The More Things Change, The More They Stay The Same

Earlier this month, SRS Health attended the 2018 American Academy of Orthopaedic Surgeons (AAOS) Meeting. For us, it is an opportunity to spend time with our clients, make new connections and most importantly keep our finger on the pulse of the industry. Each year, we come back home with a list of hot topics or trends and ensure that we are addressing them. This year however, I felt a sense of déjà vu. So, I went back to the 2017 post-AAOS blog and found that the high level topics were almost identical to what I would have written myself.

  • prescription safety
  • data mining/outcomes;
  • cost reduction/operational efficiencies; and
  • MACRA/ MIPS readiness.

Does this mean there has been no progress in the 12 months since the last conference? Not at all.

Prescription Safety – in 2017 really translated to Electronic Prescription of Controlled Substances (EPCS). In 2018, we find that although 91.9% of pharmacies now support this technology nationwide, only 22.9% of providers are EPCS-enabled. More importantly, in 2018, new complexities have been added as many states now also do or will require checking Prescription Drug Monitoring Programs (PDMPs) before prescribing certain medications.

Outcomes in 2017, outside of hospital and research settings, was limited to the basic assessment for the purposes of meeting some requirement like a quality measure, CJR or BPCI. In 2018, adoption by larger groups is starting to gain momentum. Rather than just focusing on the minimum government requirements, practices are beginning to see the value in being able to improve the quality and efficacy of care through evidence and solid data.

Cost Reduction/Operational Efficiencies in 2017 meant actual hard cost-cutting or expanding business lines to bring more of the continuum of care under the practice’s control. In 2018, not only do we see a continuation of those two strategies but more and more practices are looking to justify spending. They are looking at the value of each technology, each partner, and deciding what they can change, combine or cancel.

MACRA/MIPS in 2017 was a transition year and HCIT vendors warned providers not to be complacent. We warned that you should be ready to jump into the program in 2018 and beyond. Well, in 2018 Congress enacted the Bipartisan Budget Act of 2018. This act pushes out the full implementation, effectively making 2019, 2020, and 2021 three more transition years.

Although change management, especially in healthcare, is often slow, having the right technology to address the challenges and opportunities we face—at the right time—is key to optimizing patient care, practice performance, and population health.

At SRS Health, we’ve developed and delivered a specialized end-to-end solution that addresses the topics above, so that we are ready when you are!

Providers Heard Promises and Warnings at HIMSS

I just spent three days in Las Vegas at the annual HIMSS conference, with 43,000 of my closest friends. As the Vice President for Government Affairs at SRS Health, my goal in attending this conference each year is to get a heads-up directly from the leaders of CMS and ONC regarding what the government has in store for physicians. While no secrets are leaked in the sessions or meetings at HIMSS, several government program–related themes clearly emerged this year—topping the list was interoperability and burden reduction.

  • Seema Verma, Administrator of CMS, promised a “complete overhaul” of Meaningful Use, and (I assume) by extension, the ACI portion of MACRA. She was purposely short on details, so we don’t know exactly what that means, but subsequent conversations with her team confirmed what it does not mean: MACRA is not going away; MU3 is not disappearing; and the use of 2015 CEHRT is not off the table. I don’t expect that we will see major changes, but we will have to wait for the details to be revealed in the rulemaking that comes later this year.
  • Interoperability will be the focus going forward, and providers were warned that measures are being developed to identify and prevent information blocking, as required by the 21st Century Cures Act, going so far as to impose fines for willful actions in this regard. Patient data must be shared freely between providers; and it must be made easily—and electronically—available to, and controllable by, the owners of that data, i.e., the patients themselves, through programs like the newly announced MyHealthEData initiative.
  • Promises of regulatory relief and clinical burden reduction were abundant, and were offered within various contexts, including the overhaul of MACRA to reduce the time providers devote to compliance, streamlining documentation for the E&M coding/billing process, and the introduction of the Meaningful Measures initiative to increase the validity and efficiency of quality measurement and reporting. ONC and CMS led several ”listening sessions” in which they sought feedback on burden reduction—I sensed hopeful optimism tempered by healthy skepticism on the part of attendees.
  • The opioid crisis is on everyone’s mind. As one Congressional staffer put it, this is the “issue du jour.” It is being addressed at the national level as well as by the states, the majority of which are already mandating PDMP checking before a physician can write a prescription for a controlled substance. One challenge here will be for HIT and EHR vendors to automate this process so that the problem can be tackled without creating a new task that providers will perceive as yet another burden. 

It will be interesting to see what progress is made in all of the above areas when HIMSS reconvenes in 2019.

Congress Authorizes Changes to MIPS

mips-blogHow many times have you heard the expression, “It would take an act of Congress.”? Well, Congress has acted! Had this blog been posted just 2 weeks ago, the message would have been slightly different and a little more ominous in tone. I would have said—and you may have read articles elsewhere where I did—that the MIPS transition period is coming to an end, and providers should begin to prepare in earnest for 2019, when by law, the MIPS threshold would be much higher and the cost category would account for 30% of the MIPS score. These provisions in MACRA were not subject to CMS’ discretion; but apparently, Congress has been persuaded to extend CMS increased flexibility. As part of the Bipartisan Budget Act of 2018, Congress has pushed out the full implementation of MIPS from 2019 to 2022, effectively making 2019, 2020, and 2021 three additional transition years.

This means that:

  • There will still be winners and losers since budget neutrality remains a requirement; however, CMS is now not obligated to set the MIPS threshold at the mean (or median) of prior performance until 2022. Instead, the threshold will be gradually increased to that level over the intervening years, the good news being that it will not be as challenging to avoid a downward adjustment for a few more years. The consequence of this, however, is that the amount of money available to winners will continue to be less than the maximum provided for in the law, (i.e., 5% related to the 2018 performance year, 7% for 2019, and 9% from then on.)
  • The Cost category does not jump to 30% of the MIPS score in 2019. CMS can hold off on the increase until as late as 2022, with the flexibility to set the rate at between 10% and 30% each year until then and to make it 30% only when the Secretary is confident that the resource use, (i.e., cost), measures are ready for adoption. In addition, the bonus points for year-over-year improvement in this category have been eliminated.

Through these changes, Congress has relieved some of the immediate pressure for providers. However, this does not change the fact that it will become progressively harder to score well as providers gain experience, making MIPS increasingly competitive in the coming years:

  • The Quality and Cost categories will remain distinguishing factors among providers.
    • It will become progressively harder to score well in the Quality category. Benchmarks will be more aggressive as providers build experience. The 2018 benchmarks have been posted on the QPP website, and you can already see differences from the 2017 deciles for some measures.
    • Improving your comparative Cost position is not something you can do overnight; it takes time. So, it’s not too early to address this area more vigorously.
  • MIPS performance has implications beyond Medicare payment adjustments. Your reputation could be impacted as CMS makes more and more performance data publicly available on its Physician Compare website. Consider what you want patients, referring physicians, and payers to see about you when they are researching your practice.

So, don’t let down your guard. Take advantage of the additional transition years to secure your future success.

Getting Down to Business

“Be part of something greater than myself”—that’s what inspired my career in healthcare technology more than 20 years ago, and it’s what still drives me as I take the helm as CEO of SRS Health. As we close out the first month of the new year, I’m happy to say that the SRS team is devoted to the same goal: we are continuing to develop the solutions, services, and support that our clients need to succeed in today’s and tomorrow’s healthcare landscape.

Outcomes. Value Based Care. MACRA/MIPS. Yes, the healthcare world is changing at a rapid pace, and part of our mandate is to keep clients up tokhal-blog date on changes in technology as well as in regulations. But our larger concern is to preserve the one thing that has not changed—the passion that inspires individuals to enter medicine in the first place. We cannot allow technology and government requirements to diminish that passion, or to degrade the experience of physicians, clinicians, or patients. The SRS EHR was originally developed as an alternative to point-and-click technology that interfered with the doctor-patient relationship, and SRS promises to continue to protect our doctors’ ability to do what they do best.

How? First, by knowing our clients’ patient-care and practice goals, and then by collaborating with them and our partners to create intelligent, innovative solutions with the flexibility to fit both those blazing new trails in value-based care, and those that are just starting out. The challenge is to succeed not just at the practice of medicine, but also at the increasingly complicated business of medicine. At SRS, we believe your healthcare technology should help you do both. It should be simple, practical, and easy to use—it should take care of business so that you can take care of patients.

My experience in healthcare and frequent conversations with clients have helped me understand the challenges facing physicians and practices today. Rest assured that I will sustain SRS’ commitment to ensuring that our clients are well-informed and well-prepared to face today’s and tomorrow’s marketplace challenges: we will continue to develop core and partner solutions, services, and support that ensure that doctors can focus on what matters most.

I look forward to my new role at SRS, to further discussions about the challenges facing healthcare today, and to meeting you at an upcoming industry event!

MIPS 2018 New Year Resolutions

Check out these top 5 tips for starting your 2018 MIPS reporting on the right foot!

  1. Focus on Quality! – 2018 new-years-resolution-mipsrequires full-year reporting. With quality being the highest valued category (50% of your MIPS score), now is the time to review your quality-reporting plan and make sure you are capturing all the necessary data to report successfully. Furthermore, this is the category where providers can really distinguish themselves. It is anticipated that ACI scores will generally be high due to MU experience, and that most providers will earn the full score in the Improvement Activities category.
  1. Understand Your Cost Position – In a change from the original proposal, the cost category will contribute up to 10% of your overall MIPS score. Look for CMS reports later in 2018 to help you understand how cost is assessed and consider ways to reduce the cost of care you provide.
  1. Plan your ACI Reporting Strategy – CMS is allowing the use of 2014-certified software in 2018. Here are your options:
    • Your EHR is 2014 Certified – report the 2017 Transitional Measure Set.
    • Your EHR is 2014 and 2015 Certified – report either 2017 Transitional Measure Set, the ACI Measure Set, or a combination of both.
    • Your EHR is 2015 Certified – report the ACI Measure Set.

Compare the two measure sets and evaluate which set will likely earn you higher performance scores.

  1. Pick Your Improvement Activities – CMS has included some additional Improvement Activities for 2018. Review the list and make sure you will be able to attest to completing them for at least 90 days in 2018.
  1. Strive for Better Performance – Improvement in the Quality (and Cost) category for 2018 over last year will earn you bonus points this year. Review your CQMs and readjust workflows as necessary to support higher performance.



Why an EHR Solution Is a Must-Have for 2018

Looking back at 2017 as we head into 2018, the resounding theme in healthcare has been the push to bring down costs and drive up quality by increasing efficiency and improving care coordination. As the healthcare landscape shifts and evolves with groundbreaking alliances such as the proposed CVS Health/Aetna partnership, it is interesting to note that the percentage of office-based physicians using an EMR/EHR solution is a significant 86.9%, with only a small percentage of medical practices still using traditional paper charts. (Health IT Dashboard)

Reasons cited by physicians for remaining on paper include failed implementations, fear of a loss in productivity, and security concerns. While these are valid concerns, practicing medicine using traditional paper charts is becoming increasingly difficult as the industry moves to a value-based payment model, with more emphasis placed on patient engagement, interoperability, and shared patient data.

Typically, physicians spend 30–40 hours per week interacting with their patients. In a paper-based office, each patient visit results in approximately 10–13 pieces of paperwork, detracting from the time spent on patient care. (Benefits of Modern EMR vs. Paper Medical Records) Even if the physicians themselves do not handle the paper, their staff must, and a paper-driven staff results in an unproductive office. Since paper charts can only be in one location, clinical and administrative staff spend valuable time locating and providing charts. When there are multiple office locations, the additional chart transport compounds the problem and the practice becomes even more unproductive. Most practice administrators estimate the cost of a chart pull at $5.00 in lost productivity. Multiplied across hundreds and thousands of active charts, the numbers become staggering.

To remain competitive in the ever-changing healthcare environment and to attract patients and physician recruits, an EHR solution is a must-have for 2018 and beyond. As the penalties increase and reimbursements decline year by year, EHRs play a critical role in helping to preserve and drive revenue and reduce costs. Significant benefits of adopting an EHR include:

  • Reduced Administrative Burden An EHR can eliminate redundancies in documentation, provide fast and accurate record transmission, and drive efficiencies throughout the clinic, inclusive of patient intake. This can be accomplished while mimicking the traditional paper chart, which allows for an easy transition from paper to an electronic system.
  • Heightened Cost Efficiencies – An EHR can drive productivity, saving physicians and clinical staff valuable time and reducing the need and/or cost of transcription services, chart rooms, and record clerks. Regulatory resources through a reputable HCIT partner can assist the practice in penalty avoidance and meeting the requirements for MACRA/MIPS.
  • Patient Referrals/Community Presence – A 2006 Harris Interactive Poll reported 55% of adults believed that the use of EHRs would reduce the number of medical errors, and 60% believed the use of EHRs would lower their healthcare costs. (Benefits of Modern EMR vs. Paper Medical Records). Since that time, patients have come to expect electronic access and communication with their providers through the use of a patient portal. In addition to medical records access, secured messaging, and appointment and refill requests, an integrated patient portal embedded in the EHR allows patient-entered information and demographics to automatically populate the chart and the note, saving critical time and expense.
  • Patient Safety – EHRs improve patient safety by providing an organized, all-inclusive electronic chart that houses reminders, messages, and alerts in addition to exam notes, diagnostic images, and medical, medication, and allergy history. Each chart is readily accessible from any office location as well as remotely so providers have the complete information when responding to messages from inside or outside the office.

So why do some practices continue to hold out? The most common reason cited for not making the transition is the inability to obtain a physician consensus—there are differing opinions as to the best EHR, and even as to the best approach, including how much or little interaction they want with the solution, and the degree of elimination of paper from the practice.

Successful adoption of a solution, therefore, can be ensured by working with a vendor who can tailor the implementation to the needs of the practice and its providers, addressing individual physician workflow preferences and providing flexibility and ease of use. Further, practices can ensure that the solution will support their preferred clinical workflows by choosing an established and recognized EHR partner with proven experience in their medical specialty. The right partner will also be able to provide testimonials and client references documenting its ability to implement, train, and transition practices from paper charts without any impact on either patient volume or productivity. Is your practice still on paper and if so, what’s holding you back?