Editor’s note: MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015, and is Medicare payment reform that goes into effect Jan. 1, 2017. The associated Quality Payment Program (QPP) is the regulation that will shift the reimbursement model from straight fee for service to a more comprehensive value-based framework. In this MACRA 101 blog series, Jim Brulé dives into the details of the two tracks within the QPP, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). The Centers for Medicaid and Medicare (CMS) estimates that of the 712,000 Medicare Eligible Clinicians (ECs) that will participate in the QPP, about 87% will default to the MIPS track in the initial years. It has lower risk but also lower incentives, as it was crafted by Congress to ultimately be the less attractive option. Calculating […]

Editor’s Note: This blog post first appeared on The Standard, The Official Blog of Health Level Seven® International. You can view the original post here. Most people have heard of HL7 Fast Healthcare Interoperability Resources (FHIR®) Connectathon events, as well as IHE North America and European Connectathon events, which focus on testing the interoperability of solutions. But did you know that one of the most important content efforts – improving C-CDA® (Consolidated Clinical Document Architecture) documents – is also underway? At each HL7 C-CDA® Implementation-A-Thon, health IT activists have met to improve C-CDA quality and resolve industry differences that result from varying interpretations of standards and implementation guides. Efforts to improve the content of the C-CDA Many efforts are underway across the industry to help all of us improve the content of C-CDA documents. For example, the Relevant and Pertinent project […]

MACRA, which stands for the Medicare Access and CHIP Reauthorization Act of 2015, was legislation that reformed the Medicare payment system to help lower the cost of health care, while delivering better quality and improving health outcomes. It represents a huge change – it creates a more comprehensive value-based framework for payment and combines different quality-based measures into one system. In October, the Center for Medicare and Medicaid Services (CMS) issued the final rule for the new Quality Payment Program (QPP) following direction from the MACRA, and it goes into effect Jan. 1, 2017. As we get closer to this regulatory program, here are some key points to consider: While 2017 is a transition year, Medicare Eligible Clinicians (ECs) must take action to avoid a penalty. CMS anticipates that more than 700,000 Medicare ECs will participate in the QPP. ECs […]

Following every election cycle, the United States experiences a change in policy and direction. During his campaign, Donald Trump said little about his plans for health IT, precision medicine or delivery system reform, so it will take some time for us to have a real sense of his administration’s thoughts on these subjects. Since his election, I’ve already had many conversations with healthcare policy experts. Insights from these discussions include: 1) Interoperability – Continues to be a priority Congress remains interested in monitoring success with healthcare interoperability and the possibility of legislative action, including attention to further standards development.  Congress will also be paying close attention to the implementation of the MACRA, gauging whether it is successfully driving the adjusted behavior from clinicians that they are seeking. 2) MACRA – Adjustments may take place, but the core program will remain consistent […]

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Advancing patient-centered practice transformation

  • Dr. Ramanujam (Ram) Venugopalan, BHMS, MHA, PCMH CCE, PGDMLS
  • 11/07/2016

Healthcare market dynamics are shifting toward value-based care. For primary care practices seeking patient-centered care and the associated financial incentives, the Patient-Centered Medical Home (PCMH) model is the sweet spot. As sweeping delivery system reform kicks off in 2017, practices can look forward to a clear regulatory roadmap to align their efforts with the PCMH model and succeed in their journey to becoming truly patient centered. Increasing focus on patient-centered care Early attempts to define the framework for PCMH date back to the 1960s, with the goal of offering patient-centered, family-oriented and family-coordinated care delivery to families. Years of experience related to success of this model has led to the formation of many recognition programs. Today’s National Committee for Quality Assurance (NCQA) PCMH program is a widely known offering to recognize practices demonstrating patient centeredness. As of July 2015, NCQA […]

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6 questions to ask about EHR rating methodologies

According to research, which electronic health record (EHR) vendor is ranked number one? It may seem like a simple question, but if you’ve tried to answer it, you’ve likely found a wide range of responses. Analyst firms, researchers, industry associations and vendors all take on different perspectives when they rank EHR platforms. It’s important to know your sources and understand their market definitions and methodologies before you weigh these results in your next EHR purchasing decision. Like a good old-fashioned reporter, you should know the “Who, What, When, Where, Why and How” behind these findings. More specifically, here are questions to help you evaluate the next EHR rating that crosses your inbox: Who? Firms like Gartner and IDC take a more traditional analyst-derived opinion perspective. Other firms, like Black Book and KLAS Research, rank vendors based on survey data collected […]

As the industry recognizes the potential of genomic information to revolutionize healthcare delivery, experts describe the many challenges and opportunities related to precision medicine. A recent Health Data Management article, WEDI: EHR support for genomic medicine lacking, reviews highlights of a white paper from the Workgroup for Electronic Data Interchange (WEDI) Genomics Workgroup. Because our team has years of experience in embedding clinical knowledge in the clinical workflow, and since we are working toward making precision medicine possible at the point of care through our genomic platform 2bPrecise, I wanted to share a few thoughts and reactions here: 1) EHRs don’t lend enough support to genomic medicine Authors of the white paper contend, “Although improvements to electronic health records (EHRs) have been made, much work remains to optimize their ability to support genomically informed care, and in turn, for genomic […]

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5 interoperability findings you should know

Our industry is swirling with health data exchange initiatives to enable better population health management. Everyone understands that an open, collaborative approach will help us achieve the promise of interoperability. But to shape successful efforts, it’s important to take a step back and look at available research on interoperability. What does the evidence tell us about factors that will lead to population health success? The Office of the National Coordinator for Health Information Technology (ONC) offers many helpful resources. Two ONC data briefs* offer compelling facts and figures that should shape our interoperability efforts, including the following research about U.S. hospitals: 1) 46% of hospitals have access to electronic patient data, from sources outside their clinical systems, at the point of care This is the national average in 2015, which is up from 41% in 2014. This research also shows […]

This week I testified before the United States House of Representatives. It was an honor to represent the healthcare IT industry and share how innovations are driving efficiencies and improvements. Here are excerpts from that testimony: Despite some bumps in the road, as can be expected in times of change, there have been huge leaps forward in our industry in recent years that never would have happened had Congress not provided the impetus for ubiquitous adoption of electronic health records (EHRs). These changes have disrupted paper systems that stood for decades, and the result is a new digital ecosystem of caregivers, software developers and patients, allowing all to take a fresh look at how processes can be enhanced via automation. Fortunately, following disruption, there is innovation and opportunity. Allow me to provide a few examples: Allscripts dbMotion™ interoperability platform brings […]

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4 ways to reclaim the claims process

In an era when the healthcare community is working to improve quality of service and delivery and to reduce costs, the reimbursement process is under intense scrutiny. Organizations are asking themselves: How can we simplify the claims process? Are there ways to save time? What can we do to make our claims more accurate to help speed payments? In a series of recent case studies, three clients have shared their experiences using Allscripts Payerpath® Solutions to reclaim their claims processes. Here are four examples: 1) Collect more patient payments Patient payments are the fastest growing portion of many providers’ revenue streams. Unfortunately, according to the American Hospital Association, as much as 5.3% of expenses are written off each year as uncompensated care, representing $42.8 billion in losses. One of the ways Burton Creek Rural Clinic (West Plains, Missouri, U.S.A.) is […]