Insights From the Sixth Annual Health IT Industry Outlook Survey

Over 300 HIT professionals shared their insights in the sixth annual Health IT Industry Outlook survey. The results focus on health IT leaders working collaboratively to stay on top of evolving staffing, EHR system and technological advancement trends for operational efficiency and proactive patient care. Hospital IT departments continue to struggle with strained resources and competing projects. As the industry pushes forward with value-based care, the ability to optimize technology and workflow within an organization is vital for success. Here are four key takeaways from the 2018 survey:

  1. Need for a cross-disciplinary team

Within the survey, measuring improvement in patient care quality was rated as the top business objective (40 percent) by health IT leaders. Outdated passive measurement processes no longer work in today’s complex health systems. Considering competitive pressure in the new healthcare landscape, each hospital department must eliminate communication silos for a cohesive strategic conversation. To proactively establish efficient workflow, reporting needs and streamlined communication, create a cross-disciplinary team from all areas impacted by a new or optimized EHR system. Healthcare organizations need to look at the full picture of patient care to make proactive decisions.

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  1. HIT staffing solutions

Optimizing IT/EHR performance (32 percent) and overcoming IT staff shortages (31 percent) were cited almost equally as the most significant challenges in 2018 among survey participants. To strategically address healthcare IT staffing challenges, identify support gaps by creating a visual support map covering all facilities, applications and tools impacted by a new EHR or large-scale IT deployment. You can be creative in staffing by looking to local sources such as area colleges to utilize students in IT, healthcare administration, education, nursing or healthcare-related programs. This can be helpful during short-term projects like system go-lives or vendor upgrade support.

  1. Integration for quality care improvement

Clinical application and implementation support (32 percent) remain the top 2018 IT outsourcing requests, followed by hospital IT service desk support (28 percent). While EHR adoption is nearly universal across the country, there is much more depth to a full system implementation than an initial go live. Integration is essential for improving care quality and ensures that health organizations have a comprehensive, accurate and reliable perspective on their care performance reporting. HIT leaders can combat health system interoperability challenges by focusing on tight integration of IT platforms and data across internal hospitals, practices, providers and even patients at home. A clinically consultative HIT service desk can help identify siloed issues with workflow and end-user errors while serving as a single source of contact.

  1. Making MACRA a habit

Finally, the survey found that most organizations stills struggle to align reporting priorities with practices within year 2 of MACRA. Forty percent of survey participants reported feeling underprepared for year 2, and only 12 percent felt very prepared. When organizations are short-handed for IT support and optimization, it can impact other initiatives such as MACRA reporting strategy. By making the data capture and analysis more automated and consistent, preparation can be easier. The result will be more detailed documentation, better EHR utilization and QPP category maximization – making strategic MIPS participation a more simplified process.

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.

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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