Tech Not Up to Speed for MACRA Reporting

Health systems often rely on EHRs to record data necessary to succeed under the Merit-based Incentive Payment System (MIPS). With the complex reporting requirements of MACRA, are EHRs up to the task?  

A recent study conducted by software firm SA Ignite and Porter Research found that although most practices rely on EHR or population health management (PHM) solutions for quality reporting, the majority (61 percent) are unsatisfied with the performance of those systems when it comes to functions related to CMS' Quality Payment Program (QPP) performance.

Practices are unsatisfied with their ability to identify all eligible clinicians, pinpoint focus areas to increase scores, and see their overall MIPS score under CMS' QPP. Failure to record these functions accurately puts organizations at risk of missing out on their goals of maximizing payment incentives, experts say.

Physicians Practice spoke with Matt Fusan, Director of Customer Experience at SA Ignite to learn more about the study and what these results mean for practices.  

Were the findings of the study surprising?

The results match our hypothesis. EHRs and population health management are great tools, but they are not…driving success in regulatory programs and strict value-based-care programs. At their core are patient records. They are aimed at improving patient care and for the most part, they do a great job. A lot of times, for a regulatory perspective or client pressure, they add in base functionality for programs such as Meaningful Use or MIPS. But, that functionality isn't going to be something that lets [practices] excel in MACRA.

Why do the majority of practices lack confidence in their EHRs when it comes to performing for MIPS?

A lot of that comes from history and living through Meaningful Use and the Physician Quality Reporting System (PQRS). The sentiment that I have gotten throughout the years is that docs don't feel their EHRs can aid their success in these complex programs.

What would the long-term effects of underperforming EHRs be for practices?

Ultimately, the practices are not going to score as high as they potentially could [on MIPS]. [The stakes get higher in] 2019 when the cost category goes up to 30 percent and the performance threshold will be around 70. If you're getting scores below 70 at that point, you're going to see negative payment adjustments.

Practices will also see potential reputational effects as the scores become publicly available. As we continue down the path in society where more and more decisions are influenced by ratings and where someone can research on the internet and find out how the scores are calculated, reputations will be formed.

What can practices do to heighten chances of success under MIPS?

First and foremost, understand the components of MIPS, I know that's a hard ask because of how detailed and complex it is. But if you don't have a good understanding of what you're being asked to do, you won't succeed. Once you have an understanding, it needs to be a multi-year plan moving forward. It should not be a constant read and react process. You'll never get to where you need to be if that is the case.

The rules with MIPS have changed. You are competing with every other clinician in the country. You're not competing against yourself and your previous year's benchmark. This creates a scenario where you need to do performance improvement in the broadest sense of the words, on a daily basis. That mentality needs to be embedded in your practices culture.

Any tips for smaller practices success under MIPS?

Make sure if your EHR vendor is not able to help, which based on the study seems likely, find yourself a partner that can take on the burden of knowing the intricacies of MIPS. That way you don't have to dedicate a resource to consume all of the data - find a way to take that burden off of your practice so that you can focus on delivering care. Don't wait. CMS is making it clear that the MIPS train is not stopping.

MIPS is like a treadmill, it just keeps getting faster and faster. For 2017 and [in] 2018, it gets a little faster, come 2019 the speed is going to jump way up. If you're not already up and running and in decent shape, you're going to spit right off the back end of the treadmill.