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How Can Small Practices Thrive with MACRA?

Posted on June 29, 2016 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.

UPDATE: In case you missed the live interview, you can watch the recorded conversation below:

2016 July - How Small Practices Can Thrive with MACRA - Headshots

On Thursday, July 7, 2016 at 3:30 PM ET (12:30 PM PT) I’ll be hosting a live video interview with the Chief Medical Officers of both Modernizing Medicine and Kareo. All of healthcare has been hit with the MACRA legislation and many talking heads are saying that MACRA is going to be a challenge for small practices. In this discussion, we’ll talk about how small practices can thrive within the changes that MACRA provides.

The great part is that you can join my live conversation with this panel of experts and even add your own comments to the discussion or ask them questions. All you need to do to watch live is visit this blog post on Thursday, July 7, 2016 at 3:30 PM ET (12:30 PM PT) and watch the video embed at the bottom of the post or you can subscribe to the blab directly. We’ll be doing a more formal interview for the first 30 minutes and then open up the Blab to others who want to add to the conversation or ask us questions. The conversation will be recorded as well and available on this post after the interview.

Here are a few more details about our panelists:

We hope you’ll join us live or enjoy the recorded version of our conversation. Plus, considering the length of the MACRA legislation, we welcome you to come and provide your insights into what the MACRA legislation means for small practices. We hope this will be an open discussion of the legislation and what impact it will have on small practices. Dr. Giannulli and Dr. Sherling are very well versed on the topic and will provide some tremendous insight into what to expect from MACRA.

If you’d like to see the archives of Healthcare Scene’s past interviews, you can find and subscribe to all of Healthcare Scene’s interviews on YouTube.

Finally, if you’d like to learn more about MACRA for small practices, I’ll be doing a detailed webinar on what we know about MACRA on July 13th at 1 PM ET (10 AM PT).

2 Major Problems with MACRA

Posted on May 4, 2016 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.

Everyone’s started to dive into the 10 million page MACRA (that might be an exaggeration, but it feels about that long) and over the next months we’ll be sure to talk about the details a lot more. However, I know that many healthcare organizations are tired of going through incredibly lengthy regulations before they’re final. Makes sense that people don’t want to go through all the details just for them to change.

As I look at MACRA from a very high level, I see at least two major problems with how MACRA will impact healthcare.

Loss of EHR Innovation
First, much like meaningful use and EHR certification, MACRA is going to suck the life out of EHR development teams. For 2-3 years, EHR roadmaps have been nothing but basically conforming to meaningful use and EHR certification. Throw in ICD-10 development for good measure and EHR development teams have basically had to be coding their application to a government standard instead of customer requests and unique innovations.

Just today I heard the Founder of SOAPware, Randall Oates, MD, say “I’m grieving MACRA to a great degree.” He’s grieving because he knows that for many months his company won’t be able to focus on innovation, but will instead focus on meeting government requirements. In fact, he said as much when he said, “We don’t have the liberty to be innovative and creative.” And no, meeting government regulations in an innovative way doesn’t meet that desire.

I remember going to lunch with a very small EHR vendor a year or so ago. I first met him pre-meaningful use and he loved being able to develop a unique EHR platform that made a doctor more efficient. He kept his customer base small so that he could focus on the needs of a small group of doctors. Fast forward to our lunch a year or so ago. He’d chosen to become a certified EHR and make it so his customers could attest to meaningful use. Meaningful use made it so he hated his EHR development process and he had lost all the fire he’d had to really create something beautiful for doctors.

The MACRA requirements will continue to suck the innovation out of EHR vendors.

New Layers of Work With No Relief
When you look at MACRA, we have all of these new regulations and requirements, but don’t see any real relief from the old models. It’s great to speak hypothetically about the move to value based reimbursement, but we’re only dipping our toe in those waters and so we can’t replace all of the old reimbursement requirements. In some ways it makes sense why CMS would take a cautious approach to entering the value based world. However, MACRA does very little to reduce the burden on the backs of physicians and healthcare organizations. In fact, in many ways it adds to their reporting burden.

Yes, there was some relief offered when it comes to meaningful use moving from the all or nothing approach and a small reduction in the number of measures. However, when it comes to value based reimbursement, MACRA seems to just be adding more reporting burdens on doctors without removing any of the old fashioned fee for service requirements.

MACRA is not like ICD-10. Once ICD-10 was implemented you could see how ICD-9 and the skills required for that coding set will eventually be fully replaced and you won’t need that skill or capability anymore. The same doesn’t seem to be true with value based care. There’s no sign that value based care will be a full replacement of anything. Instead, it just adds another layer of complexity, regulation, and reporting to an already highly regulated healthcare economic system.

This is why it’s no surprise that many are saying that MACRA will be the end of small practices. At scale, they’re onerous. Without scale, these regulations can be the death of a practice. It’s not like you can stop doing something else and learn the new MACRA regulations. No, MACRA is mostly additive without removing a healthcare organization’s previous burdens. Watch for more practices to leave Medicare. Although, even that may not be a long term solution since most commercial payers seem to follow Medicare’s lead.

While I think that CMS and the people that work there have their hearts in the right place, these two problems have me really afraid for what’s to come in health IT. EHR vendors the past few months were finally feeling some freedom to listen to their customers and develop something new and unique. I was excited to see how EHR vendors would make their software more efficient and provide better care. MACRA will likely hijack those efforts.

On the other side of the fence, doctors are getting more and more burnt out. These new MACRA regulations just add one more burden to their backs without removing any of the ones that bothered them before. Both of these problems don’t paint a pretty picture for the future of healthcare.

The great part is that MACRA is currently just a proposed rule. CMS has the opportunity to fix these problems. However, it will require them to take a big picture look at the regulation as opposed to just looking at the impact of an individual piece. If they’re willing to focus MACRA on the big wins and cut out the parts with questionable or limited benefits, then we could get somewhere. I’m just not sure if Andy Slavitt and company are ready to say “Scalpel!” and start cutting.

The Downside of Interoperability

Posted on May 2, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

It’s hard to argue that achieving health data interoperability is not important — but it comes with risks. And I’ve seen little discussion of the fact that interoperability may actually increase the chance that a major attack could hit a wide swath of healthcare providers. It might be extreme to suggest that we put off such efforts until we step up the industry’s security status, but the problem shouldn’t be ignored either.

Sure, data interoperability is a critical goal for healthcare providers of all stripes. While there’s room to argue about how it should be accomplished, particularly over whether providers or patients should drive health data management, there’s no question it needs to get done. There’s little doubt that most efforts to coordinate care will fall flat if providers are operating with incomplete information.

And what’s more, with the demand for interoperability baked into MACRA, we pretty much have no choice but to make it happen anyway. To my knowledge, HHS has proposed neither carrot nor stick to convince providers to come on board – nor has it defined “widespread” interoperability to my knowledge — but the agency has to achieve something by 2018, and that means change will come.

That being said, I’m struck by how little industry concern there seems to be about the extent to which interoperability can multiply the possibility of a breach occurring. Unfortunately, security is only as good is the weakest link in the chain, and data sharing increases the length of the chain exponentially. Of course, the risk varies a great deal depending on who or what the data-sharing intermediary is, but the fact remains that a connected network is a connected network.

The problem only gets worse if interoperability is achieved by integrating applications. I’m no software engineer, but I’m pretty sure that the more integrated providers’ infrastructure is, the more vulnerabilities they share. To be fair, hospitals theoretically vet their partners, but that defeats the purpose of universal data sharing, doesn’t it?

And even if every provider in the universal data sharing network practices good security hygiene, they can still get attacked. So it’s not a matter of requiring participants to comply with some network security standard, or meet some certification criteria. Given the massive incentives these have to steal health data (and lock it up with ransomware), nobody can hold out forever.

The bottom line is that I believe we should discuss the matter of security in a fully-connected health data sharing network more often.

Yes, we almost certainly need to press ahead and simply find a way to contain the risks. We simply can’t afford our fragmented healthcare system, and data interoperability offers perhaps the best possible chance of pulling it back together.

But before we plunge into the fray, it only makes sense to stop and consider all of the risks involved and how they should be addressed. After all, universal interconnection exposes a virtually infinite number of potential points of failure to cybercrooks. Let’s put some solutions on the table before it’s too late.