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Are EMR Clicks the Problem? – Deep Thought Thursday

Posted on February 15, 2018 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 agree with David Chou here when it comes to needing to make EMRs easier. However, I don’t believe reducing the number of clicks is the real issue. Clicks are just a symptom of the real problem. The real problem is regulations and reimbursement requirements that need revision and simplification.

If we simplified regulations and reimbursement requirements, EHRs would be significantly more usable and would require fewer clicks.

The next question you should ask yourself is whether this administrative simplification will happen first or whether the technology will evolve to the point where it can automatically document the patient visit to any level of complexity while not disrupting the physician workflow.

Where’s your bet? On government and payer changes? Or on technology?

My bets on technology even if Seema Verma, CMS Administrator, is calling for administrative simplification. However, we’re certainly not there yet on either front.

There’s a Disturbance in the Force We Know as MACRA

Posted on February 13, 2018 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 Anne Zieger wrote about AAFP’s proposals to reduce the EHR Administrative Burdens and then we got this tweet from CMS Administrator Seema Verma:

That’s some really strong language from the CMS Director.

If you care about this topic, you should go and read all of Seema Verma’s tweets, but here are two more for those who don’t want to read them all:

Change is in the air it seems. Many providers are rejoicing if you look through the replies to Seema Verma’s tweets.

Dr. Ronald Hirsch asked the question that I’m sure many doctors were asking:

The short answer is no MACRA and MIPS aren’t going away. If my understanding of policy is right, Seema Verma doesn’t have the authority to make MACRA go away. That would take actions from Congress and I don’t know anyone holding their breath on that one. However, Seema can streamline the way MACRA and MIPS are implemented to make it much easier for doctors. That seems to be what’s happening now.

What will this mean for the future of MACRA? I don’t think anyone knows the answers to that question. However, what does seem clear from these tweets is that change is in the air. We’ll have to wait and see what those changes are and who influences the changes they make.

What do you think this means for MACRA and MIPS? I’d love to hear your thoughts in the comments.

Blockchain in Healthcare

Posted on February 8, 2018 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’m predicting that one of the hot topics at the HIMSS 2018 Annual conference in 3 weeks is going to be blockchain. I must admit that I’m a little torn on blockchain and what its impact will be on healthcare. I see the potential, but we still have a way to go with the technology. For example, it needs to find a way that it can scale.

Those specific issues aside I had two recent experiences that have me thinking more and more about blockchain and healthcare.

The first came from Jim Tate who shared “Death of the Middleman: Healthcare & Blockchain.” Jim is one of the bright, intelligent, pragmatic people I look to for insights into the industry. He’s got deep experience and understanding of the healthcare machine. So, it always causes me to wake up a little when he’s espousing something like he is with blockchain.

Jim’s comments are really fascinating as far as blockchain having the potential to be revolutionary while other things like 3D Printing, AI, and Cloud being evolutionary or as he calls them “The Next Big Thing.” We could have a discussion about whether these things are, have been, or will be revolutionary, but I agree with Jim Tate the blockchain has much more potential to be revolutionary. That’s exciting. As I dig into it more, I can see some little aha moments for how Blockchain’s distributed nature can change a lot of things. That’s really exciting even though we’re still in the early days. It’s close to when people saw Netscape for the first time. You could see the potential, but there’s still a lot of things that need to be built out and problems to solve.

The other experience I had recently was having lunch with a friend who has dove head first into blockchain ICO (Initial Coin Offering) consulting. Without going into all the details and discussion of ICOs, it was crazy to hear him talk about all the companies that are willing to gain his consulting wisdom and influence (he has a few hundred thousand followers on Twitter) in return for what he called funny money and they’d call coins. On paper, those coins can be worth a lot, but it depends on a lot of things. They could also end up being worth nothing. That’s what makes it all so scary and crazy. I live in Vegas and this feels much crazier than any gamble on the strip. At least on the strip there are clear odds for how much you’re going to lose. With ICOs and other blockchain efforts, it’s anyone’s guess.

The message I got is that we’re entering a different world that’s going to be hard to understand and comprehend if you don’t really dig into it. Could it lead to a blockchain bubble pop similar to what happened with the internet and the dotcom bubble pop? Absolutely. Some are already saying it’s happening now as bitcoin and other cryptocurrencies have dropped dramatically in value. While it bears watching, I think the blockchain bubble (which I should note is different than bitcoin or even cryptocurrency) is just starting to grow. I don’t think we’re close to it blowing up.

While this wild speculation is scary for me to consider, this type of wild investment and speculation could be a great thing and some might argue is a necessary part of blockchain maturing. All the crazy investment will hopefully sift the wheat from the tares and better help us understand what’s good and what’s bad with blockchain. It’s a necessary part of its maturation.

What does this mean for healthcare? I’m not sure. I’m still watching and trying to learn as we go like everyone else. On the one hand, it’s exciting but there’s plenty to be feared. I’d love to hear your thoughts on blockchain and healthcare. Will it have an impact for good, bad, or other? Let us hear your thoughts in the comments.

Crypto Breach at Hospital, EHR Customization, and Some EHR Humor – Twitter Roundup

Posted on February 7, 2018 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.

It had been a while since we did a Twitter roundup. So many interesting, entertaining, and insightful things are shared. We decided to keep this one light but valuable. We hope you enjoy the Twitter roundup and some of our own added commentary.


Not sure this is the first, but certain it’s not the last. A lot of money to be made from cryptocurrency mining and hospitals have a lot of CPU that can be stolen to mine cryptocurrency. This is going to become a popular malware. It goes mostly hidden from site and so many organizations don’t even realize what’s happening.


If you’ve been part of an EHR implementation you know that Linda is right. However, there are some general lessons learned that are extremely valuable and help every implementation or now EHR optimization. The question I’d ask is, should EHR be standard?


I should have saved this for a Fun Frdiay post, but why not treat Wednesday like Friday. Some other replies to this tweet were just as hilarious (until you realize what they really mean):
If my patients went unresponsive as often as my EMR, I’d be a coroner. – @FredWuMD

Just spray a little epi into the USB port – @roto_tudor

Yes it would be like an episode of the resident. Multiple codes a day. @CaitlynMooneyMD

“What’s the Fix?” (WTF) Patient Conference is Back in 2018

Posted on February 2, 2018 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.

When I first heard about the What’s the Fix? (or WTF if you prefer) conference, I knew that WTFix would be the most patient-centered conference ever. In its first-year HealthSparq and their team achieved this vision of a patient-focused conference in excellent fashion. So, I was excited to hear the recent announcement of What’s the Fix? 2018.

For those not familiar with WTFix, watch this video to get a feel for what went down at the first event:

I love that this year HealthSparq has partnered up with the Design Institute for Health at Dell Medical School to host the conference. No doubt this year will be more connected, empathetic, and vulnerable than ever. Plus, if you can’t make it to Austin, WTFix will be facilitating virtual attendance at the conference. This is great for patients, caregivers, and healthcare professionals that aren’t able to travel to attend the event but want to hear these amazing stories.

I’m sure many patients are wondering if they can afford to attend the event. Don’t worry about that. WTFix is Free to register! In fact, I know the organizers worked really hard to ensure their conference was Patients Included accredited. Seems appropriate for a conference that’s so focused on patients.

I really appreciate HealthSparq for bringing all of these patient stories to the forefront to remind us all of the important work we have to do. Check out the WTFix video section and the #WTFix hashtag on Twitter to get a feel for the community that’s forming. You won’t find a more passionate, caring, empathetic community than WTFix.

Evaluating a Quality Doctor

Posted on February 1, 2018 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.

Today I had a really great exchange with a doctor on Twitter where we discussed a wide variety of things including patients and their ability to know who is a quality doctor. I’d link you to the Twitter exchange, but it seems the doctor has deleted all of his tweets. Not too surprising since he was so anti-social media. Although, I always love when someone engages you on social media to explain why social media is useless (his words, not mine).

The reality is that the doctor and I are aligned on many of the things he said. First, a doctor needs to have their time freed up so that when they’re in the exam room with the patient they can focus on the patient. Many of the things we’ve done in healthcare (including technology) have distracted the doctor from properly caring for the patient. Healthcare IT and EHR software can and should do better.

However, where I didn’t agree with this good doctor was when he asserted that patients know when they have a quality doctor and that great care is provided when doctor and patient have quality time in the exam room.

Let’s start with the first idea. Patients have no good way of measuring if they’ve received quality care from their doctor or not. They certainly can know if they received good customer service. They can evaluate if they enjoyed a doctor’s bedside manner. They can even know if they think their doctor cared about them and their condition. All of these are important aspects of a doctor visit, but they don’t necessarily mean that you received quality care.

A doctor could have amazing customer service, an awesome personality, and still give you awful care. How does a patient know? Most patients barometer is, “Did I get better?” I guess in some ways this is a good measure. However, patients have no idea if they could have gotten better faster if another course of treatment was taken. Patients don’t know if they were overtreated. Patients don’t know if the treatment they received caused some other damage that could have been avoided. Some of them find it out later or have a gut feeling about things, but how could patients know this as it’s happening? If they could know, they wouldn’t need to go to the doctor.

This reality is reflected in all the various physician ratings sites and all of the various quality measures which are thrown at doctors. The best they can do is rate a patient’s customer service experience. The quality measures I’ve seen just create a false or at least misleading impression of what’s really being measured. I have yet to see one that truly measures a physician’s quality. I’m still torn on if it’s possible to measure this.

Now let’s switch to the second assertion, that the key to great care is quality time between doctor and patient in the exam room. Certainly, we all agree that doctors generally can provide better care if they have more time with a patient in the exam room. The above mentioned doctor even tweeted that sometimes what’s needed most is a hug. I agree. Sometimes that’s the case, but not always.

Care is much more nuanced. Sometimes what you need is more time with the doctor. Sometimes what you need is less time with the doctor because you need to get somewhere else or because you suffer from patient trauma and the less time you spend with the doctor the better. Sometimes what you need is a telemedicine visit because the trauma to you or to your family of going into the office is so awful.

Going back to where I started with this post, we do need to free up doctors from all the distractions they experience in the exam room. That will help to improve care. However, that’s not the only solution that’s needed for healthcare to really provide well for patients. A much more sophisticated approach to understanding your patient and catering to their needs is needed. Some of that’s facilitated by technology and some of that is technology enabling a doctor to have more time to create human connections and some of it is humans just doing what they do best.

The future of healthcare is not an either-or world between human connection or technology. The best quality doctors are going to require amazing human connection and healing enabled by and supported by technology.

Two Medical Practices’ Reactions to MACRA Ruining Healthcare

Posted on January 31, 2018 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.

Last week I wrote a post that discussed whether MACRA was ruining Healthcare. It’s an important discussion to have as we look at where healthcare IT legislation should go in the future.

In response to the article I got some pretty heated responses from medical practices that I thought were worth sharing with the wider audience who doesn’t get a chance to read the comments (yeah, I know that’s most of you).

The first comment is from Billy who said the following:

I wouldn’t say MACRA is ruining healthcare, but it’s starting to drive the decision train, which may be the first step.

From my corner of healthcare in America, our practice is forcing adherence to MACRA to set the tone for an ever growing portion of the workflow. The benefit from such is viewed as non-existent aside from protecting revenues. We have compliant doctors (with plenty of grumblings), but no happy ones that are doing this in the belief it’s good for medicine.

Taking two parts of your post I think I can speak towards in view of that…

“All of this leaves doctors I know upset with MACRA and MIPS. They wish it would go away and that the government would stop being so involved in their practice.”

They’re upset at the government because MACRA is seen as an intrusion with no benefit. At best, it’s a threat to their income (both to the business and their end of year salary), and at worst, they don’t trust the government entering the realm of “quality” which traditionally was limited to clinical relevancy. We’ve had plenty of internal discussions of how MACRA quality measures are worlds away from what the physicians view as truly important quality measures for their profession.

“Let’s imagine for a minute that Congress was functional enough to pass a law that would get rid of all of MACRA. Then what? Would doctor’s problems be solved?”

This doesn’t account for the primary reason MACRA was passed in the first place- controlling the costs of Medicare. They can talk about quality all they want, the government needed to eliminate the near automatic 2.5% (or thereabouts) increase in Medicare fee reimbursements. They do that with the freeze in rate increases, and making the physicians battle each other for what remains with the reward/penalty system.

Congress will never get rid of MACRA, it’s their plan to keep Medicare costs from blowing up until 2025 as the boomer generation keeps adding to the rolls.

So, MACRA is seen as having no benefit but a lot of downside in income and daily operations. About the only other thing that could have brought these emotions about would come from the IRS, but this is worse in some ways, as it’s forcing changes in clinical operations for the purpose of checking a box to protect income.

Welcome to the new normal.

It’s hard to think that Billy is right that this is the new normal. Should it be? Could we do something to make it so it’s not?

The next comment was from a long time reader who’s been commenting against MACRA and meaningful use before that (ie. a long time). Here’s meltoots’ take on the question of if MACRA is ruining healthcare:

Yep.
Count me as another mid career MD that sees the futility in any hope for the future of medicine. We are doomed. I do everything I can to talk everyone out of becoming an MD. Including my children.

We have 100% of the accountability and zero authority. Worse I am penalized by our government because I refuse to play stupid counting and clicking games. I was just discussing again (seems daily) my plans to exit this career. Too bad as I am one of only 4 orthopaedic surgeons left at our hospital. 20 years ago we had 35 on staff.

Every single person on earth seems to be saying all this data entry by MDs is silly, inefficient, useless, complex and frankly a huge costly waste of time. Everyone is speaking to burdens and the ridiculous nature of all this forced mindless data entry, super complex reporting, terrible auditing and penalizing for no good reason. When we look back a decade from now and wonder how we made medicine like the postal service, I know I can say I did try to point out better ways. But no one listened. At all.

If all these programs are so wonderful, tell me all the great things that have come out of MU, PQRS, VBM, QPP? So you got MDs to buy EHRs. Great. Everyone hates them. Great work.

HITECH set back real IT innovation in medicine at least a decade.

CMS touts patents over paperwork with absolutely no action, even worse, they made the MACRA program even more burdensome this year. AAPM, you want me to take even MORE risk, and hire more admins to run it? For 5%? Come on.

I have finally come to realization, that medicine has been destroyed by administrators, CMS /ONC, regulators, bean counters and the dozens of people I support just trying to stay ahead of the complexity. Its like the movie Office Space when I forget to click something in the 1000 clicks I have to do a day, I get 10 admins telling me about my TPS reports on what I did wrong.

What is really the worst part, is that I am pretty darned good at what I do, I am super busy and loaded with patients, too many. So I will be yet another MD, that has just had enough, that left the game in his prime. We should all be ashamed at what we did to our physicians.

Healthcare Administration, Healthcare Insurance, and Drug Prices – Twitter Roundup

Posted on January 29, 2018 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.

As most of you know, I like to occasionally go around the twittersphere and highlight some interesting or thoughtful tweets that are shared. Plus, I like to add a little of my own commentary to each tweet to provide some quick analysis on what they’re saying. We hope you enjoy this quick Twitter roundup.


I’m surprised this tweet didn’t also include the chart which shows the growth in the number of physicians and the growth in the number of healthcare administrators. It would fit perfectly with these tweets. The real question here isn’t if there’s a problem. The real question is how do we roll this back?


This story has been all over Twitter. However, I was fascinated by Roman comparing healthcare insurance to other insurance like home and car. It does seem to be very different. I wonder if there’s some important lessons we can learn here.


This was my question when I heard about Alex Azar as HHS Secretary. Will Alex take the side of the people or will he take th side of his buddies? He can say what he wants on air. We’ll see if he can deliver on lowering prescription prices. He’s definitely got an uphill battle.

Healthcare IT Solutions Must Be Seamless

Posted on January 23, 2018 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.

Ever since I saw this tweet from Shereese, I’ve been pondering on how important the concept of seamless technology is to healthcare:

Shereese is spot on that for patients to become users of healthcare technology solutions and health applications, they need to provide a seamless experience that works with their lives. This is why so many Fitbit like wearable solutions have been abandoned. Those solutions didn’t fit seamlessly into their lives. Pair that with many of them not being very clinically relevant and it’s no wonder that wearable use falls off a cliff.

Turns out that the same is true for providers. Providers want whatever healthcare IT application they’re using to fit seamlessly into their workflow. The problem with many EHR is that they didn’t fit seamlessly into a provider’s workflow. Why then did they adopt them? The answer is simple: $36 billion of stimulus money. If that incentive didn’t happen, most doctors would still not be using an EHR. At least not until one figured out how to fit into their practice seamlessly.

I don’t want to let doctors completely off the hook. When implementing an EHR or any healthcare IT solution, some adaption is good. Being obstinant about your current workflow just because “it’s the way you’ve always done it” is a mistake as well. Technology can enable new workflows that wouldn’t have been possible before implementing technology into your organization. So, some change is good when technology enables something new and better.

Like most things in life. It’s all about balance. The technology needs to keep improving so that it can fit seamlessly into our personal lives as patients and physician’s work lives. However, we also need to be open to change when it means improvement over our current approach. Add in the need to provide clear benefits (see my post yesterday) and you have a recipe for success. Without these things and you have a disaster.

Is MACRA Ruining Healthcare?

Posted on January 22, 2018 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 watch social media, physician forums or other places physicians gather, you’d be sure to hear complaining about MACRA and it’s partner in crime MIPS. Some are even still complaining about things like meaningful use and PQRS even though those have all been rolled into MACRA/MIPS now. At the end of the day, I don’t know a single doctor that likes MACRA and MIPS.

I take some of this with a grain of salt because I don’t know a single doctor who likes charting a patient visit either. This was true in the paper chart world and is just as true in the EHR world. Why would a doctor find joy in recording data from a patient visit? That’s like asking a lawyer if they like writing really long legal briefs or contracts full of legalese. We’d all rather just do the fun parts of our job. In medicine that’s seeing the patient, treating the patient, etc.

Charting will never be seen as fun, but doctors do it because it’s necessary to get paid. Although, this oversimplifies it. Doctors are amenable to charting the patient visit because having that information could help them at a future visit. Having a record of what happened at various visits is useful to the doctor the next time you come to see them. So, between reimbursement and continuity of care, there are clear benefits to why a doctor needs to record the visit.

This is the real problem with MACRA and MIPS. There’s no clear benefit to doctor for participating in MACRA and MIPS. At least with meaningful use there was a clear $44k payment that they’d receive. MIPS is much more nebulous and it’s revenue neutral so doctors really don’t know how much they’re going to be paid for participating.

Certainly, there are a whole lot of other nebulous reasons why a doctor should participate including physician reputation damage, lower provider compensation, diminished practice value, and even the ability to obtain and maintain loans. Some of these are going to hit doctors in the face and it’s going to hurt. However, most practices aren’t thinking in these terms. It takes a pretty wide vision to see all of these potential issues.

What about the clinical value associated with MACRA and MIPS? The studies haven’t really shown much clinical value. There’s a lot of hope around what could be done, but not any clear evidence of the benefits. Especially the benefits related to the specific MACRA requirements vs using an EHR generally.

All of this leaves doctors I know upset with MACRA and MIPS. They wish it would go away and that the government would stop being so involved in their practice.

The challenge I have with this idea is that many blame MACRA and MIPS for everything that’s wrong with EHR use and implementation in healthcare. Let’s imagine for a minute that Congress was functional enough to pass a law that would get rid of all of MACRA. Then what? Would doctor’s problems be solved?

We all know that healthcare would still have plenty of problems. In fact, doing away with MACRA would do very little to alleviate the burden doctors are experiencing in healthcare today. They’d all celebrate MACRA’s death, but then they’d realize the impact would be pretty small.

I’m not suggesting that just because it would only have a small impact it shouldn’t be done. Healthcare got to where we are because we were unwilling or unable to make the incremental changes that would improve the healthcare system. Now the problems are so big and complex that they’re much harder to solve. I’m am suggesting that there are bigger fish to fry than MACRA.

That said, I would suggest an overhaul and simplification of MACRA. I’d suggest we take all the requirements and pass them through this question “What does this requirement do to improve patient care?” If this were the test, I think MACRA would look significantly different. In fact, it might mean that MACRA should really just be interoperability, ePrescribing, and a HIPAA risk assessment (which we could argue is already required by HIPAA). Imagine the value patients would get if we blew MACRA up and just replaced it with interoperability requirements which have no natural incentive in our current system. That’s something I think doctors could get behind.

At the end of the day, MACRA could be improved. It should scare us that very few doctors are fans of it. However, we also should be careful to not overstate MACRA’s impact on healthcare. There are plenty of other issues we have to deal with as well.