements aren’t clinically useful. We should be glad doctors are upset over this.

However, will the next generation of doctors care?

Besides the fact that new doctors are digital natives who grew up with technology, there’s also the fact that new doctors won’t know what life in a medical office was like before EHR. EHR documentation will just be part of the status quo for them and when you don’t know about the alternative, then you don’t hate it as much. It’s just a required part of the profession and it’s always been that way.

The reality for most new doctors is that there are so many things that are screwed up with our healthcare system, that the EHR is just one more to add to the pile of things that don’t make much sense. They’ll just consider it a feature of the profession and likely not complain much.

The one thing that could change all of this is for a new EHR or related solution to come out and blow all the current EHR vendors off the map. It would have to be something so dramatically better for organizations that healthcare organizations can’t resist it. Think of the way the iPhone made us rethink cell phones. It needs to be a solution which is that much better. Does such a solution exist? Can such a solution be built? Or do the current healthcare regulations prevent such a solution? Will it take changes in regulation and reimbursement to enable a new EHR that doctors love and not a change by an EHR software vendor?

A Look At RECs Success or Failure

Posted on July 28, 2016 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.

ONC has recently put out a report evaluating the performance of the REC (Regional Extension Center) program. The report is only 124 pages, so you might want to save the light reading for the weekend. If you want something more consumable, you can read this blog post from Thomas A. Mason, MD which includes this nice summary:

Survey data included in the report released today indicates that 68 percent of the eligible professionals who received incentive payments under Stage 1 of the incentive program were assisted by an REC, compared to just 12 percent of those that did not work with a REC. The survey also found that many providers working with RECs received frequent and tailored help – often face to face, for as long as it was needed. Many RECs also created both structured and informal opportunities for clinicians to learn from one another, creating economies of scale to reach more providers with limited resources and spread providers’ EHR product-specific knowledge.

In the same blog post he also points out ONC’s numbers that “nearly all hospitals and approximately three-quarters of doctors reported using certified EHRs.”

That all sounds like a success to me. All these rosy numbers about people being helped. Lest we think this report doesn’t matter, HHS has already announced another $100 million over 5 years for what I’d call REC like support money for those participating in MACRA. I expect many of the RECs to get this money, but we’ll see.

What’s clear to me is that these REC organizations did indeed help many organizations get access to the meaningful use money. Only in the government could you spend money to get people to have you spend more money, but I digress. Most of the REC organizations that I met with really did a lot to help small practices with the meaningful use program. Some of their EHR selection efforts could be questioned, but not the MU help they provided. I can’t remember how many posts I’ve written about the random methodology that RECs seemed to use in their efforts to help their clients choose an EHR. It was a mess and full of weird influences (Note: There were some exceptions where certain RECs just supported everyone and every EHR or at least did a good job having their clients drive the process of which EHR to support).

When you look at the recent study be Deloitte that many doctors don’t know about MACRA, that could partially be because the RECs did a lot of the meaningful use education for doctors. We don’t have that yet for MACRA.

Personally, I’m torn on how valuable the RECs have been to the progression of health IT. Did they really help practices choose the right EHR and implement it in an effective way? What would have happened if they weren’t there? At the end of the day, the cost of the RECs is small potatoes next to the billions we spent on meaningful use. I’m sure some rural practices would have never considered participating in meaningful use if it weren’t for the RECs. No doubt that’s who the politicians are thinking about when they included the money for RECs and now for MACRA support.

The harder question to answer is if healthcare is better off with all these rural practices being “meaningful users” of EHR.