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!

MACRA Monday: MIPS Imposes A Major Burden

Posted on August 28, 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.

A new study by the Medical Group Management Association has concluded that most practices find participating in the MACRA Quality Payment Program to be very challenging. The study, which focuses on regulatory burdens affecting group practices, also identifies several other rule-related challenges practices face.

In its press release, the MGMA notes that almost half of practices surveyed said they spent more than $40,000 per FTE physician each year to comply with various regulations. Nonetheless, they continue to participate in programs that reward them despite the hassles involved.

According to the research, the vast majority of respondents are participating in the Merit-Based Incentive Payment System (MIPS) this year, and 72% said they expected to exceed the minimum reporting requirements.

That being said, their success clearly hasn’t come easily, with 82% of practices rated MIPS as either “very” or “extremely” burdensome. Within MIPS, groups cite clinical relevance (80%) as their top challenge. Seventy-three percent of survey respondents said MIPS doesn’t support their practice’s clinical quality priorities.

In fact, many respondents said that complying with MIPS was like pulling teeth. Over 70% reported that they found the MIPS scoring system to be very or extremely complex, and 69% said they are very or extremely concerned that unclear program guidance will impact their ability to participate in MIPS successfully.

Eighty-four percent of respondents agreed or strongly agreed that if Medicare’s regulatory complexity were reduced, they could shift more resources to providing patient care. Their frustration is palpable, as the following anonymous comment illustrates: “The regulatory and administrative burdens have dramatically increased over the past two years. However, the biggest problem isn’t the increase itself, [it’s] that the increase is for no good purpose.”

Other programs respondents named as very/extremely taxing included national electronic attachment standards (74%), audits and appeals (69%) and lack of EHR interoperability, followed by payer use of virtual credit cards (59%).

It’s interesting to note the disconnect between the number of practices participating in MIPS (and seemingly, crushing it) and the complaints most are making about participation. Clearly, given how painful it can be to comply with the rules, most practices see their involvement as necessary from a financial perspective.

It’s unlikely that this participation it will get much easier in the near future, though. Eventually, as regulators keep taking feedback and streamlining the MIPS program, they may be able to streamline its requirements, but I wouldn’t hold my breath waiting for that to happen.

Medical Groups Struggling To Collect Payments Promptly

Posted on August 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.

Particularly as patients assume responsibility for more of the costs of care, it’s getting harder for providers to collect on outstanding bills.

My recent look at a dashboard created by the Medical Group Management Association certainly underscores the point. The story it tells is a grim one. Despite their best efforts, few practices are succeeding at meeting RCM challenges.

The MGMA intends the dashboard, which focuses on the number of days bills spend in Accounts Receivable, to give medical groups some benchmark RCM data. It relies on data from the group’s 2016 DataDive Cost and Revenue study, and allows users to view (at no cost):

  • Mean percentages of accounts receivable aged 0-30 days, 31-60 days, 61-90 days, 91-120 days and over 120 days
  • Mean days gross fee-for-service charges in A/R
  • Meeting days adjusted fee-for-service charges in A/R

It also allows users to select a specialty group type, including primary care, nonsurgical, surgical and multispecialty practices and look at their specific profile.

For example, the dashboard reveals that roughly 50% of accounts held by primary care practices spent a mean of 0-30 days in A/R, 11.2% of accounts were aged 31-60 days, 6.9% were at 61-90 days, 6.2% stayed in A/R for 91-120 days and 25.4% for 120+ days in A/R.

The MGMA page also stated that primary-care groups had an overall average of 61.86 adjusted days in A/R and 35.60 gross days in A/R.

Does that sound depressing? Well, it should. What’s more, other specialties’ performance was nearly as bad in some categories and even worse in others.

Look at the performance of nonsurgical groups. Only 44.7% of nonsurgical groups’ revenue came in within 30 days in A/R or less, almost 13% of accounts averaged 31-60 days before being paid, and almost 15% of accounts spent between 61 and 120 days in A/R. Twenty-eight percent of accounts had a mean 120+ days in A/R before being satisfied.

The other stats were even worse. For example, nonsurgical groups’ accounts spent a mean of 88 days in A/R and 46.2 gross days in A/R. Not very encouraging.

Even well-paid surgeons weren’t exempt from this problem. Most of the account aging stats were distributed similarly to the other specialty areas, and only 28.2% of accounts in this area spent more than 120 days in A/R. However, adjusted days in A/R came in at 136.7 and gross days in A/R at 54.

Meanwhile, the tally for multispecialty groups was a bit better, but not much. Account aging benchmarks were very similar to primary care practices, and adjusted days in A/R came in at 69.4.

Most of you probably had an idea that medical groups were facing these kind of collection problems, even if you didn’t have these benchmark numbers in hand. The thing is, they were even worse than I feared. (An acquaintance working in medical billing called the results “comical.”)

I don’t know what percentage of the accounts in question were self-pay, but given that self-pay is becoming a steadily higher proportion of medical practice revenue, these stats are pretty bad news. Something’s gotta give eventually. Plus, we’ll have to keep tracking how this data trends over time.

Few Practices Rely Solely On EMR Analytics Tools To Wrangle Data

Posted on May 23, 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.

A new survey done by a trade group representing medical practices has concluded that only a minority of practices are getting full use of their EMR’s analytics tools.

The survey, which was reported on by Becker’s Hospital Review, was conducted by the Medical Group Management Association.  The MGMA’s survey called on about 900 of its members to ask how their practices used EMRs for analytics.

First, and most unexpectedly in today’s data-driven world, 11 percent of respondents said that they don’t analyze their EMR data at all.

Thirty-one percent of respondents told MGMA that they use all of their EMR’s analytical capabilities, and 22 percent of respondents said they used some of their EMR’s analytics capabilities.

Another 31 percent reported that they were using both their EMR’s analytics tools and tools from an external vendor. Meanwhile, 5 percent said they used only an external vendor for data analytics.

According to Derek Kosiorek, CPEHR, CPHIT, principal consultant with MGMA’s Health Care Consulting Group, the survey results aren’t as surprising as they may seem. In fact, few groups are likely to get  everything they need from EMR data, he notes.

“Many practices do not have the resources to mine the data and organize it in ways to create new insights from the clinical, administrative and financial information being captured daily,” said Kosiorek in a related blog post. “Even if your practice has the staff with the knowledge and time to create reports, the system often requires an add-on product sold by the vendor or an outside product or service to analyze the data.”

However, he predicts that this will change in the near future. Not only will EMR analytics help groups to tame their internal data, it will also aggregate data from varied community settings such as the emergency department, outpatient care and nursing homes, he suggests. He also expects to see analytics tools offer a perspective on care issues brought by regional data for similar patients.

At this point I’m going to jump in and pick up the mic. While I haven’t seen anyone from MGMA comment on this, I think this data – and Kosiorek’s comments in particular – underscore the tension between population health models and day-to-day medical practice. Specifically, they remind us that doctors and regional health systems naturally have different perspectives on why and how they use data.

On the one hand there’s medical practices which, from what I’ve seen, are of necessity practical. These providers want first and foremost to make individual patients feel good and if sick get better. If that can be done safely and effectively I doubt most care about how they do it. Sure, doctors are aware of pop health issues, but those aren’t and can’t be their priority in most cases.

Then, you have hospitals, health systems and ACOs, which are already at the forefront of population health management. For them, having a consistent and comprehensive set of tools for analyzing clinical data across their network is becoming job one. That’s far removed from focusing on day-to-day patient care.

It’s all well and good to measure whether physicians use EMR analytics tools or not. The real issue is whether large health organizations and practices can develop compatible analytics goals.

MGMA Blames Rise in HIT Costs on Fed’s Regs

Posted on September 15, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

MGMA’s released a study of 850 member’s practices showing HIT costs up by more than 45 percent in the last six years. MGMA puts much of the blame on federal regulations. It’s concerned that:

Too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing better patient care. Unless we see significant changes in the final MIPS/APM rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.

There may be a good case that the HITECH act is responsible for the lion’s share of HIT growth for these and other providers, but MGMA study doesn’t make the case – not by far.

What the study does do is track the rise in HIT costs since 2011 for physician owned, multispecialty practices. For example, MGMA’s press release notes that IT costs have gone up by almost 47 percent since 2009.

In fairness, MGMA also notes that costs may have also gone up do to other costs, such as patient portals, etc. However, the release emphasizes that regulations are at great fault.

Here’s why MGMA’s case falls flat:

  • Seeing Behind the Paywall. If you want to examine the study, it’ll cost you $655 to read it. Many similar studies that charge, provide a good synopsis and spell out their methodology. MGMA doesn’t do either.
  • Identifying the Issue. It’s one thing to complain about regulations. It’s quite another to identify which ones specifically harm productivity without compensating benefit. MGMA cites regulations without so much as an example.
  • Lacking Comparables. MGMA’s press release notes that total HIT costs were $32,000 per practitioner. However, this does not look at non HIT support costs, nor does it address comparable support costs from other professions.
  • Breaking Down Costs. The study offers comparable information to practitioners by specialty types, etc. However, all IT costs are lumped together and called HIT.
  • Ignoring Backgrounds. MGMA notes that HIT costs rose most dramatically between 2010 and 2011, which marked MU1’s advent. It doesn’t address these practices’ IT state in 2009. It would be good to know how many were ready to install an EHR and how many had to make basic IT improvements?
  • Finessing Productivity. Other than mentioning patient portals, MGMA ignores any productivity changes due to HIT. For example, how long did it take and what did it cost to do a refill request before HIT and now? This and similar productivity measures could give a good view of HIT’s impact.

It’s popular to beat up on HITs in general and EHRs in general. Lord knows, EHRs have their problems, but many of the ills laid at their doorstep are just so much piling on. Or, as is this case, are used to make a connection for the sake of political argument.

Studies that want to get at the effect HIE and EHRs have had on the practice of medicine need to be carefully done. They need to look at how things were done, what they could accomplish and what costs were before and after HIT changes. Otherwise, the study’s data are fitted to the conclusions not the other way around.

MGMA’s a major and important player with a record of service to its members. In this case, it’s using its access to important practice information in support of an antiregulatory policy goal rather than to help determine HIT’s real status.

Working on Value Based Care and Fee For Service at the Same Time

Posted on November 2, 2015 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.

While at MGMA I had a chance to sit down with Mike Hofmeister, Vice President of Value-Based & Community Solutions at Allscripts, to talk about Allscripts’ Chronic Care Management (CCM) and other value based care efforts. Coming out of MGMA I’d say that Chronic Care Management (CCM) was one of the biggest topics people were talking about.

What’s a bit unique about CCM is that it’s a hybrid of value based care in a fee for service world. In fact, when I asked Mike about how Allscripts was balancing value based care with fee for service he told me that they were looking at opportunities to implement processes, procedures, and workflows that benefited both value based care and fee for service.

I found this to be an incredible insight into the path forward for those of us trying to figure out how to navigate this new value based reimbursement world. No doubt there are plenty of efforts that can satisfy both sides of the equation. The reality is that we can’t just flip the value based care switch on and the fee for service switch off. We’re going to be living in a hybrid reimbursement world for a long time to come.

Mike also told me about how Allscripts was well positioned to help with doctor’s CCM efforts because at the core of the CCM program is access to healthcare data, analytics capabilities, and call center capabilities to follow up with the patients. Sure, there are a few more details to the program, but Mike is right that CCM requires the right healthcare data, data processing, and the right patient follow up procedures. For many patients a phone call is still the best follow up procedure. Although, I’m still interested to see how quickly this switches over to secure text from phone calls.

What seems clear to me is that most provider organizations aren’t going to take part in CCM on their own. A few larger ones will try it, but most provider organizations will be looking to an outside company to help them participate in the CCM program together with a larger group of providers.

Of course, we also have to realize that CCM is just the start. The companies that deliver great CCM solutions will be well positioned to deliver on future value based care programs. They’ll just want to make sure that they balance their value based care work together with the ongoing fee for service world.

Prematurely Calling the End of Small Practices

Posted on October 16, 2015 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.

I continue to hear people predicting the death of small practices. In fact, I’ve met many vendor executives that have essentially started treating small practices as an extinct species. While there are certainly a lot of pressures and challenges associated with running a small practice today, we’re far from the end of small practices.

The biggest challenge to small practices is these major hospital systems that are buying up small practices left and right. We’ve seen this happen all over the country and they’ve become extremely dominant in some parts of the country. No doubt this is a threat to many of the small practices out there and is worth watching.

While many hospital systems are buying up practices, I over heard Dr. Halee Fischer-Wright, President and CEO of MGMA, make a really interesting counter point to this trend. The media and the acquiring hospital systems love to talk about small practices being acquired. However, we don’t give the same coverage to all of the doctors who leave a hospital system or those practices which get divested from a hospital system because they’re not working out as expected.

What does this mean? It means we hear about all of the small practices being acquired, but we don’t really hear about the small practices that leave the hospital system. This means we likely have a false impression of how many small practices actually still exist. I still know of many in my local area and I’m sure you do too. They just don’t get the same coverage as the large systems.

I do think that this current health care environment is harder for small practices than it was previously. The shift to value based care will continue that pressure. However, I heard over and over at MGMA about small practices coming together with vendors to be able to receive the benefits of value based reimbursement while still maintaining their independence.

Certainly this is no longer your father and your grandfather’s healthcare system. However, I still think the small practice is alive and will be for a long time to come.

90% of the World’s Data Was Created in the Last 12 Months

Posted on October 14, 2015 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.

Vala Afshar shared the following data insight from @salesforce.

Then, Jim Rawson, MD asked an important question for those of us in healthcare: How do you plan to manage it?

I’ve been having a discussion around healthcare data with a lot of people recently. One person I talked with at MGMA says we need more filters with that data. I thought it was interesting that he used the word filters. I’m not sure it’s quite the right word since filters means you only look at part of the data. In healthcare we need something that looks at all the data, but only boils up the data that matters to the healthcare provider at the time and place they need it.

Unfortunately, I’ve seen most healthcare analytics and healthcare data companies focused on the data. I haven’t seen many of them really work on the intelligence (filters if you prefer) that’s needed on top of that data. Healthcare organizations need solutions. They don’t need more tools.

We all know why companies are providing tools as opposed to solutions. It’s much easier to build the tools. It’s much harder to discover and share the solutions. However, the reward is going to be massive for those organizations that provide solutions.

Going back to the original question: How do you plan to manage all the data? I think that most healthcare providers have no idea. I think they assume they’ll be able to purchase solutions that do the work for them. I’m not seeing many of those solutions yet, but I’m sure they’re coming.

Chronic Care Management Infographic

Posted on October 13, 2015 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.

Smartlink Mobile Systems has put out an infographic that looks at interest in the chronic care management program by physicians. This data is quite interesting since the chronic care management program has been one of the popular topics at the MGMA annual conference this week. There’s a lot of discussion about the program and a lot of organizations trying to work out how to do the program effectively. I think that’s illustrated in the graphic below.
Chronic Care Management Infographic

What do you think of the Chronic Care Management program? Are you participating? Are you planning to participate? I’m sure we’ll be writing a lot more about this in the future.

Bold Insights from the #MGMA15 Keynote Kickoff

Posted on October 12, 2015 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.

Yesterday was the start of the MGMA Annual conference in Nashville. The event kicked off with a really great opening keynote from MGMA’s President and CEO Dr. Halee Fischer-Wright. While most keynotes from organization Presidents are boring and dry, I loved how candid and straight forward Dr. Fischer-Wright was in her comments. She definitely is pushing forward a new vision for the organization.

Here’s some highlights I tweeted from her keynote:


This reminds me of my post on EHR induced PTSD. I could have easily called that post Healthcare Buzzword induced PTSD.


Pretty brave of her to be so bold. I’ll be interested to hear people’s reactions.


I agree with her that Healthcare has changed, but I’d also argue that healthcare is still changing. That just compounds the problem.


I agree that apathy is an extraordinary challenge. Most doctors and healthcare professionals feel paralyzed and feel that they can’t do anything to make a difference or change the trajectory of where healthcare is headed. That’s a good thing since that’s a perception you can change. Apathy because people don’t care would be a much harder challenge.


This leads to some apathy as well, but also is converting to anger.

Needless to say I was impressed by Dr. Fischer-Wright. Appropriately, Jeremy Gutsche spoke after Dr. Fischer-Wright and commented about the need of organizations and people to take risks and fail. Much of the learning we get comes from taking risks and accepting that sometimes we’re going to fail. I think that’s where Dr. Fischer-Wright is taking the MGMA organization. She’s looking at big, ambitious goals. She might fail at some, but I predict that those that don’t fail are going to make a big difference.

#MGMA14 Twitter Roundup

Posted on October 27, 2014 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.

I’ve been spending the past couple days at the MGMA Annual conference in Las Vegas. It’s been interesting to talk to many of the leaders in healthcare. There seems to be a lot of confusion and uncertainty in the air. In fact, that seems to be the case at all the healthcare conferences I’m attending lately. While the industry is going through a turbulent period, it’s still been interesting to see the ongoing evolution that’s happening.

The Twitter stream has been a little disappointing to me. I’d like to see more attendees tweeting content. The vendors are extremely active. However, I found a few tweets which highlight a few of the topics being discussed.


I’m always amazed with how many people want their EHR to be connected. If it being connected was so valued by end users, then why hasn’t it happened? There’s still a misalignment of incentives that needs to be solved.


Lots of these ideas floating around. Everyone agrees that the move to some sort of quality based reimbursement is coming. We’re going to see a lot more discussions like the one above. Unfortunately, right now it’s a lot of speculation.


I wasn’t able to make this session, but it certainly brings up some interesting questions. We’ve written a number of times before about the value of a practice with and without an EHR. This certainly seems to call into question whether a practice without EHR is worth saving. This is going to become a really interesting topic as more doctors who’ve never used EHR in their practice decide to retire.