While the rigors of quality reporting get a lot of attention when it comes to the Medicare Access and CHIP Reauthorization Act, or MACRA, physicians may find their success hinges on their use of electronic health records. But while physicians must do everything they can to optimize their knowledge and use of EHRs, many doctors argue vendors who sell these systems must do their parts to help them succeed.
"The reality of today's medical environment is that you could have one version of the software, and they are offering the upgrade on another version, you must buy up to the other version which can be pricey," said Robert Tennant, director of healthcare information technology policy and government affairs for the Medical Group Management Association. That's an unfortunate situation if physicians don't understand that they will have to purchase 2015 editions of the software that is certified for MACRA.
For that reason, Tennant urges clinicians to ask a few vital questions of their vendors. First, ask if they'll be offering a 2015 certified product, and if so what version of the software will get the upgrade. Also, find out when that upgrade will be available, an important detail if your ehr is server based, as transitions take longer. Finally, clinicians need to know if will any hardware upgrades will be needed, what training is necessary and if it's included in the purchase agreement.
While hospitals are still mandated to report under the Meaningful Use program, MACRA replaced that program for physicians. Instead, a quarter of a doctor's final MACRA score will be determined by new Advancing Care Information requirements.
Vendors need to help clients understand the importance of accuracy in EHR use before MACRA takes effect, said Pat Wise, vice president of health information systems for HIMSS. For starters, they can help doctors ensure their risk adjustments are correct by making sure data is being entered correctly, and any automatic calculations that influence risk adjustments are also happening as they should. For instance, if you enter a patient's height and weight, and your system is supposed to then calculate their BMI, it is important to make sure all of that is correct.
Vendors could also provide clients with 60 days of data to review so that they can check for accuracy, and/or data gaps that need to be addressed, ensuring the data represents them properly.
"The data clarity is very important and I think it's important for vendors to help the practices understand the importance of this issue," said Wise. "It's important for providers to understand it, and both need to work together to make sure that what is submitted accurately reflects your practice," Wise said.
Providers have a responsibility not just to learn the new MACRA rules, but also to know their EHRs inside and out. Tennant said at top of the ACI list of requirements is a security risk analysis, which is problematic because it is the leading cause of failing a meaningful use audit.
"If you don't do it you get an automatic zero on your ACI score, and it is likely that CMS will be auditing practices for ACI scores."
He said vendors could first educate clients on how to properly perform the analysis, and even help practices conduct the risk analysis.
When meaningful use came out, Allscripts Vice President of Policy and Government Affairs Leigh Burchell said they held more than 100 in-person free training sessions for clients all over the country.
"We could just hear how confused they were, and this is no different," she said.
MACRA is a highly complicated piece of legislation that providers have no choice but to engage, Burchell said, so perhaps the greatest way vendors can help is by making sure all the education tools are out there so clients can optimize their understanding and use of their EHRs. That includes no-cost options to help clients learn about new systems and new regs, webinars and online community forums where clinicians can connect and help guide each other. Burchell Allscripts also offers online classes.
She also said Allscripts offers a reporting package, which the company charges a fee for, that helps with the analytics side, and a tool-kit specific to the requirements of MACRA's Quality Payment Program that can be configured to other programs.
For a company whose clients range from single physician practices to multispecialty organizations with thousands of physicians, Burchell said they know they are foundational to clients making the transition to MACRA.
"We take it really seriously. We did the same with meaningful use and we will do it now."
Mark Segal, vice president of government and industry affairs for GE Healthcare Digital, said their Centricity ambulatory EHRs have about 31,000 clinical users. He said they too offer several educational tools to help their clients, including online webinars and other free online support services.
Their model also includes rolling out updates in "digestible pieces", meaning they are rolled out in a more modular fashion in an effort to make them more manageable.
"The more people understand that there are continuities between meaningful use and advancing care information, and that the quality measurement piece sort of seamlessly moves ahead from what had been out there already with PQRS and VBM, that gives you a real leg up on the improvement activities."
Helping to clear away the confusion and making the law more digestible is central to their education efforts, Segal said.
Looking ahead, Segal said vendors will be stepping up to advocate more and more, both for themselves and on behalf of their clients in trying to steer MACRA's evolution with lawmakers.
"We are working with groups like physician and hospitals orgs to make sure we're understanding their needs and able to reflect their perspective in our communication with the federal government. That kind of advocacy, informed by what our customers need, is a responsibility that we take very seriously."
Vendors may have no choice, though, when it comes to helping their clients. An unhelpful EHR vendor may find their systems replaced by one that provides better outreach, said Tennant, and that hurts their market share. But providers may have no choice too. Value-based care isn't going anywhere and practices will need the technology to produce high quality care and move towards at-risk contracting arrangements, as well as to compete and attract consumers looking for technological conveniences, he said.
"Practices trying to recruit new doctors will have tougher time if they are still paper-based. Vendors know this and want to attract and keep business so stepping up is in their best interest," Tennant said.
Wise agreed that both sides have their parts to play.
"I think it's a mutual success. I think the EHR vendors help ensure the quality of care through their product and in turn providers have a professional responsibility to of ensuring they maximize their utilization of the product, and take time to get to know it."