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If MACRA Fails, It Will Be a Failure of IT, Not Doctors or Regulators

Posted on August 8, 2016 I Written By

The following is a guest blog by Steve Daniels, president of Able Health.

There has been a whole lot of mudslinging over the last month between regulators and healthcare providers over MACRA, which shifts Medicare payments further toward pay-for-performance starting January 1. On the one hand, CMS Acting Administrator Andy Slavitt is clear that CMS is ready for change. “We need to get out of the mode of paying physicians just to run tests and prescribe medicines,” he told a Senate Finance Committee hearing. Meanwhile, Dr. Thomas Eppes of the American Medical Association has called MACRA a “quantum shift” and pushed for a delay.

Yes, the Medicare Quality Payment Program instituted by MACRA should—and will—evolve based on comments made on the proposed rule. But the reality is the program provides enormous opportunity for providers to increase bonus payments, while streamlining reporting requirements across a patchwork of outdated and duplicative programs. And it’s worth noting that the potential penalties under the Merit-Based Incentive Payment System (MIPS) over the next four years are actually lower than the sum of the penalties of the programs it is replacing.

To meet MACRA goals, it will take a well-prepared team of providers and administrators—empowered by data and well-designed tools. Doctors can’t be solely responsible for achieving patient outcomes, reducing costs and documenting it all for CMS as they go. Unfortunately, the history of health IT has not been kind—or affordable—to doctors. And today, the health IT stack has a new challenge—keeping pace with the proliferation of value-based programs, from accessing data all the way through enabling new clinical practice.

We must move from a mindset of meeting Meaningful Use checkboxes toward supporting a more effective way of operating. And in the modern world of software-as-as-service, there’s no good reason left that IT needs to cost providers millions of dollars. We can do better. As things stand, if MACRA fails, it will be a failure of IT, not doctors or regulators.

Gathering all the data

For value-based care to work, patient data needs to be made available for providers to coordinate with each other, as well as to payers, to properly evaluate performance based on all known information. Those still blocking or jacking up prices for data access are complicit in obstructing the vision of a learning value-based system.

It is time to remove technical barriers through modern and open data standards like FHIR, as well as rules and unreasonable fees that prevent parties from accessing data when they need it. Thankfully, the Advancing Care Information performance category will reflect the emphasis on information exchange set forth in Meaningful Use Stage 3.

Calculating performance flexibly

The new era of performance-based pay requires continuous monitoring of quality and cost, with the ability to track progress across multiple programs on an ongoing basis. To measure quality today, we often use static algorithms hard-coded by EHRs vendors and health system IT departments, conforming to standards set by NCQA or CMS.

But providers need tools that are tailored not just to one or two programs like Meaningful Use and PQRS, but across the organization’s full range of value-based programs as these program continue to expand, evolve, and proliferate. With efforts to standardize IT for quality measures stalling, vendors need to focus less on one-size-fits-all quality measure calculations and more on flexible systems that enable measures to be rapidly constructed and customized to move with the trends. Expect change to be the norm.

Informing new behaviors

With so many health IT professionals focused on gathering and reporting data, it is not surprising that design has taken a back seat so far. But this year, not a single population health vendor earned an “A” rating from Chilmark, due to poor user engagement and clinical workflow. This is no longer acceptable. The challenge of enabling the new clinical and administrative behaviors associated with value-based care is too vast. User experience must be top of mind for any IT implementation, with representative users involved from the start. We have seen the impact of poor user experience in the fee-for-service system, from frustrated clinicians to alarming patient safety issues.

Design is even more important when the challenge is not just documenting billing codes but also achieving health outcomes for patients across a care team. Don’t bombard clinicians with notifications and force clumsy form-filling. Instead, employ best practices from cognitive psychology to inform professionals with lightweight and intelligent touchpoints. Automate documentation and interpretation of data wherever possible.

A new era of health IT

Whether or not it’s delayed, the Quality Payment Program is coming. And the healthcare industry is moving inexorably toward value-based care. Will health IT step up to the challenge of building toward a value-based future that is accessible to all providers? Or will we sit back and wait for the next list of requirements?

About Steve Daniels
Steve Daniels is the President of Able Health, which helps providers succeed under MACRA and value-based programs. Formerly the design lead for IBM Watson for healthcare and a lifelong patient advocate, he is passionate about the role of open data exchange and intuitive experience design in fostering a continuously improving healthcare system. Find him on Twitter and LinkedIn.

ePrescribing Through Online AMA Platform

Posted on April 27, 2009 I Written By

John Lynn is the Founder of the 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 and 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 was recently sent a news release about DrFirst offering their ePrescribing services to physicians through a new online American Medical Association (AMA) platform. Here’s a short description of the new AMA platform:

DrFirst is the first company to announce that it is offering its services through the new AMA online platform. The platform, which is currently in beta testing, is aimed at providing physicians access to information, products, services and resources that can facilitate medical practice and ease adoption of evolving health information technologies. The AMA aims to launch its new platform in early 2010.

I find the concept of the AMA offering a platform for doctors interesting. Does anyone else know anything about this platform? On face it just sounds like the AMA trying to get a piece of the revenue that can be generated from adopting these technologies. I’m just not sure why someone would use this new AMA portal instead of just buying the software themselves. What advantages does the AMA portal provide outside of being a recommendation source for various software?