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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.

External Incentives Key Factor In HIT Adoption By Small PCPs

Posted on January 25, 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 study appearing in The American Journal of Managed Care concludes that one of the key factors influencing health IT adoption by small primary care practices is the availability of external incentives.

To conduct the study, researchers surveyed 566 primary care groups with eight or fewer physicians on board. Their key assumption, based on previous studies, was that PCPs were more likely to adopt HIT if they had both external incentives to change and sufficient internal capabilities to move ahead with such plans.

Researchers did several years’ worth of research, including one survey period between 2007 and 2010 and a second from 2012 to 2013. The proportion of practices reporting that they used only paper records fell by half from one time period to the other, from 66.8% to 32.3%. Meanwhile, the practices adopted higher levels of non-EMR health technology.

The mean health IT summary index – which tracks the number of positive responses to 18 questions on usage of health IT components – grew from 4.7 to 7.3. In other words, practices implemented an average of 2.6 additional health IT functions between the two periods.

Utilization rates for specific health IT technologies grew across 16 of the 18 specific technologies listed. For example, while just 25% of practices reported using e-prescribing tech during the first period of the study, 70% reported doing so during the study’s second wave. Another tech category showing dramatic growth was the proportion of practices letting patients view their medical record, which climbed from one percent to 19% by the second wave of research.

Researchers also took a look at the impact factors like practice size, ownership and external incentives had on the likelihood of health IT use. As expected, practices owned by hospitals instead of doctors had higher mean health IT scores across both waves of the survey. Also, practices with 3 to 8 physicians onboard had higher scores than those were one or two doctors.

In addition, external incentives were another significant factor predicting PCP technology use. Researchers found that greater health IT adoption was associated with pay-for-performance programs, participation in public reporting of clinical quality data and a greater proportion of revenue from Medicare. (Researchers assumed that the latter meant they had greater exposure to CMS’s EHR Incentive Program.)

Along the way, the researchers found areas in which PCPs could improve their use of health IT, such as the use of email of online medical records to connect with patients. Only one-fifth of practices were doing so at the time of the second wave of surveys.

I would have liked to learn more about the “internal capabilies” primary care practices would need, other than having access to hospital dollars, to get the most of health IT tools. I’d assume that elements such as having a decent budget, some internal IT expertise and management support or important, but I’m just speculating. This does give us some interesting lessons on what future adoption on new technology in healthcare will look like and require.