Holy MACRA! Patient Engagement rides again!

Regulatory-signage“What was that masked legislation? Why that, my boy was CMS! The greatest regulator in the west!” (Cue The March of the Swiss Soldiers in the William Tell Overture aka, theme song for one of my childhood heroes, The Lone Ranger).

What is MACRA?

MACRA is the abbreviated version of the “Medicare Access and CHIP Reauthorization Act of 2015” which was signed by President Obama on April 16th of this year. (Healthcare and CMS sometimes really can’t help it’s communication to the public when they make these abbreviations something that only so called “healthcare insiders” will understand).

The new law repeals Medicare’s sustainable growth rate (SGR) formula and creates a way to increased Medicare payments. At HIMSS16 this year, there was a focus was on “MIPS” or Merit Based Incentive Payment System which is the program that the SGR will be replaced with.

Physician rates are understood to be increased by 0.5% starting in July and each January through 2019 and then, bonuses could reach 12% and then 27% by 2022 (physicians could also face penalties for not meeting quality targets down the road).

On the CMS site, it asks the question, “How does the Medicare Access & CHIP Reauthorization Act of 22015 (MACRA) reform Medicare payment?”

Apparently, in a couple of ways:

It makes 3 changes to how Medicare pays those who give care to Medicare beneficiaries. The changes create a Quality Payment Program (Abbreviated to ‘QPP’).

  1. Ending the SGR formula for determining Medicare payments for health care providers services.
  2. Making a new framework for rewarding heal care providers for giving better care not just more care.
  3. Combining CMS’ existing quality reporting programs into one system.

The changes have been named QPP and replace other Medicare reporting programs with a flexible system that allows providers to choose from 2 paths that link quality to payments either MIPS or something called Alternative Payment Models (APMs)

MIPS – This combines parts of the PQRS (Physician Quality Reporting System), the Value Modifier (VM or Value Based Payment Modifier) and the Medicare Electronic Health Record (EHR) incentive program in which EPs (Eligible Professionals) will be measured on:

  1. Quality
  2. Resource Use
  3. Clinical Practice Improvement
  4. Meaningful Use of Certified EHR technology.

APMs – Alternative Payment Models give new methods to pay healthcare providers for the care they give to Medicare recipients as from the year 2019 to 2024, CMS will pay some participating healthcare providers an incentive lump sum; increase transparency of physician focused payment models and starting in 2026, offer some participating healthcare providers higher annual payments.







Life, The Universe & Healthcare in India

Vidhana Soudha - Bangalore's Capital

It’s been more than a month since I came back from Bangalore, India. When I was last in Bangalore during the month of December, the year was 1994. The internet had not yet really come to the city, no mobile phones, many more trees and no high rise apartments, you could get across the city in about 45 minutes and there were no flyovers,  people rarely, if ever traveled overseas for vacations and the vast majority of people were either engineers or doctors (if their parents wanted their children to be perceived as doing well career wise). You could at least call an ambulance and possibly get to one of the small clinics that were around and hope that the doctor there knew how to take care of you (there were only a couple of private hospitals around then.

That’s not the Bangalore (or Bengaluru as it is now called when the city officials changed the name of the city to reflect the state’s Kannada language pronounciation) that I saw this past December. Everybody uses their mobile smart phones for everything, you need to use Ola or Uber, even if you live here because the number of cars in the city is unbelievable and growing more by the minute, many flyovers across the city and some of them even have stops at the top of the flyover (because someone in government didn’t plan properly), there’s a metro that the government has been working on for a decade (similar to Boston’s Big Dig of old) and if you get into an Ambulance, you may want to say your farewells to your family…as 9 out of 10 times, you will not make it to the hospital in time to save your life. See the YouTube video here for some perspective on what I’m talking about.

There are some solutions to these issues; air ambulances (visions of M*A*S*H) have been touted as one of the ways in which India can get some of their critical patients to their provider facilities.


These though may be only available for the upper middle class to rich and may not be something that regular people can avail of. Tele-Medicine or Tele-Health is an option. One of the premier solution providers talks about “Telemedicine as a service” that has been touted as possibly being able to be offered by local telecom service providers, who can bundle the service along with bandwidth. Healthcare providers can use the tele-health solution as a managed service by paying a monthly subscription fee or on a per event basis.They further say that these providers can market this service to a wide cross section of provider organizations who may be able to offer affordable tele-health services to their populations. Providers can also offer this as a value added service to their patients, and charge them on a subscription basis. An added advantage to this is that healthcare providers do not need to make any upfront capital investment in the technology infrastructure. The challenge is that nearly 70% of India’s population lives in rural areas and there will be vast differences when it comes to access to basic healthcare facilities and capabilities for different regions as well as languages (India became one country in 1947 when different kingdoms, princely states and former British India joined together to become one country…all of these places had different languages, culture and traditions).

The United States’ 911 protocols and procedures as well as the infrastructure that backs it up is probably the best in the world by far. Our country needs to be proud of itself for maintaining this edge on the world. While we still need to improve our value for money, we are making headway, I am positive about that fact. Our Healthcare Information Technology professionals are working hard to continuously improve our provider organizations and their delivery systems as we never accept that we have done our best but continually strive for process improvement. I appreciate our providers more than ever, though we must do a better job of containing costs. My belief is that we may treat many times to avoid litigation rather than do what’s best for the patient. This belief stems from recent personal experience with providers both in India and the US and the vast differences in cost structure administering the same treatment.I had the good fortune of visiting Cisco’s offices in their multi acre campus in the heart of Bangalore and I was extremely impressed with their ability to put tele-health solutions into practice for their own employees. The picture below was taken on their campus at one of the rooms where employees can visit on site for tele health visits with their care provider. The opportunity to save millions of lives in India through basic healthcare facilities is tremendous and many organizations are trying to figure out ways in which they might be able to achieve that objective. Kudos to all those who are working hard to make that happen. image

Miami University Healthcare IT Speaker Series – November 3rd, 2015

Come and see us at the Miami University Healthcare IT Speaker Series where Victor Simha and I will be talking about what we call “Healthcare Version 3.0” and where we believe, when we look into the crystal ball, that the healthcare IT ecosystem is heading and the opportunities for students in the program to focus their attentions on. Check out the link for more information about the series.

Speaking at Miami University’s Greentree Health Science Academy

I am looking forward to speaking with the students at Miami University’s Greentree Health Science Academy in Middletown OH this evening about “A Practical Approach to Healthcare Information technology: The Paradigm Shift in Healthcare”. This will include my experience with a recent case study that I jointly presented recently at our CSO HIMSS conference in Spring with UC Health. Victor Simha from The Christ Hospital will be there to support the efforts to share our experiences with students of their HIT program. Now that’s collaboration!

Check out the location at http://www.regionals.miamioh.edu/greentree/