Potential Pitfalls for Healthcare providers stemming from MACRA

Hidden MACRA IT Challenges

Potential Pitfalls for Healthcare providers in Health IT


MACRA has made a lot of changes to the healthcare system as we know it.  The main object is to improve the quality of care, while simultaneously lowering the cost.  In order to achieve this goal, MACRA has examined the different areas of the healthcare system that can be utilized, improved and changed.  Health IT is a major area that MACRA has sought to revamp.


However, now that experts have had a chance to review the changes and requirements, many feel that the legislation contains some perilous pitfalls for small practices and healthcare providers. We’ll take a look at a few of them in this post.


Originally, when the Centers for Medicare and Medicaid first rolled out the changes to the healthcare system, there were 11 measures that needed to be reported on that affected Health IT, but now with the finalization of The Quality Payment Program, there are only five.


Health IT Changes under MACRA and the Challenges Therein


Under Advancing Care Information, the section of the legislation that directly deals with Health IT, are the following areas in which healthcare providers will be measured:

  1. Clinical Effectiveness
  2. Information Security
  3. Patient Safety
  4. Patient Engagement
  5. Health Information Exchange


Clinical Effectiveness


CMS has established that extra points will be awarded to those healthcare providers and practices who use certified Electronic Health Records (EHRs) to achieve clinical practice improvements established by CMS. Sharing care summaries with other healthcare providers is a key way that physicians and clinicians can coordinate care both improving care quality and lowering cost. However, many of the EHR solutions available to care providers were created before MACRA and therefore do not fully adhere to the new regulations.  

Practices have already started to adopt these EHR solutions to improve their records and revenue cycle management, but now it looks like they may have to purchase and implement a different solution in order to comply with MACRA.  This creates many challenges, such as cost, time and data integrity which we’ll explore later in this post.


Information Security


EHRs track, store and should share sensitive patient information and have safeguards built into the software to protect this data’s integrity.  This is one of the reasons that CMS has made it a requirement that healthcare providers use EHRs by the year 2018.


Many have started to adopt EHR software in order to prepare for this impending requirement.  The challenge here is that many of these software options available to healthcare providers had been designed to meet the requirements of Stage Three of the Meaningful Use Program, as they have not had the time conform the software to the new requirements.  This will force software providers to rush to make changes, or for healthcare providers to switch to yet another software which is costly and takes time.


Patient Safety


With the current restrictions in existing EHRs, the inability to share patient care summaries, individual practices and hospitals will need to once again update their software.  This additional roll out could cause complications with data integrity.  These rollout projects are large tasks that require a lot of information to be exchanged, and updated.  Sometimes data is lost or corrupted during the process.  Regulation may be established to require current EHR providers to make updates to existing software solutions to save practices from having to make these changes, but only time will tell.


Patient Engagement


While the concept of patient engagement and patient generated information in healthcare is not new, some of the ways this information might be generated or shared with the new IT provisions in MACRA are. One current avenue is to collect and share information generated from personal fitness trackers.  How these devices will share information with EHRs is a new and relatively unexplored concept which could create potential security risks.


Health Information Exchange


Another challenge comes from a core requirement of Advancing Care Information, that healthcare providers use EHRs to share care summaries in order to provide a full picture of the care the patient is receiving and better enable care providers to work together.  It seems like a simple enough requirement but a lack of regulation has lead EHR companies to restrict the ability of healthcare providers to share summaries with other types of EHR software as a way to try to grab more market share.  
Main Street Medical Consulting works with a number of health care providers that are already utilizing EHR software to improve their visibility into and ability to manage their revenue cycle management. As a result we understand the challenges and opportunities that the new MACRA legislation creates in terms of IT and data management in healthcare.  Our experts are able to help suggest an EHR solution that works for your practice, and best complies with MACRA requirements.