Digital Technology’s Role in MACRA Reimbursements

Updated on April 6, 2019

By Bill Ho

This year, healthcare can expect a revamp in patient care and outcomes due to the implementation of the Department of Health’s new Medicare Access and CHIP Reauthorization Act (MACRA) and the associated Quality Repayment Program. 

In short, MACRA allows the U.S. Department of Health and Human Services (HHS) to implement value-based care initiatives to improve quality of care and the patient experience. With a larger focus on providing optimal care versus the number of patients treated, healthcare will ultimately shift from a fee-for-service model to a pay-for-performance model. However, there are a number of requirements that healthcare professionals must follow in order to receive reimbursements and avoid penalties. 

Healthcare organizations and professionals will be evaluated by the use of composite performance scores determined by one of the two Quality Payment Programs paths under MACRA: the Merit-based Incentive Payments (MIPS), or Alternative Payment Models (APM). Clinicians eligible for MIPS will be scored based on quality (45%), promoting interoperability (25%), costs (15%), and improvement activities (15%). 

If healthcare professionals do not meet or exceed MACRA’s requirements, organizations can lose up to 7% of Medicare reimbursements. On the other hand, if organizations meet the scoring criteria, they may be eligible to receive up to a 3.58% exceptional performance bonus. This reimbursement influx of about 11% will motivate organizations to incorporate digital technology that will help them qualify for incentive payments.

Technology’s Impact on Care

Healthcare often faces challenges with patient information management, including document inaccuracies and disorganization. Consequences of these issues include wasted time, clinician burnout, and frustrated patients. Additionally, these consequences go beyond business performance as these aspects of information management, especially around patient care, can increase treatment times, reduce the availability of clinicians as they wrangle these systems, and delay care – ultimately reducing the overall number of patients that can be treated. With patient lives on the line, digital technology applications and integrations will play a big role in solving these issues.

The Value of EHR Interoperability

Because EHRs are at the center of patient information, they must be able to work with other technologies in the healthcare ecosystem, including those that facilitate fast, secure, and reliable communications of patient data. Additionally, with MIPS and APMs requiring the use of certified and up-to-date EHR technology, successful and efficient use of EHR interoperability will be critical for healthcare organizations to improve automated workflows and increase efficiencies. For example, sharing information to support preauthorization with payers — including files that contain patient history and diagnostic data — helps patients quickly get the care they need. From connecting physician networks to process referrals and sending prescriptions to pharmacies, successfully integrating disparate clinical data sources into EHRs can help organizations automate business processes and strengthen care coordination and communication.

In addition, enhanced EHR interoperability can significantly improve patients’ quality of care. Technology integrations with EHRs should engage patients after they leave a facility, strengthen care coordination efforts, and enhance the patient-caregiver relationship to improve patient care. When patients are discharged from hospitals to extended care facilities outside the health network, patient records and other documents must be exchanged quickly in a format that both parties understand. Therefore, to be fully interoperable, EHRs must integrate with secure messaging and fax systems.

Oftentimes, attending physicians must collaborate with specialists outside the health network to treat a patient. Using reliable and secure applications for document delivery and messaging enables care teams in different locations to quickly share information such as lab test reports, high-resolution radiographs, and MRIs. 

For patients, comprehensive EHR integration can mean the difference between a positive and negative patient outcome, which factors into the quality of performance scoring that represents 45% of MIPS’ criteria. 

A Results-Driven Approach Provides Optimal Care

For healthcare organizations, investing in digital technology applications and integrations that support secure document transmission solutions within EHRs not only helps organizations benefit from greater MACRA reimbursements, but also from improved organizational workflows and patient satisfaction. Through MACRA’s direct focus on improving the quality of patient care, clinicians and healthcare organizations will be forced to update or replace the outdated systems and technologies that hinder them. The new pay-for-performance model will not only motivate organizations to implement EHR technology and integrations, but also require them to modernize processes to ultimately provide seamless clinical experiences and the treatment patients deserve.

Bill Ho is CEO of Biscom.

14556571 1295515490473217 259386398988773604 o

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.