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Is Your Practice Ready for MACRA?

One of the most recent examples of the changing healthcare landscape is the Medicare Access and CHIP Reauthorization Act, or MACRA. This law is primarily focused on encouraging physicians to deliver valuable healthcare services to patients as part of the Affordable Care Act. With the first performance reporting period beginning on January 1, 2017, many physicians still have a lot of work to do to meet the requirements. Here is what you need to know.

What is MACRA?

MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that is focused on quality, value, and accountability. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service. MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-Baased Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-Based Incentive Payment System, or “MIPS.”

What is MIPS?

MIPS includes four performance categories: quality (50%), resource use (10%), advancing care information (25%), and clinical practice improvement activities (15%). These categories are used to evaluate a provider’s quality, use of services, EHR use, and quality improvements to care coordination and delivery. A provider’s quality score determines the payment adjustment in subsequent years. The payment adjustment is 4% in 2019, 5% in 2020,  7% in 2021, and 9% in 2022 and beyond.

Advanced care information: Health information measure

Under MACRA, Meaningful Use has been transformed as part of MIPS scoring. The new model includes an expanded APM track now known as Advanced APM. Advanced care information is significant because it contributes to 25% of the total score in year one. Clinicians can choose to report customizable measures that reflect how they use EHR technology in their day to day practice, with a particular emphasis on interoperability and information exchange.

How the RGV HIE can help

The RGV HIE offers an affordable solution for clinics and health organizations to share patient health information to meet current legislation requirements such as Meaningful Use, PCMH, and MACRA. Essentially, you connect your EHR to the HIE one time and we can direct your data to any destination required at a reasonable fee. Our technology will enable your organization to have the option to participate in our HIE, disease registry, or quality reporting tool.

Reaching Healthcare Goals Through HIE

Health Information Exchange (HIE) has the potential to change the way we provide and receive medical care. It will eliminate fatal medical errors and save lives. No wonder governments all over the world are promoting this practice.

The first step towards the exchange of medical information is the creation of Electronic Health Records (EHRs). More and more service providers have started using EHRs. There is a common belief that the use of EHR will increase provider productivity, improve patient care, and decrease practice costs. Small practices may find the idea of converting to EHR fairly overwhelming, but technical and financial assistance is available to them.

Preventable medical errors cost the lives of thousands of patients each other. In fact, medical errors are claiming more lives than motor accidents, AIDS, and breast cancer combined. Miscommunication is the cause of 80 percent of these errors. It is time we created a system that provides more responsible care and facilitates better communication.

Health Information Exchange

The creation of a nationwide health information exchange (HIE) program will facilitate better communication among health care providers, staff, and patients. The objective of this program is to bring about revolutionary changes in the health care system. Effective implementation of HIE will ensure that each patient receives optimal care. HIE will optimize health outcome, improve patient experience, reduce health care costs, and increase provider satisfaction.

A robust EHR system is the cornerstone of HIE. A typical EHR system has the following components – the history and demographics of the patients, clinical notes of the physician, a comprehensive list of the medications and allergies of the patient, and computerized orders for prescriptions among others. In addition, EHR will enable the patient to see imaging and laboratory results electronically. The factors that limit the application of HIE are high financial investments, workflow redesign requirements, and an increase in the training time of the physician and the staff. In addition, health care facilities will probably have to employ new staff to provide HIE support. If these hurdles can be overcome, HIE will create a database of health information that will coordinate patient care and improve communication amongst health care providers about shared patients. The overall outcome will be beneficial to both the patients and the care providers.

Benefits of HIE include better access to health care, less paperwork for doctors and patients, better care, increase in administrative efficiency, decrease in the cost of healthcare, and prevention of deadly medical errors. HIE will also ensure that patients and their families are actively involved in their healthcare.

An electronic health record converts paper record into electronic format. This enables faster communication, clinical decision making, and recall. The use of EHR changes the way a practice communicates. It provides instant access to patient data and redesign workflows. There are several benefits to this. It will reduce transcription costs, and facilitate the easy identification of patients with specific needs and conditions.

E-prescribing is another aspect of this. This allows a physician to send an error-free and understandable prescription from the point-of-care to the pharmacy electronically. Health Information Exchange (HIE) technology is crucial to the success of this program. Proper HIE will enable the secure sharing of health care data between organizations.

Before they can create an HIE, organizations have to define their goals, align stakeholders, and focus on the various components that will make information exchange successful.

Where to start

A successful HIE program will create patient data that can be shared, tracked, and analyzed by physicians and other health care providers. Before plunging into HIE deployment, health care organizations should assess their readiness. They should ask themselves if they have the right technology. They should analyze the current structure of the organization to see where new staff has to be incorporated. Organizations should also identify medical trading partners.

MACRA: What You Need to Know

“The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) proposed rule represents a fundamental change in the way healthcare is paid for and is aimed at establishing the infrastructure for value-based reimbursement.”

Learn more about this proposed rule here.