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MACRA and EHRs: What Practices Need to Know


Per proposed rules from CMS on implementation of MACRA, increased use of certified EHR technology will be required starting in 2018.

The past year has ushered in a flurry of brand-new acronyms - and a 962-page proposed rule that outlines implementation of the  Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It is intended to welcome more physician practices to the value-based care fold.

What do physician practices need to know? For one, practices will need to increase their use of certified EHR technology (CEHRT), but there’s no regulatory pressure to do so until 2018 - when it will be mandatory, according to Larry Kocot, principal and national leader of KPMG’s Center for Healthcare Regulatory Insight.

Physicians Practice recently interviewed Kocot to discover what else practices need to know about MACRA and their EHR.

Physicians Practice: What’s the most important thing physician practices need to know? How will this be different from meaningful use?

Larry Kocot: The most important thing physician practices should understand is how the [proposed rule] works and whether they will meet the requirements to be designed as an Advanced Alternative Payment Model (APM) or whether they will be required to participate in the Merit-Based Incentive Payment System (MIPS) program. Most small- to medium-sized physician practices will likely fall into this latter category. MACRA makes changes to EHR meaningful use requirements for all physicians.

Physicians Practice: Tell me what that means in terms of what will be required of practices.

LK: First, successful reporting on many of the performance measures for both APMs and MIPs will require increasing the use of CEHRT over time.

Second, use of CEHRT systems meeting the new 2015 edition certification standards will be optional for 2017. However, they will be mandatory for the 2018 performance period and beyond.

Third and most importantly, MACRA payment incentives are intended to drive the electronic flow of information when and where [it's] needed for the benefit of the patient.

Physicians Practice: How can practices prepare for any changes?

LK: Every physician group will need to know which payment track they will be participating in - MIPS or Advanced APMs - and how quality and performance measurement will affect their Medicare payments. Physicians must also review and understand the preliminary lists of proposed measures to determine which are most aligned with improving their patients’ outcomes, and therefore most appropriate for their practices. Physician practices will need to evaluate and address any gaps between current tracking and reporting capabilities and these new measures for 2017.

Physicians Practice: The new MIPS program is intended to support the vision of a simpler, more connected, less burdensome technology. How do you interpret that?

LK: [CMS] has provided for more flexibility in the options for physicians to select and report quality and performance measures. This is intended to provide practices the opportunity to select measures that are more directly aligned with quality outcomes for the patients they see and reduce the burden of reporting on less relevant activities. The flexibility will also help reward practices that are at different stages of experience with quality reporting. CMS’ stated intent is to provide more flexibility to recognize incremental steps or exceptional performance in any one area and incentivize improvement.

Physicians Practice: Do you think these efforts will help enable interoperability?

LK: Interoperability will likely occur faster if physicians find more benefits in using EHRs to capture and share patient information to promote care coordination for better patient outcomes. The Advancing Care Information (ACI) performance category of MIPS seeks to give providers more flexibility and greater incentive to exchange relevant clinical information. The ACI category moves away from the “all or nothing” scoring approach under meaningful use and allows more flexibility scoring and attempts to reduce reporting burdens.

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