HIMSS18 Pushes Immediate Patient-Centered Change

We have all heard the saying, “the customer is always right.” Consumers should drive how a business functions, next steps and where the industry is headed. In healthcare, it is no different. Patients expectations are raising higher standards in technology, experience and outcomes. The providers who fail to recognize the patient-centric culture forming will struggle to stay competitive.

HIMSS18 brought a multitude of insights to over 45,000 healthcare IT professionals on how to provide better patient outcomes. Technology is booming in healthcare, but adoption still lags behind other industries. Here are four themes from HIMSS18 to competitively propel healthcare providers:

  • Consumerism is here to stay. Patients are looking for a patient experience built on consumer preferences, personalization, flexibility and clear communication. This can include digital options for registration and billing, better ways to share EHRs digitally and personalized physician-to-patient interactions. Providers must use patient communities as an eye toward the next direction of their organizations.
  • Healthcare is moving from diagnosis and treatment to anticipation and prevention. Start looking at technology abilities not only as a tool or data storage, but to analyze and predict. Smart data enables insights toward physician care decision making, patient experience improvement, readmission reduction, population health management and prescription monitoring. The latter comes into play with the country’s opioid crisis, as prescribing systems are now working to flag addiction patterns and medication discrepancies.
  • Artificial Intelligence is the name of the game. AI has been introduced before, but its presence is finally in practical application in healthcare. Artificial intelligence will allow healthcare professionals to analyze the healthcare data they already have stored, alarm physicians of things that should be noted and let physicians better focus on patient experience while the machines look for gaps in data. The next step though is to make the technology accessible in practice at the point of care without adding workflow burden to end users.
  • Disruption is key. Healthcare organizations must focus on the consumer and how technology will evolve their abilities. Some say that health systems will be known as tech companies with a healthcare focus considering all of the technology advances leading to the future of healthcare.

Here’s a look at how several CHIME provider organizations are staying ahead with these themes: http://bit.ly/2Fs5dNU

HIMSS18 elicited many insights for the future of health IT. After all, it is not every day that you get to talk about machine learning detecting cancerous tissue. Then again, HIMSS brought up many tactics applicable to any healthcare organization despite differences in budget, patient communities, region or specific EHR. The conference teases what’s on the horizon for care possibilities but also grounds us with consideration of where reporting, CIO pain points, physician burnout and standardization need to be addressed.

Staying In the Know on MACRA

As a follow up to our last post, we want to give an update on the state of MACRA’s Merit-based Incentive Payment System and reporting tips. First, let’s address continued year 1 reporting.

Data Submission
Given feedback from clinicians across the country, CMS is working to lessen reporting confusion and burden. The center recently launched a data submission system for Quality Payment Program (QPP) participation. With the new platform, clinicians will need to create a login to submit and manage year 1 data, which is due by March 31, 2018. The system will connect clinicians to the Taxpayer Identification Number (TIN) associated with their National Provider Identifier (NPI) as eligible clinicians report either as individuals or a group. The system provides immediate feedback with real-time scoring as data is entered. However, scoring may change based on additional data input or new quality measure submission. To learn more, check out CMS’ QPP 2017 Data Submission Factsheet.

MIPS’ Future
Though CMS recently unveiled QPP year 2’s final rule, the group is now accepting recommendations for new specialty measure sets or revisions for 2019’s MIPS program year. CMS will accept suggestions until Feb 9, 2018.

While program planning moves along, pushback from the Medicare Advisory Board (MedPAC) arose. The advisory body to Congress recently suggested replacing MIPS with an alternative program model that is less burdensome and complex for participants. Meeting notes are here, and no changes have been officially made.

As each MACRA public discussion and policy adjustment occurs, clinicians may find more and more uncertainty. Our goal is to keep readers in the know, so they can focus on quality patient care.

Assessing QPP Year 2’s Final Rule

In the last leg of 2017, CMS has issued the MACRA Quality Payment Program (QPP) final rule for year 2.

After gathering feedback during the lengthy comment period, Acting Administrator of CMS, Seema Verma said, “During my visits with clinicians across the country, I’ve heard many concerns about the impact burdensome regulations have on their ability to care for patients. These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system.”

As medical and health IT professionals across the country work to assess the 1,653-page published final rule, let’s address key provisions.

MIPS Final Performance Categories
In calendar year 2018, the performance categories shift in weight to Quality at 50 percent, Improvement Activities at 15 percent, Advancing Care Information at 25 percent and Cost, the most significant change, moves to 10 percent of the final score. The final rule projects Cost to increase to 30 percent of the total MIPS performance score by the 2021 payment year.

Much to organizations like MGMA and CHIME’s dismay, both Cost and Quality require a full year of reporting. The MIPS performance threshold increased as well from just three points in 2017 to 15 points in 2018. CMS is also finalizing changes to 27 existing Improvement Activities with plans to introduce an additional 21 to the inventory.

Exemption and Bonus Opportunities
For QPP year 2, the low-volume threshold for MIPS exemption stands at 200 Medicare patients, while the reimbursement threshold is $90,000 in Part B.

As seen in the proposed rule, year 2 allows up to five bonus points toward the MIPS final score for treating complex patients. Bonus is also possible under the Advancing Care category for providers solely using 2015 certified EHR technology (CEHRT). However, 2014-edition CEHRT is permitted; the bonus just does not apply.

CMS has made concentrated effort toward small practices, which are defined by MACRA as 15 eligible clinicians or fewer. Small practices can earn a bonus of five points toward the final MIPS score. A hardship exemption also applies under Advancing Care Information for MIPS, providing three points even if small practices submit quality measures below data completeness standards.

In light of recent natural disasters, year 2’s final rule automatically weights the Quality, Advancing Care Information, and Improvement Activities performance categories at 0 percent for final score for those impacted by Hurricane Harvey, Irma, Maria or other natural disasters

MIPS Virtual Groups
As previewed in the proposed rule, QPP year 2 enables virtual group participation in the MIPS program. This is helpful for small practice clinicians, since they can team up for MIPS reporting on an aggregate basis, regardless of specialty or location. Those reporting under virtual groups must opt in by Dec. 31, 2017 for QPP year 2.

Advanced APMs
Under Advanced APMs, CMS extended the nominal amount standard of 8 percent until the 2020 performance year. The Medical Home Model holds a 2.5 percent risk with plans to gradually increase over time.

Starting in 2019, qualified payers (QPs) can leverage the All Payer Combination Option. An eligible clinician must participate in an Advanced APM with CMS as well as an Other Payer Advanced APM for this.

While most of the final rule’s provisions were previewed in the proposed rule, the industry is still assessing how the 2018 plan will impact clinicians and their practices. Stay tuned for part II of our QPP year 2 final rule follow-up, discussing implications and tips for success.

Staying Afloat As a CIO Amidst Industry Pressures

Across the country, over 80 percent of healthcare organizations now have an EHR system in place. While initial implementation no longer serves as a major issue, with the new technology comes added CIO pressures, including reimbursement program requirements, technology disparities and security challenges.

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Reimbursement reporting challenges

With year 1 of the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP) well underway, the healthcare industry forges ahead in the transition to value-based care reimbursement. While the shift aims to advance patient care, many providers find themselves swimming in reporting requirements or completely oblivious to the program altogether. According to a NueMD survey, 50 percent of physicians are unfamiliar with the reimbursement legislation, and 49 percent have never encountered any information about it at all.

Health IT can help clinical care fill in knowledge gaps by facilitating assessment of current patient care and technology practices that meet QPP measure requirements. By strategically aligning data capture, maintenance and analysis with outlined QPP measures while looking ahead to potential year 2 program leniencies, providers can ease burden. With a little preparation, IT can help find the low-hanging fruit for the reporting quick wins that will help avoid QPP penalties while maximizing the program’s financial bonuses.

Rural health disparity

As value-based care requirements elevate, critical access, small and rural healthcare providers lag behind. From 2008 to 2015, only one-third of hospitals surveyed by the American Hospital Association had at least eight of 10 performance management EHR functions in place. Just 33 percent of hospitals with fewer than 100 beds adopted such systems.

Discrepancies in technology advancement between rural or small providers and large medical systems creates a digital divide across the country. Small providers face the decision of closing shop, joining group purchasing arrangements, becoming part of ACOs or sticking it out on their own. These struggling providers need continued representation in HIT policy and government regulations beyond progress with the 21st Century Cures Act for vendor transparency or MACRA’s QPP year 2 leniencies.

Cybersecurity concerns

While advancing technology is vital for new patient care needs and expectations, its growing significance also puts healthcare providers at risk. In a recent MGMA survey, only 55 percent of healthcare professionals have confidence in their organizations’ IT infrastructures against cyber attacks, while almost one-third have faced a cyberattack.

As healthcare ranks poorly at 13th in U.S. industries for cybersecurity practices, more and more HIT departments are turning to outsourcing expertise. Total IT budget spent on outsourcing has increased from 10.6 percent in 2016 to 11.9 percent in 2017. Now, healthcare organizations are turning to third-party advisors to train and certify staff on security best practices, while partnering with external security providers and adding defense tools to the HIT suite of applications.

Despite these three areas of concern, by strategically planning for value-based care requirements, today’s healthcare CIO stand better equipped against mounting pressures, while assessing market trends, turning to third-party expertise and staying on top of industry policy change.

Defining MACRA: What Is It, and How Will It Impact Your Organization?

(Updated June 21, 2017)

The first reporting year of the Medicare Access and CHIP Reauthorization Act (MACRA) is officially underway, but many physicians and healthcare organizations across the country still struggle with comprehending where they stand. Providers no longer have time for guessing. Instead, healthcare organizations must create and maintain strategic plans for reimbursement, covering everything from who will head MACRA initiatives to what reporting measures best match organizational strengths. Let’s begin by answering some key questions about the final rule.

What is it?
MACRA replaces the old sustainable growth-rate (SGR) formula for physician payment, transitioning focus from fee-for-service to value-based care. Clinicians now need to pick from one of two reimbursement tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

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APM versus MIPS
A lot of confusion can arise when physicians try to understand what path under MACRA is best suited to their business. With the initial reporting year already underway, if you’re unsure of your path, you’re likely not reporting under APMs. The Advanced APM track offers practices the opportunity to earn more in exchange for taking on some risk related to patient outcomes. Models qualifying for 2017 reporting include the Comprehensive ESRD Care Model (Large Dialysis Organization arrangement), Medicare Shared Savings Program (Track 2), Medicare Shared Savings Program (Track 3), Next Generation ACO Model, Comprehensive Primary Care Plus (CPC+) and Oncology Care Model Two-Sided Risk Arrangement. In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through participation in these Advanced APMs.

The other option, MIPS, is based on reporting quality metrics, resource use, clinical practice improvement and advancing care information categories. Performance tracking for MIPS began January 1, 2017, with reported data submission due by March 31, 2018, for the 2019 adjustment payment period. In this initial 2017 performance year, physicians can earn or lose a potential 4 percent of their reimbursement. Those exempt from MIPS reporting are providers who do not generate at least $30,000 in Medicare Part B billing, and those who do not provide service to at least 100 Medicare patients per year. For the 2018 reporting year, CMS is now proposing to amend exemption threshold to $90,000 and 200 Medicare patients per year to help small practices.

The difficulty with MIPS is determining the metrics for reporting that best align with physician care and organizational strengths. Also, physicians have options within this first year toward what reporting pace they’re utilizing.

The significance of MACRA moving forward
No matter your health organization’s reporting path, MACRA requires physicians to properly capture, maintain and analyze data from both financial and clinical areas to maximize their reimbursement opportunity. In the transition to value-based care, MACRA pushes healthcare providers to be more strategic and stringent with their data to meet reporting requirements, prepare for future regulation changes and cater to today’s evolving patient needs.

Progress for Small and Rural Health

Today’s small and rural healthcare providers still find themselves hindered by financial and staffing limitations amidst growing industry standards and regulations. As patient expectations evolve in the transition to value-based care, these organizations’ IT capabilities fall behind the curve. Lack of budget prevents the ability to transition EHR vendors or bring in outside resources to aid with optimization initiatives. With limited staff, practices cannot pull individuals away from regular duties to focus on IT training. In turn, practices struggle with moving beyond inefficient workflows and processes or being able to effectively gather and analyze data for quality measures. For rural health, geographic location also limits patient engagement and population health management capabilities. Patients are less likely to complete wellness visits or additional health maintenance when they have long commutes or limited access to physicians.

Despite these small and rural health IT challenges, positive progress across the industry can aid these struggling providers.

Mobile health- Mhealth app usage doubled from 2013 to 2015, according to a PwC survey, and growth is expected to continue in 2017. Mobile health applications can help isolated healthcare providers improve outreach, population health management and patient engagement efforts, while keeping patients out of the hospital. Mhealth capabilities can also expand rural providers’ impact on patient follow-up care and wellness decisions for improved care delivery. M-health capabilities can expand small and rural providers’ impact on patient follow-up care and wellness decisions for improved care delivery.

Telemedicine- According to a recent survey, 20 percent of patients would switch their current primary care provider if another provider offered them telehealth visits. Congress’ 2016 passing of the Expanding Capacity for Health Outcomes (ECHO) Act offers opportunity for remote and rural health providers to offset budget, specialty care and staffing limitations. ECHO expands Project ECHO’s model that pairs academic medical specialists with primary-care providers through virtual clinics for mentoring with behavioral and population health management. Proven through several academic studies, Project ECHO’s model overcomes rural physicians’ physical isolation through cost-effective access to specialty care best practices.

HRSA funding- The Health Resources and Services Administration (HRSA) allocated more than $16 million toward rural health telehealth and quality improvement initiatives. Administered by the Federal Office of Rural Health Policy, funding benefits 60 rural communities amongst 32 states. Of that, seven Rural Health Research Centers will receive $700,000 annually to investigate the health, economic and access challenges among these populations and how federal programs are impacting care and outcomes.

Interoperability- Small and rural health providers are often at the mercy of their EHR vendors in terms of willingness and capability of data sharing, as well as necessary version updates to meet with reporting requirements. With the passing of the 21st Century Cures Act, the U.S. government now clearly defines data blocking while issuing a commitment to holding the private sector accountable for transparency in health IT. This puts pressure on vendors to enable interoperability, which better connects small and rural providers for better patient care and safety across patients’ medical journeys.

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.

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