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Healthcare in 2018: MACRA, Tech and More


With the new year fast approaching, health care experts weigh in on what practices can expect from what is sure to be an eventful year.

The past 12 months were chock full of changes in health care. From a new physician payment system, a growing number of data breaches, and the increasing importance of health care technology, this past year was nothing if not eventful.

As 2018 draws near, Physicians Practice spoke with health care experts to find out what practices can look forward to in the coming year, and more importantly, how they can prepare.

MACRA is here to stay

Despite the outcry, criticism, and concerns expressed with CMS' Quality Payment Program (QPP), better known for the law which made it a reality, the Medicare Access and CHIP Reauthorization Act (MACRA), experts do not see the program going away any time soon.

In fact, practices will be required to more fully participate in the Quality Payment Program (QPP) during 2018.

"Practices still need to be cognizant of the quality and cost of care that they incur for their assigned patient population. They need to continue to do well in the [Merit-based Incentive Payment System (MIPS) program] and look into any alternative payment models that come along," says Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA).

The new year will bring a new challenge for physicians regarding MACRA, and more specifically, MIPS. For the first time, CMS will include cost as a component of a physician's MIPS score. "It's important that practices understand that the attribution calculations will kick-in January 1, and then practices will be held accountable for the entire year. Cost may be just a token 10 percent, but it represents a mindset change," says Gilberg. 

Like MGMA, the American Academy of Family Physicians (AAFP) is worried physicians may not realize the changes 2018 is bringing to MACRA and when those changes take effect. "For example, March 15, 2018, is an important date, as that is the deadline to report 2017 data to avoid a negative payment adjustment in 2019," says AAFP President Michael Munger, MD.

In addition to the cost factor, practices will be required to submit six quality measures for 60 percent of patients who qualify for each measure, with one being an outcomes measure, according to the MACRA final rule passed in November.

2018 will also bring an update to the fee-for-service payments, but it will not be the full .5 percent [increase] that was promised under MACRA legislation, according to Gilberg. "It was reduced by about a tenth of one percent due to the fact that CMS did not hit its target on the miss-valued code initiative. The update will be about .4 or .41 [percent]," says Gilberg.

Technology will continue to emerge

During 2017, EHRs remained at the center of controversy amid complicated reporting requirements and overall functionality and ease of use. Health care experts see the angst over EHRs continuing into 2018. "EHR refinements continue to be a major concern and are that is not going to change," says practice management consultant Owen Dahl.

In 2018, physicians will not be required to upgrade their EHRs for regulatory reasons, but there are bonuses in the QPP for practices that are meeting updated certification criteria, according to Gilberg. "It takes time to upgrade software, and it's never too early," says Gilberg.

When it comes attempts to reduce regulatory burdens, Gilberg believes the White House is willing to work with physicians. "The administration is pretty physician-friendly in terms of reducing the regulatory burden and dialing back any mandatory demonstration programs that require physician participation. I think the climate in Washington is fairly positive for physicians in that way," he says

Mergers could also play a role in shaping health care IT during 2018, according to Munger. The recent announcement of CVS Health's proposed acquisition of Aetna is something he expects to see more of in 2018, especially in the health IT space.

"Hopefully, we will see a large outside player such as Amazon disrupt the health IT market. I know Stanford University and Google Research are working together on a 'digital scribe' project in which the scribe is integrated into a major EHR product. The device uses speech recognition and machine learning tools to automatically enter information into an EHR system," says Munger.

Another area that cannot be overlooked when it comes to health IT in 2018 is the protection of healthcare information. "At this point, cybersecurity almost raises above government regulations when it comes to fear for practices," says Dahl. There are three main questions practices must ask to improve their cybersecurity in 2018, he notes.

• How can we prevent breaches?

• How will we detect a breach?

• How will we respond if hacked?

If your EHR vendor comes out with upgrades, review them seriously and implement them if it makes sense for your practice, urges Dahl. This will allow you to be as upgraded and secure as possible.

Making sure that all software is updated and secure is a strategy Munger also recommends, along with securing devices from practice employees. "Lock down office computers to not allow installation of applications by employees. Ensure a backup process is in place, and test to ensure the backup data is restorable," he says.

When it comes to the continued advancement and innovation of health care technology, Dahl sees almost no limitations for the coming year, "You can almost literally go to an Apple store now and buy a glucose testing option and an EKG machine. I think those type of things will continue to evolve and grow in 2018."  

Is the ACA here to stay?

The current administration and Republican members of Congress attempted to repeal and replace the Affordable Care Act (ACA) numerous times during 2017, ultimately coming up short while garnering criticism from groups including MGMA, AAFP, and the American Medical Association. So where does that leave the ACA for the coming year?

"I think the ACA is here to stay on unstable legs. It seems that there won't be a wholesale repeal. It seems like it's going to continue to be chipped away," says Gilberg.

The medical groups that came out against the notion to repeal and replace the ACA acknowledged the law needs refinement. "The Republicans have the majority in [Congress] and the White House, so the question is: Do they want to put forward policies to address it? Or, do they still want to run as more or less an opposition party?" says Gilberg.

One thing Dahl is keeping a close eye on when it comes to the ACA its future is the individual mandate. The proposed GOP tax bill would kill the individual mandate requirement brought by Obamacare.

"Termination [of the mandate] would create more uninsured, meaning more private pay money. That's something practices should be aware of. Don't be an ostrich and put your head in the sand. Keep your eyes and ears open," says Dahl.

With 2018 being a midterm election year, the uncertainty in health care is almost certain to continue, according to Gilberg.

"There's not necessarily going to be any kind of plan to replace the ACA, but the underpinnings of the insurance market will keep getting chipped away in the meantime. That will cause continued uncertainty and disruption, and not in a good way. The fact that there's a midterm election in 2018, there may be another run at repealing the ACA."

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