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What Will Be Trump’s Impact on MACRA? – MACRA Monday

Posted on November 21, 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.

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

Next week we’ll be kicking off our weekly series of details from the MACRA Final Rule. However, before we start going through the changes and what you need to know about MACRA, I wanted to cover an important topic of concern for many practices. I’ve heard a lot of practices that are afraid of what they consider the uncertain future in the coming Trump presidency.

While I believe that healthcare could see significant impact from a Trump presidency, I don’t believe that MACRA will be impacted by the change in presidency. First, MACRA was as bipartisan as you could find in Washington DC. Even if Trump wanted to replace, modify, repeal MACRA, I can’t imagine it getting enough support in the senate and house. If this is true, Trump won’t even try to do anything with MACRA. Second, Trump has plenty of bigger fish to fry. When you look at the various priorities that Trump has said he has for his presidency, nothing indicates that MACRA will be anywhere near those priorities. Third, it’s hard for me to imagine that Trump would see a problem with the move to technology in healthcare.

What also is worth noting is that MACRA is separate from ACA (aka Obamacare) and even ARRA (the HITECH Act). I’ll leave the predictions for what will happen with ACA for other people. I have no doubt that ACA will be impacted by the change in presidency, but even if they did a full repeal of Obamacare (which looks like it’s impossible), MACRA will still remain and be in force. If MACRA was part of Obamacare, I’d have a different view, but since it’s not then I think MACRA will continue forward as planned.

Those of you hoping for MACRA to disappear due to the new president and those of you waiting for MACRA to change after the comment period is over are grasping at straws. Love it. Hate it. Feel however you may about MACRA, I really don’t see any scenario where MACRA is not part of the future of healthcare.

What do you think? If you disagree, I’d love to hear why in the comments. If you agree, I’d love to hear from you as well. With that view, we’ll be continuing MACRA Monday blog posts for the foreseeable future so that our readers are ready.

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

We’re Just Getting Started with an Internet of Healthy Things (Part 1 of 3)

Posted on November 24, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The release of Joseph Kvedar’s book The Internet of Healthy Thingscoincided with the 15th annual symposium on Connected Health, which he runs every year and which I reported on earlier. Now, more than ever, a health field in crisis needs his pointed insights into the vision widely shared by all observers: collaborative, data-rich, technology-enabled, transparent, and patient-centered.

The promise and the imminent threat

A big part of Dr. Kvedar’s observations concern cost savings and “scaling” clinicians’ efforts to allow a smaller team to treat a larger community of patients with more intensive attention. As I review this book, shock waves about costs are threatening the very foundations of the Affordable Care Act. Massive losses by insurers and providers alike have led to the abandonment of Accountable Care Organizations by many who tried them. The recent bail-out by UnitedHealth was an ominous warning, eagerly jumped on by Fox News. Although other insurers issued assurances that they stay with the basic ACA program, most are reacting to the increased burden of caring for newly signed up patients by imposing insufferably high deductibles as well as extremely narrow networks of available providers. This turns the very people who should benefit from the ACA against the system.

There is nothing surprising about this development, which I have labeled a typical scam against consumers. If you sign up very sick people for insurance and don’t actually make them better, your costs will go up. T.R. Reid averred in his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care that this is the sequence all countries have to follow: first commit to universal healthcare, then institute the efficiencies that keep costs under control. So why hasn’t that happened here?

Essentially, the health care system has failed us. Hospitals have failed to adopt the basic efficiency mechanisms used in other industries and still have trouble exchanging records or offering patients access to their data. A recent study finds that only 40% of physicians shared data within their own networks, and a measly 5% share data with providers outside their networks.

This is partly because electronic health records still make data exchange difficult, particularly with the all-important behavioral health clinics that can creat lifestyle changes in patients. Robust standards were never set up, leading to poor implementations. On top of that, usability is poor.

The federal government is well aware of the problem and has been pushing the industry toward more interoperability and patient engagement for years. But as health IT leader John Halamka explains, organizations are not ready for the necessary organizational and technological changes.

Although video interviews and home monitoring are finding footholds, the health industry is still characterized by hours of reading People magazine in doctors’ waiting rooms. The good news is that patients are open to mobile health innovations–the bad news is that most doctors are not.

The next section of this article will continue with lessons learned–and applied–both by Dr. Kvedar’s organization, Partners Connected Health, and by other fresh actors in the health care space.

Healthcare Costs and the New Cost Conscious Patient

Posted on June 30, 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.

My favorite health economist, Jane Sarasohn-Kahn, has put out a really interesting post on her Health Populi blog talking about what the SCOTUS ACA ruling means for health consumers (Side Note: Here’s the lesson I took from the ruling.). Jane offers an important perspective that we should think about as we look to the future of healthcare. Here’s an excerpt from her article:

There are still tweaks and adjustments to be made to the law, and market supports that must deal with the ever-rising price of health care. While optimists report health care cost increases moderated to 6.5% in 2015, this growth rate is nonetheless many times greater than peoples’ wage increases (relatively stagnant for a decade) and the Consumer Price Index which in the previous year was actually negative (due to lower costs of petrol and other decreasing costs in the household budget). The one cost households can count on going up, up, up is….healthcare.

And so with the growth of high-deductible health plans and health savings accounts, health consumers must become health care shoppers — that is, if people want to gain some control over their financial wellness.

What does this new cost conscious patient mean for healthcare? What systems are we going to need to be able to handle the patient? Will we be able to continue providing care to patients without any real idea on how much that care will cost? Or will we need systems that help us know what the cost of care will be so the patient can choose to buy that care or not? Will cost conscious patients want to be kept well instead of just having their current complaint treated?

There are these and a lot of other questions that are raised by this shift in patient consumption of healthcare services. Understanding these changes is going to be extremely important for healthcare organizations to survive.

Do Doctors Care About the Triple Aim?

Posted on May 13, 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.

The stated goal of Patient Protection and Affordable Care Act (PPACA) (i.e. Obamacare) and healthcare reform is what people like to call the Triple Aim. For those not familiar with it, it goes as follows:

  • Improve patient satisfaction and quality of care
  • Improve the health of the community/population
  • Reduce the cost of healthcare.

I’ve regularly heard people reference the triple aim as a reason why we should act a certain way. They refer to the triple aim as the main goal of what we are doing with healthcare IT. It’s the unifying vision for which all of healthcare wants to achieve.

I’m here to tell you that it’s just not the case. There are plenty in healthcare that couldn’t care less about the triple aim of healthcare. Many in that group are doctors. Ok, maybe the word “care” isn’t the right one. They do care about patient satisfaction and quality of care. They do want the health of their community to be better. They do want the costs of healthcare reduced. They do care about those things, but do they care to the point where it will actually spur action?

Another way to look at this is do they care about the triple aim enough for them to change what they’re doing. Plus, do they care about other things more than the triple aim.

Let’s look at them backwards. Do doctors want to reduce the cost of healthcare? As citizens, of course they want the cost of healthcare reduced, but with one small caveat: As long as it doesn’t mean I get paid less. This isn’t a knock on doctors either. This is the perfectly rationale response to the idea of lowering costs in healthcare. It’s not something we should criticize. It’s something we should understand and apply to whatever we’re trying to achieve.

The same thing applies to improving the health of a community or population. Hopefully the shift to value based reimbursement, population health, and ACOs will help to realign the incentives to make it so doctors care more about this than they do now. Otherwise, many of these programs look like we’re asking our providers to provide more free work for the benefit of the community. Hard to blame them when you phrase it like that, no?

The majority of doctors embrace this first aspect of the triple aim. They really want to provide the very best care they can to the patients (with a few sad exceptions which give a bad name to the hundreds of thousands of doctors who are doing their best). The question I’d ask ourselves is are we putting doctors in a position where they can have satisfied patients who receive quality care or are we burdening our highest paid resource with tasks that don’t work towards this end goal? Every doctor I know would welcome the opportunity to have better satisfied patients and improved outcomes.

I love the components of the Triple Aim as an ideal, but as it is today I think there’s a misalignment between the ideal and the day to day reality for doctors. I’m not against being idealistic and ambitious in our goals. Although, don’t expect our healthcare system to reach the triple aim if we don’t realign the incentives. Plus, let’s not forget that not all incentives are financial.

EMR Mandate Delay, Patient Focused EMR, and Guaranteed EHR Benefit

Posted on October 27, 2013 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 article makes some interesting points about the challenge of EMR. However, I don’t think there’s any shot that the EHR train is going to slow down. At the best there might be a delay in meaningful use stage 2. Although, that could be unlikely as well. P.S. There is no EMR Mandate.


Not true. It takes GREAT EMR design to do that. The regulations are just brutal and don’t focus on the patient.


It’s always beautiful for me to find someone tweeting a blog post I created 4 years earlier. The content is still quite good. Reminds me that I need to finish my EHR Benefits series.

Don’t Take Health Insurance Exchanges TOO Seriously

Posted on October 3, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

In an effort to raise everyone’s spirits during these gloomy days of government shutdowns and health insurance exchange glitches, I thought I’d gather all of the recent comedic coverage about Obamacare and the aforementioned topics into this week’s post. You’ll laugh, you’ll scratch your head, and you might even throw a plate or two against the wall at the utter absurdity of much of what is going on right now. I know I did.

From Saturday Night Live

 

From Funny or Die

 

From The Colbert Report

 

From the Daily Show

(My apologies for the captions. Enlarge to full screen for easier viewing.)

 

From Jimmy Kimmel

HealthCare.gov

Posted on December 26, 2012 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 haven’t been to HealthCare.gov for a while, go and check it out. If you didn’t know better, you’d think that HealthCare.gov was built by a company and not the government. This is true all the way down to the HealthCare.gov Blog featured on the home page. I applaud Todd Park and the others at HHS who took a different approach to how a government website should look and feel. They even have a scrolling set of stories about patients and benefits. You’d think they have something to sell us.

Well, I guess they do have something to sell. They are definitely trying to sell us on ACA (aka Obamacare) and the benefits that come from Obamacare. Although, the tools that I found most interesting were the Insurance Options Wizard which walks you through all the options you have to getting insurance. Not to mention a whole set of tools to try and help people understand using insurance. Although, I’m pretty sure most of that’s not going to be read. So, hopefully it’s got a good dose of search engine optimization applied so that it will show up in search engines where it might get a chance at being read.

We’ve written about the “Comparing Care Providers” part of HealhCare.gov before. It’s pretty gutsy for a government organization to go there at all. Certainly they are taking a pretty high level approach to their “comparison” but we’ll see how much they dig into it going forward. Will those doctors that are part of an ACO that’s striving to be reimbursed on the quality of care be listed different than other doctors? It will be interesting if tools like these start to differentiate which patients go to which providers.

I do wish that the website did more to get patients involved in their healthcare. Here’s what I said in my “All I Want for Christmas…” post on EMR & HIPAA:

More Empowered and Trusted Patients – Imagine where the patient was a full participant in their healthcare. That includes being trusted and listened to by their doctor and a patient who thoughtfully considers and listens to their doctor. This is not a one sided issue. This is something that both patients and doctors can improve. There are as many belligerent patients as their are arrogant doctors. We need a good dose of humility, care and trust re infused into healthcare. I think they only way we’ll get there is for the lines of communication to open up on an unprecedented level.

Seems like HealthCare.gov is one place that could help reach this goal. I guess in some ways the physician comparison engine could work towards this. How cool would it be if they listed which of the physicians used EHR and which EHR that physician used? Reminds me of “Got EMR?” ad campaigns I first wrote about about 6 years ago.

EMR or Not, we’re quickly heading to a world where doctors are differentiated on the technical services they provide their patient. Doctors are starting to be judged by their medical website and the services they provide on that website. Do they accept online appointment requests? Do they accept online payments? Can the patient communicate electronically with the clinic? Can the patients receive their patient records electronically?

It will start with a handful of doctors and then start to spread. Plus, it will be accelerated if HealthCare.gov or some other website starts to highlight those doctors who offer these type of services and those that don’t.

ACA Implications, Hurricane Sandy, and Interoperability — #HITsm Chat Highlights

Posted on November 10, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: Obama’s re-election secures the future of the #ACA, but what changes/concessions are we likely to see during its rollout?

Topic Two: What #healthIT strengths and weaknesses did Hurricane Sandy expose?

Topic Three: What business continuity/disaster recovery strides do health providers still need to make?

 

Topic Four: A national #HIE would have come in handy during #Sandy, so why does the industry still fail to embrace interoperability?

 

 

Obamacare Before SCOTUS

Posted on April 2, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

So the Affordable Care Act got hauled up before the SCOTUS last week. From the way the questions were framed it looks like the individual mandate portion might be struck down, though it is too soon to tell.

I have mixed feelings about the Affordable Care Act. On the one hand I can see why affordable health for all must be a priority. I know people who use the ER room as their sole point if contact with the healthcare system, and sadly some of them have paid the price with their lives. There’s also a selfish reason behind my reasoning. Each time someone uninsured turns up at the ER, and gets top notch care, it is MY tax dollars that fund the treatment. Surely there are better ways to use tax dollars.

And yet a mandate makes me queasy. If the government mandates health insurance today, will it start mandating annual exams and flu shots a few years down the road. I think the most succint response on this topic was summarized thus by a Twitterer: “The problem with the mandate is the insurance is private. Make the insurance public and call it a tax. Problem solved.”

I can hear Americans collectively go This isn’t Canada at this point. But think about it: directly or indirectly, we are paying for the uninsured with our tax dollars. Public health insurance might take away some of the worries we have around bouts of non-insurance resulting from unemployment or old age.

Effect of Obamacare on EMR Industry

Posted on March 16, 2010 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.

One of my readers sent me the following email…

New England Journal of Medicine survey:
46% of primary care physicians would quit if Obamacare becomes law!

I’m not sure I agree with the statement. Should I? If this does happen, how will it affect the EMR industry? Should EMR vendors should be preparing for the healthcare reform (Obamacare) in their projections?