Dear Clients and Friends,
Much has been written about “TrumpCare”- the successor to Obamacare – and what the new administration may or may not do with the ACA and Medicare/Medicaid programs. Rather than speculating about specific provisions, we would like to offer a few suggestions regarding the importance of the emerging industry standards.
MIPS (Merit-based Incentive Payment Systems) aimed chiefly at ambulatory providers and MACRA (Medicare Access and CHIP Reauthorization Act of 2015), which establishes new ways to pay physicians for caring for Medicare beneficiaries, are both good ideas and we hope the new administration will accelerate their adoption. The shift away from fee-for-service to value-based reimbursement models are here to stay. It is likely that the start date for the legislations may be pushed back a bit. That said, we hear that the Trump team is eager to implement as many of the quality measures as fast as possible. This is further reinforced in Paul Ryan’s healthcare policy paper, “A Better Way”. After all, he was the chief author of MIPS and MACRA regulations.
We need a new set of technical standards for Clinical Decision Support (CDS) Rules and Clinical Quality Metrics (CQM) now. Without them, MIPS and MACRA can not be effectively implemented. To measure quality across various care settings, we need more than just interoperable exchange of structured data from medical records.
Watch for HSPC’s and PCPI’s next moves. Embrace the new consortiums that have emerged to address and support the authoring of CDS and CQM rules for submission to ONC. Healthcare Services Platform Consortium and Physicians Consortium for Performance Improvement are two new non-profit organizations that are sponsoring and organizing collaborative efforts to build shared software components. Welcome them and join them because we need their input to get it right.
Allow those who don’t go along with the program to fail. Once common software components are agreed upon, and CDS and CQM can be seamlessly executed, a shakeout of the consulting, system integration and population health management companies becomes inevitable. If you are a provider organization that wants to take advantage of the government incentive programs, you must be ready to make radical changes to your IT infrastructure. Today, most organizations are using HL7 standards and custom integration to the back-end data bases plus clinical NLP to harvest data out of their EMR. This is what takes up 90% of engineering and development efforts. With the next generation standards such as FHIR/ADL and CQL (extensively covered in our April newsletter) none of that is necessary. Providers will soon get the wake up call that the existing technology infrastructure cannot pass the new certification processfor incentive programs.
Use the incentives to force the urgency in reducing the administrative costs, which account for 20% of our healthcare spend. As with any new legislation, it will take some time for the dust to settle and for that reason, we believe that the HIT industry will be in a state of flux in 2017. But fear not, we are confident that at the end of the day, no matter who occupies the White House, our industry will continue to grow and prosper.