Making Sense of MACRA

After a slew of feedback from healthcare and HIT professional organizations, like CHIME, AMA and MGMA, CMS announced new flexibilities in the Medicare Access and CHIP Reauthorization Act (MACRA) final rule. Though CMS released the final ruling several weeks ago, physicians still struggle to grasp the impact or even understand what the new reimbursement structure is.

MACRA replaces the old sustainable growth-rate formula for physician pay. Under MACRA, physicians can pick from one of two Medicare reimbursement tracks – the Merit-based Incentive Payment Program (MIPS) or Advanced Alternative Payment Models (APMs). To better aid physicians with these programs, CMS has set up additional resources:

  1. With $700 million in funding, CMS created practice transformation networks as frontline assistance focusing on elevating clinicians’ population health to enable physician success under MIPS and eventually transition them APMs.
  2. With $100 million in funding, CMS specifically directed aid toward solo, small and rural health practices to get them up to speed and in the know about reporting requirements and means for success.

Beyond these initiatives, how can you become better informed? For a breakdown of MACRA regulations and questions to consider, check out our slide set Making Sense of MACRA.


Tips for Negotiating with EHR Vendors

Before signing the contract with a new EHR vendor, think about the immediate and future implications on your healthcare organization, end users, workflow, business operations and the patient community. Be willing to consider the following questions when approaching this daunting IT decision:

  1. What is the main goal we are trying to achieve?

    Don’t buy or opt in for additional or added features when you don’t need them for your practice. Additional functionality and available modules can always be negotiated from a pricing standpoint (which you should be able to be lock in for at least two years) as an option exercised at a later date if the scope of the practice changes and there is a need for the additional product. Another thing to remember is, just like cars and furniture, software is always on sale. The level of discount you are able to achieve will depend on a number of factors, including success of the vendor, timing in the quarter or fiscal year and length of agreement you are willing to enter into.

  2. What’s the best way to achieve win-win outcomes in the negotiation with a new EHR vendor?

    Remember that the best executed software agreement is one that both the customer and the vendor feel good about. The goal is for the agreement to be a win-win result. It should provide a quality and supportable product for the medical practice in an agreement that the vendor feels good about to provide the appropriate support. With a win-win agreement, the vendor is much more likely to go the extra mile in assisting the customer when issues arise outside of the normal support process.

    There doesn’t necessarily need to be a bad guy in the negotiating scenario if open and honest communication is on the table during the negotiation process. Both the customer and the vendor are going to having non-negotiable items that they cannot concede on for various reasons. These should be communicated at the appropriate time during the process. Good representation from the right individuals from both a financial and clinical perspective will help to ensure that expectations are communicated for what is required and what the vendor is offering to meet the needs.

  3. What else should you consider when working with a new EHR vendor?

    Reference checks are the key to making this very important decision for your practice. Ask for a minimum of three references and at least one of those references should be a “bad” reference provided by the vendor. Although it may not have necessarily completely been the vendors’ fault for the bad references, it will provide you, the potential customer, with some insight on why that reference failed with the implementation or has not been able to fully utilize the capabilities the vendor is proposing to your healthcare organization. Good references are just that, but take the time to learn as much as possible from them about how they feel they successfully implemented the product. What was their staffing model? How long did the implementation take? Did it stay within the budget parameters? What would they have done differently to make it an even better implementation? Exchange contact information with the good references in hopes of communicating with them further in the future.

Best of luck with your negotiations!

Today’s Healthcare Industry Pressures Call for New Executive Capabilities


When you think about individuals in a hospital c-suite, what characteristics come to mind? Perhaps passion and drive with combined analytical and relational skills? These characteristics unite to meet the needs of today’s patients and industry demands while aiding cross-organizational collaboration. Collaboration is a critical component in leading a complex and integrated healthcare system of care. No longer can separate facets of a healthcare organization operate in individual information silos, and CIOs hold an increasingly important role in connecting a hospital through technology. Considering the building pressures of executives, here are three quick tips for healthcare leadership:

Planning for the Future

Healthcare organizations now look to leaders who are seasoned team players, willing to offer up fresh perspectives affecting the whole. While much of the healthcare industry is in flux, looking toward the future may seem difficult. However, long-term strategies are important for executives new to a position or an organization, especially when considering demands to stretch tightening budgets.

Leading by Example

Frontline staff, from check-in to patient visit follow up, play a crucial role in patient satisfaction. With such a significant role, healthcare leaders need to motivate and lead these individuals by example to impact their actions and decisions toward each patient interaction. C-suite leaders should take the time to engage one-on-one when possible with frontline staff. Those who deliver valuable care are incredibly important to the success of a healthcare organization.

In an article by Becker’s Hospital Review, former Modern Healthcare publisher and author/public speaker Chuck Lauer said the following:

“The healthcare field needs new ideas and courageous leaders to make them happen. Leaders must show resolve and a willingness to change if the conditions merit doing so. On the other hand, a leader must also be consistent and mature in their personal behavior. After all, a leader sets the tone of a given organization and if they are not consistent that can often sow the seeds of unrest and stress. Any of those things can be a major component of failure and consequently must be avoided!”

Addressing “No”

By all means do we understand the incredible juggling act that c-suite executives manage in balancing multiple projects, but what happens when stakeholders want an exciting new project that really isn’t within bandwidth? Within the same Becker’s article, Beth Israel Deaconess Medical Center CIO John Halamka shared that “What not to do is as important as what to do, because each of us gets this laundry list of hundreds of things that stakeholders want. The technique I usually use is not to say ‘No.’ ‘No’ is such a negative word, so loaded with emotion. So, I say, ‘Not now.’ My role on the resource side is not to create fear, uncertainty and doubt, but to explain to the board what we need to do.”

ICD-10 Preparedness and Clarified Flexibilities

Can you believe we’re in the final stretch before the looming ICD-10 October 1 deadline? Well, for some healthcare providers, the thought is still surprising. According to a recently conducted RelayHealth survey of 130 HFMA ANI attendees, 17 percent of participants said they think ICD-10 will be delayed again, while only 13 percent felt they are fully ready for ICD-10.

Within the same survey, 32 percent believed the ICD-10 transition will actually take place on October 1, 2015, but with provisos. A majority of participants (59 percent) thought physicians need more training on documentation, and 39 percent felt coders need more training or opportunity for practice with new codes.

Considering it’s already August, providers can’t bank on another delay. Instead, they must make sure they have the necessary processes in place for this transition and work with thoroughness and urgency, not panic. Consider the possible problem areas for ICD-10 testing, and be proactive about them.

In the meantime, the Centers for Medicare and Medicaid Services (CMS) has clarified flexibilities after the ICD-10 compliance deadline. Providing a question-answer formatted document, CMS gave feedback to the healthcare industry. However in doing so, CMS has reiterated the release of this FAQ does not indicate another ICD-10 delay.

CMS clarified the following ICD-10 specifications below:

  • The ICD-10 ombudsman will be in place by Oct 1.
  • If a submitter’s claims are denied, they will receive explanation of the rejection.
  • Submitters should follow existing procedure for correcting and resubmitting rejected claims.
  • CMS will indicate whether a claim is rejected for invalid code versus lack of specificity needed for Local Coverage Determinations or National Coverage Determinations.
  • Added ICD-10 flexibility only applies to Medicare fee-for-service claims, but each state’s Medicaid program will be responsible for processing submitted claims that include ICD-10 codes for services on or after Oct 1 in a “timely manner.”

A full list of the 2016 ICD-10-CM codes and code titles can be found here, with codes listed in tabular order.


At this stage in the game, our experts offering the following pieces of advice for ICD-10 preparation:

  1. For each physician, make a list of the top 25 ICD-9 diagnosis codes utilized over the past 12 months (Set A).
  2. From Set A, have your coding group research and prepare a crosswalk of each ICD-9 code to its ICD-10 counterpart (where there is 1:1 correlation).  Note if there are any additional documentation requirements the physician will need to make going forward for Set A.
  3. For the subset of codes that do not have a 1:1 match (Set B), have your coding group create a flow chart by code that depicts the required documentation and medical rationale needed in order to identify the correct ICD-10 code. Denote the additional required documentation requirements.
  4. Perform physician education.
    1. Present Set A and highlight additional recommended documentation that will be needed going forward. For many physician lists, there will be a 1:1 match from the ICD-9 code to its ICD-10 counterpart.
    2. Present Set B and highlight the ICD-10 coding requirements (documentation and decision rationale). Work with each physician to personalize education as needed. Remember, it is estimated that an additional 20 percent of time will be required to fully and accurately document the correct ICD-10 code. Time spent in education prior to October 1 will lessen the negative impact on the revenue cycle.
  5. For physicians with lists where the majority of codes do not have a 1:1 match, arrange education in small focused groups, perhaps using their medical specialty. The impact of ICD-10 is greater for some medical specialties than others (cardiology, orthopedics, emergency medicine, surgery). Use this knowledge proactively and offer additional specialized education for these physicians as their claims typically show higher dollar values and therefore pose more risk to the revenue cycle.
  6. For hospitalists, arrange separate education that includes SNOMED training. The October 1 deadline will also bring a dramatic change in inpatient procedural coding.

Linking Smart Data Analytics and Population Health Management

With the overwhelming amount of data accumulated by healthcare providers across the country, the application of true smart healthcare data analytics can seem challenging. Last month at HIMSS15, we saw HIT leaders express confusion toward data analytics in our third annual Health IT Industry Outlook Survey. Within the survey,  84 percent of participants, representing CIOs, CMIOs, IT project managers, IT directors and consultants had questions around type, quantity, and ways in which to use their healthcare data. On top of this, 62 percent stated the biggest barrier to IT initiatives around MU and data analytics was a lack of organizational buy-in or financial resources. So, how do we transition these concerns into smart actions?

In a recent article for HISTalk, Stoltenberg Vice President Shane Pilcher addresses this question and ties smart healthcare analytics into population health management. See Shane’s article here.


Looking Back on Big Data Effectiveness

With HIMSS15 right around the corner, it seems fitting to focus on one of the conference’s upcoming hot topics: The Future of… Big Data. In a survey published by InformationWeek, participants were asked about the effectiveness of their organizations in identifying critical data and using it to make decisions.


Big data, big trouble

Of those surveyed,  30 percent shared that their companies are very or extremely effective at identifying critical data and analyzing it to make decisions. This figure falls from 2013’s 42 percent. Additionally, 63 percent said they are only moderately effective, while 7 percent claim defeat in the big data journey.

Revisiting these results makes us wonder if the health IT industry will have similar apprehensions about big data at this year’s conference. Has the year span made enough of a dent in these issues to incite organizations to use big data and business intelligence toward informed clinical and business operations decision-making?

While we celebrate the buzz big data’s popularity provoked over the past year, we also note that organizations cannot blindly jump onto the big data bandwagon. Healthcare organizations should not simply collect data for the sake of collecting data. For true big data success, healthcare organizations need to work towards obtaining smart healthcare data. The differentiating factors of smart healthcare data are the types of data being collected, the volume of the data, and its validity. By establishing best practices in the data collection process for the right type and amount, organizations won’t be left with large quantities that cannot be analyzed well.

People + processes

Additionally, while key performance indicators, benchmarks, and dashboards help to indicate progress of data collection, BI initiatives and efficiency of organizations, true success cannot be met without organization-wide support and a strategic roadmap. Both clinical and financial end users must come together to engage with, understand, and support BI technology and processes. At the same time, these end users should be provided with information relevant to their roles and department goals to effectively alter staff performance. Executive leadership must also lead organization-wide buy-in by example and prepare BI processes to answer anticipated future “what if” questions. A BI solution is not a cookie-cutter solution. Hospitals must combine industry insights and experience to interpret the right data to transform both clinical and financial processes, supporting unique organizational goals and cultural change.

HIMSS15 blog carnival

This blog post was created to promote and join in on the #HIMSS15 Blog Carnival buzz, following the topic of “The future of big data.” For more information on the Blog Carnival, please contact: For more information on HIMSS15, please visit: Http://

Thank you for your time, and we hope to see you at HIMSS15 in Chicago!

HIMSS15 Blog Carnival

Whether you’re attending HIMSS15 in Chicago or not, you and your organization can still join the HIMSS buzz in this year’s Third Annual #HIMSS15 Blog Carnival from April 6-10! The Blog Carnival will promote health IT hot topics one week before the actual HIMSS conference to provoke meaningful conversations.


HIMSS15’s five Social Media Ambassadors will serve as the carnival hosts. Each Social Media Ambassador will host one day of the carnival, offering his or her industry expertise and perspectives on the topic of the day.

The overall theme of the carnival will be “The Future of…,” with a specific focus for each day:

· Day 1: The Connected Healthcare System

· Day 2: Big Data

· Day 3: Security

· Day 4: Innovation

· Day 5: Patient Engagement

 Anyone from the health IT community is welcome to submit his or her blog posts by the March 20 deadline.

How to submit to the #HIMSS15 Blog Carnival

  • Create a blog post that fits the five subject areas specified above and theme of the Carnival.
  • Make posts non-promotional in content and focused on the designated topics.
  • Submit blog posts to for review before March 20.
  • Clearly state in your email subject the theme topic you are have written about. Authors are welcome to write several posts for one or multiple topics.

Good luck with your posts!