- With the Quality Payment Program (QPP) under MACRA now in its first year, both healthcare providers and federal agencies such as CMS hope participating hospitals and physician practices are better prepared to meet requirements and avoid payment penalties.
However, the outlook for most physicians is not good. A survey by the American Medical Association (AMA) and KPMG found more than 75 percent of physicians feel unprepared to meet MACRA requirements in 2017.
“This survey showed that about a third of respondents are unlikely to meet the basic standard of one patient, one measure, no penalty,” stated AMA President David O. Barbe, MD.
Under QPP, providers must either participate in the Merit-Based Incentive Payment System (MIPS) track or the Advanced Alternative Payment Model (APM) track.
With the October 2 deadline for MIPS participation approaching, providers at least need the confidence of knowing their EHR systems have the capabilities to fulfill the federal reporting program’s requirements.
As a baseline, hospitals and physician practices participating in QPP need to use ONC-certified health IT to meet requirements. The health IT certification program is intended to confirm the quality of certain EHR systems and ensure oversight of developing technologies. To earn certification, technologies must meet key industry security and interoperability standards.
According to the 2017 QPP proposed rule, eligible clinicians can use 2014 Edition Certified EHR Technology (CEHRT) to meet reporting requirements.
However, the use of 2015 edition CEHRT is encouraged. CMS stated it will add “bonus points in the scoring methodology for caring for complex patients and using 2015 Edition CEHRT exclusively.”
While ONC health IT certification can be useful in earning payments under QPP, providers should be wary of relying too heavily on certifications during EHR selection.
Following the $155 eClinicalWorks lawsuit to settle allegations of false EHR certification, healthcare industry insiders have warned against trusting CEHRT at face value.
“The best advice for a provider buying health IT is not just to rely on the certification and on responses to the RFP the vendor provides, but to do site visits and reference calls,” said Epic Vice President of Interoperability Peter DeVault at the Value-Based Care Summit earlier this month. “You have to see it in action.”
Beyond ensuring an EHR system is certified, hospitals and physician practices also need assurance their system has a high degree of usability.
The administrative burden associated with fulfilling reporting requirements could sap many physicians’ love of medicine, heightening the risk of physician burnout.
Data entry often eats up the lion’s share of a physician’s workday. A recent study by the University of Wisconsin and AMA found primary care physicians spend almost six hours on EHR data entry during a typical 11.4 hour workday.
“This study reveals what many primary care physicians already know – data entry tasks associated with EHR systems are significantly cutting into available time for physicians to engage with patients,” said Barbe. “Unfortunately, clerical and administrative demands are not being reconciled with patient priorities and clinical workflow.”
EHR systems with a high degree of usability could be useful in deterring some physician frustrations. The extra clicks required to fulfill administrative tasks in some EHR systems add up, ultimately leading to many providers disliking the technology.
“Poorly-designed and implemented EHRs have physicians suffering from a growing sense that they are neglecting their patients and working more outside of clinic hours as they try to keep up with an overload of type-and-click tasks,” said Barbe.
According to a 2017 KLAS global EHR marketshare report, usability was one of the primary factors driving EHR selection this year. Specifically, the usability of Epic EHR catapulted the system to become a worldwide frontrunner along with InterSystems.
As part of QPP, eligible clinicians can also participate in improvement activities. The improvement activities performance category assesses how often clinicians participate in activities that improve clinical practice and patient health outcomes.
Improvement activities include population health management, care coordination, and behavioral and mental health integration, among others.
Optimizing an EHR system with population health management software could boost a practice’s ability to meet the improvement activities category.
Many health IT companies including Epic Systems and Cerner Corporation have begun offering population health management platforms. The Cerner population health management platform in particular has gained traction at large health systems including Carolinas HealthCare System (CHS).
In addition, implementing alerts such as admit, discharge, and transfer (ADT) notifications could assist in improving care coordination. A recent editorial by Utah Health Information Network (UHIN) showed enabling ADT notifications could improve care coordination, reduce hospital readmissions, and save money.
“This level of care coordination quite literally saves both lives and money,” said UHIN President and CEO Teresa Rivera. “However, for it to be successful, all of Utah’s hospital systems must be willing to securely share their admission and discharge transactions with the appropriate health care community responsible for the patient’s care — including those outside their own system.”
Selecting an EHR system with the necessary health IT certification, degree of usability, and capabilities to meet reporting requirements for MACRA in 2017 could assist a practice in earning incentive payments and avoiding potential penalties.