“Is that going to be simpler?” asks the Advisory Board’s Levinthal. “Should people be breathing a sigh of relief? I don’t think anyone should jump to that conclusion, because arguably, that would be harder than the [current] Meaningful Use requirements.”
Because MIPS is going to be so difficult for doctors, she adds, MACRA includes a financial allocation to revive the health IT regional extension centers that helped small practices implement EHRs and show Meaningful Use in stage 1.
EHRs will be used for quality measurement both in MIPS and the alternative payment model track. Many practices are already traveling down that path by electronically reporting PQRS data, which CMS has aligned with Meaningful Use’s quality reporting criteria and is used in the value-based modifier. For example, both Gold’s and Ejnes’ groups are using the Group Practice Reporting Option (GPRO) to report quality data just once for Meaningful Use, PQRS, and the Medicare Shared Savings Program for the ACOs they belong to.
But this simplification is not as straightforward as it seems, especially for small practices that have been using special Medicare codes to report PQRS data. To switch to EHR reporting, practices not eligible for GPRO must use a qualified clinical data registry provided by a third party or must use expensive, glitchy software provided by EHR vendors to report directly to CMS.
David Kibbe, MD, president of DirectTrust, a trade association for Direct messaging participants, says that many issues still need to be resolved for efficient quality reporting, including what is to be measured, how to store the information in EHRs so that data can be extracted automatically, and how to extract the data in a standardized format. He predicts that smaller groups will have to use some kind of clearinghouse to clean up and normalize their data for quality reporting.
“Many practices worry that they won’t be able to do this or it’s going to cost them a ton of money,” he says. “The vendors, for the most part, are way behind them. The EHR certification criteria aren’t zeroing in on that at all.”
Hashey expresses another concern: “If they really start squeezing down on outcomes, what’s to stop doctors from firing their noncompliant patients, and only keeping the compliant ones? Who’s going to take care of the patients who need the most help?”