The fee-for-service payment system has long been criticized for being a major culprit in soaring healthcare costs and even for impeding progress on delivering high quality care. In response to these criticisms, we are now seeing large-scale changes to how physicians and clinicians are being paid. Implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) is responsible for many of these changes, including some with major implications for the use of electronic health record (EHR) technology.
MACRA is in motion to revolutionize how physicians and clinicians are reimbursed based on payment for quality over volume. Under MACRA, the Quality Payment Program (QPP) will affect the majority of providers who accept Medicare Part B payments. The program’s two payment tracks are:
- Advanced Alternative Payment Models (APM)
- Merit-based incentive Payment Systems (MIPS)
It is estimated that about 25% of clinicians will participate in APMs, while the remaining 75% will be paid under MIPS. These programs are designed with the intention of physicians who operate under MIPS will be incentivized to improve and progress to APMs.
Regardless of which program a physician is enrolled in, EHR technology is a critical part of being properly reimbursed and even receiving bonuses under MACRA. Providers eligible as an APM must have “significant use of EHR technology,” according to an Ernst & Young Report. They must use a certified EHR platform based on 2015 standards and at least meet the requirements set for providers in the MIPS program.
Under the MIPS scoring system, advancing care information makes up 25% of a provider’s composite score. MIPS simplifies previous regulation regarding HER reporting. Reporting requirements have been decreased from 18 to 5. However, providers now have to report 90 days of EHR data on at least 5 metrics including:
- Perform risk analysis
- Provide e-prescribing
- Provide patient access
- Send summary of care
- Request/accept summary of care
For those providers enrolled in MIPS, “Advancing care information will require providers to invest in and improve the functionality and interoperability of their EHR systems,” especially if they look towards qualifying for the APM program. Overall, investing in technology, especially those that facilitate connecting and integrating data is crucial for reporting and improving processes.
While many doctors report frustrations with existing EHR systems, they are only becoming more and more intertwined into all aspects of care, including financial reimbursement. With oncoming changes from MACRA, the uphill battle to find EHR systems that work for frontline staff is only becoming more urgent.
“MACRA: Disrupting the health care system at every level”
“MACRA: Goodbye, meaningful use. Hello, Advancing Care Information”