MACRA: As Physicians Prep, Hospitals, Tech May Lag

There is a disconnect between the MIPS / MACRA push for physicians and what is happening on the hospital side of the equation.

Physicians might be ready for MIPS and MACRA, but are their EHRs and other technology tools up to the challenge?

It depends on who you ask.

"It's unfortunate that some physicians and hospitals have not made the investments in the tools that can improve the provision of care for patients," says Bill Kramer, MBA, executive director for national health policy at the San Francisco-based Pacific Business Group on Health.

"They were given lots of money under the meaningful use program to put those tools in place. There are many quality improvement organizations, consultants, to help providers improve the quality and efficiency of care," he says.

"There are clinical guidelines that specialty societies have developed that should be used and they aren't. There are measures to improve patient safety in hospitals that have only been used sporadically."

"I think," continues Kramer, "physicians and clinicians and hospitals should be doing the right thing to improve care for patients, not just doing this in response to regulations."

MACRA, the End of Meaningful Use, and Beyond

And yet, in my own reporting on MIPS and MACRA, I have often heard that the technology tools built all around meaningful use remain immature when it comes to the kind of quality reporting that MIPS and MACRA will require from day one, January 1, 2017.

Kramer dismisses these concerns. "We shouldn't be having a debate about whether the tools exist," he says. "The question is now, will clinicians use them to improve quality of care?"

Two Different Systems

There is a disconnect between the MIPS / MACRA push for physicians and what is happening on the hospital side of the equation.

"We have a completely unequal system right now," says Russ Branzell, president and CEO of the College of Healthcare Information Management Executives (CHIME).

"We have a system that gave leniencies to physicians, while at the same time not giving the same leniencies for the hospital-based side. Yes there are physicians, and a lot, that still work in a private practice setting, in a private environment, but wouldn't you want a harmonization of the entire system to be out there?"

According to Branzell, "we are still a long way from a universal set of clear, objective, clinical-based quality measures that we all agree on that should be used. "

"There's still a significant fragmentation out there that we have the opportunity to still bring together," he says.

CHIME's comments on the MACRA NPRM, filed in late June along with a torrent of other comments from stakeholders, mentions a long list of technology-related issues which could thwart MIPS and MACRA from achieving their aims.

In particular, CHIME is concerned that a provision of MACRA requires providers to attest they are not data blockers. In its MACRA comments, CHIME stated that while the nation still lacks a national patient identifier, "clinicians may experience matching patients to their records when records are exchanged; however, this should not be considered data blocking."

CHIME also considers immature technical standards a barrier to a second proposed attestation statement providers must sign under MACRA, basically stating that they are following applicable standards for successful implementation of MACRA and MIPS objectives.

"It's imperative that such standards are clearly defined and appropriately matured to facilitate meaningful data exchange," CHIME's letter said.

Given where we sit in the midst of an election year, while there is interest on the part of some politicians to pass legislation modifying MACRA to address these concerns, Branzell notes that "we do have the rules that we have."

More legislation seems unlikely until after this election cycle. Meanwhile, Branzell's concern remains that CMS is "repeating now the same mistakes we made in [meaningful use] stage 1 and stage 2."

Both Kramer and Branzell note that forward-looking healthcare organizations are not waiting for further rulemaking, but are making the best effort they can, with the resources they have, to pivot from fee-for-service to value-based care, using the tools available.

"The good organizations that are out there, of which there are many, are already working on that for the right reasons, and it's not because the government is going to come out with one of these models," Branzell says.