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“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.

Your Front Desk Is You

Posted on January 30, 2018 I Written By

Is your front desk welcoming, or repelling your patients, your customers?  Yes, patients are your customers, they are the ones that create your income by coming to your practice.  And whom do your customers first encounter” Your front desk staff. Are they a reflection of what you want your practice to be, representing you, or are they something you really don’t want to think about, low paid, marginal help that you have to have? High turnover, “you can’t get good help”, not worth paying more than minimum wage, staff?

That glass window that you installed for HIPAA privacy in the patient’s view is a device that allows them to hide from their view, to avoid eye contact, avoid dealing with them, the patient. Behind the glass window, are the people that greet your patients, expected to make them feel “welcome”, instruct them on the necessary registration materials to be signed, and most importantly, set the tone, and culture of the office for your patients?  This is critical to your practice’s success.

Such people should be a positive contact point for your practice, yet a study published in the Journal of Medical Practice management reported that 96% of patient complaints about a practice have to do with customer service. It’s not the clinical care, the physicians care, but how they are treated in the experience of visiting your practice.  And the first point of contact in the office is your front desk staff.

Is Your Practice Perfect or Does It Need Improvement?

Now you need to look at your scheduling process as well to see if that is a point of friction, online or by phone, but the human aspect once in the office is your front desk staff.

How is the reception configured, and how are the staff trained?

If that glass window is a barrier that hides the staff, that allows them to ignore the patients, then your message is that they, your customers are secondary to everything else.  If the patient has to ring a bell or tap on the window, or even read a hand-written sign that says sign in and take a seat, this is for the benefit of your staff, not your patients.  Now if you have an alert on the door when it opens and that signals staff to open the window and welcome the patient, inviting them to start the registration process, you have a very different tone to kick off the patient visit.

And that welcoming staff person has to be hired for personality, a welcoming personality, and then trained to do the job, the tasks that need to be performed at the time of registration.  Even if it requires more than minimum wage to fill the slot, the right person sets the cultural tone for the office and set you as the physician up for a better encounter with the patient. The glass window when opened, should not be to simply thrust a clipboard into the hands of the patient saying “fill these out”.  The exchange between your staff and the patient would be welcoming and appreciative.  In other words, make the exchange about the patient.

Take a look at your waiting room as well, is it inviting, clean, up-to-date, and comfortable? If not, take some time to make sure your waiting room reflects the kind of quality care you provide your patients.

About Alex Tate
Alex Tate is a Healthcare IT Researcher and writer at CureMD who focus various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, Electronic Medical Records, revenue cycle management, privacy, and security of patient health data.

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.

E-Patient Update: Clinicians Who Email Patients Have Stronger Patient Relationships

Posted on January 26, 2018 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.

I don’t know about you, but before I signed up with Kaiser Permanente – which relies heavily on doctor-to-patient messaging via a portal – it was almost unthinkable for a primary care clinician to share their email address with me. Maybe I was dealing with old-fashioned folks, but in every other respect, most of my PCPs have seemed modern enough.

Few physicians have been willing to talk with me on the phone, either, though nurses and clinical assistants typically passed along messages. Yes, I know that it’s almost impossible for doctors to chat with patients these days, but it doesn’t change that this set-up impedes communication somewhat. (I know – no solution is perfect.)

Given these experiences, I was quite interested to read about a new study looking at modes of communication between doctors and patients in the good old days before EHR implementation. The study, which appeared in the European Journal for Person Centered Healthcare, compared how PCPs used cellphones, email messages and texts, as well as how these communication styles affected patient satisfaction.

To conduct the study, researchers conducted a 16-question survey of 149 Mid-Atlantic primary care providers. The survey took place in the year before the practices rolled out EHRs offering the ability to send secure messages to patients.

In short, researchers found that PCPs who gave patients their email addresses were more likely to engage in ongoing email conversations. When providers did this, patients reported higher overall satisfaction than with providers who didn’t share their address. Cellphone use and text messaging didn’t have this effect.

According to the authors, the study suggests that when providers share their email addresses, it may point to a stronger relationship with the patient in question. OK, I get that. But I’d go further and say that when doctors give patients their email address it can create a stronger patient relationship than they had before.

Look, I’m aware that historically, physicians have been understandably reluctant to share contact information with patients. Many doctors are already being pushed to the edge by existing demands on their time. They had good reason to fear that they would be deluged with messages, spending time for which they wouldn’t be reimbursed and incurring potential medical malpractice liability in the process.

Over time, though, it’s become clear that PCPs haven’t gotten as many messages as they expected. Also, researchers have found that physician-patient email exchanges improve the quality of care they deliver. Not only that, in some cases email messaging between doctors and patients has helped chronically-ill patients manage their conditions more effectively.

Of course, no communication style is right for everyone, and obviously, that includes doctors. But it seems that in many cases, ongoing messaging between physicians and patients may well be worth the trouble.

Partners AI System Gives Clinicians Better Information

Posted on January 25, 2018 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.

While HIT professionals typically understand AI technology, clinicians may not. After all, using AI usually isn’t part of their job, so they can be forgiven for ignoring all of the noise and hype around it.

Aware of this problem, Partners Connected Health and partner Hitachi have come together to create an AI-driven process which isolates data physicians can use. The new approach, dubbed ‘explainable AI,’ is designed to list the key factors the system has relied upon in making projections, making it easier for physicians to make relevant care decisions.

Explainable AI, a newer term used by the two organizations, refers not only to the work being done to develop the Partners system, but also a broader universe in which machines can explain their decisions and actions to human users. Ultimately, explainable AI should help users trust and use AI tools effectively, according to a Hitachi statement.

Initially, Partners will use the AI system to predict the risk of 30-day readmissions for patients with heart failure. Preventing such readmissions can potentially save $7,000 per patient per year.

The problem is, how can organizations like Partners make AI results useful to physicians? Most AI-driven results are something of a black box for clinicians, as they don’t know what data contributed to the score. After all, the algorithm analyses about 3,000 variables that might be a factor in readmissions, drawing from both structured and unstructured data. Without help, there’s little chance physicians can isolate ways to improve their own performance.

But in this case, the AI system offers much better information. Having calculated the predictive score, it isolates factors that physicians can address directly as part of the course of care. It also identifies which patients would be the best candidates for a post-discharge program focused on preventing readmissions.

All of this is well and good, but will it actually deliver the results that Partners hoped for? As it turns out, the initial results of a pilot program are promising.

To conduct the pilot, the Partners Connected Health Innovation team drew on real-life data from heart failure patients under its care. The patients were part of the Partners Connected Cardiac Care Program, a remote monitoring education program focused on managing their care effectively in reducing the risk of hospitalization.

The test compared the results calculated by the AI system with real-life results drawn from about 12,000 heart failure patients hospitalized and discharged from the Partners HealthCare network in 2014 in 2015. As it turned out, there was a high correlation between actual patient readmissions and the level predicted by the system. Next, Partners will share a list of variables that played the biggest role in the AI’s projects. It’s definitely a move in the right direction.

Ways To Minimize Physicians’ Administrative Burdens

Posted on January 24, 2018 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.

It’s hardly a secret that physicians are buckling under the weight of their administrative responsibilities. The question is, how do we lessen the load? A new article published on a site backed by technology vendor CDW offers some creative ways for doing so.

One suggestion the article makes is to have patients write and add notes to their personal medical charts.According to the piece, doctors at UCLA Health and Beth Israel Deaconess Medical Center will pilot “OurNotes,” a tool allowing patients to input medical data, in 2018. Patients will use the new tool to add information such as symptoms, emerging health issues and even goals for future visits. OurNotes is an outgrowth of the OpenNotes project, an initiative that encourages clinicians to share their notes with patients.

Will the OurNotes effort actually make things easier for physicians? Dr. John Mafi, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, believes it can.

“If executed thoughtfully, OurNotes has the potential to reduce documentation demands on clinicians, while having both the patient and clinician focusing on what’s most important to the patient,” Dr. Mafi said in a statement about a research project on the OpenNotes approach. (Mafi was the lead author of a paper on the project’s results.)

Another option is using “remote scribe” services via Google Glass. Yes, you heard me right, Google Glass. Google is relaunching its smart glasses and it’s retooled its approach to serving the healthcare industry. The number of applications for Glass has crept up gradually as well, including an EMR accessible using the smart glasses from vendor DrChrono. DrChrono calls it the “wearable health record,” which is pretty nifty.

San Francisco-based clinical practice Dignity Health has been working with Google Glass startup Augmedix to access offsite scribes. Dignity Health vice president and CMIO Davin Lundquist told MobiHealthNews that after three years of using Glass this way, he’s cut down on time spent administrative tasks from 30% per day to 10% per day. Pretty impressive.

Yet another way for healthcare organizations to reduce adminsitrative overhead is, as always, making sure their EMR is properly configured and supports physician workflow. Of course, duh, but worth mentioning anyway for good measure.

As the CDW piece notes, one way to reduce the administrative time for physicians is to make sure EMRs are integrated with other systems effectively. Again, duh. But it never hurts to bear in mind that making it easy for physicians to search for information is critical. There’s no excuse for making physicians hunt for test results or patient histories, particularly in a crisis.

Of course, these approaches are just a beginning. As interesting as, say, the use of Google Glass is, it doesn’t seem like a mature technology at this point. OurNotes is at the pilot stage. And as we all know, optimizing EMRs for physician use is an endless task with no clear stopping point. I guess it’s still on us to come up with more options.

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.