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Philadelphia HIT Summit: Does MACRA "Suck"?


The language regarding EMRs and MACRA at large was fairly straightforward during a panel at the Philadelphia HIT Summit.

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At the Philadelphia HIT Summit today, a panel of experts parsed the path forward for healthcare organizations looking to stay compliant (and profitable) amidst the implementation of MACRA.

“Events like this exist because the topic is so complex,” began moderator Mark Stevens, Principal at ARRAHealth Consulting, Inc, before introducing the group. Despite the complexity of the topic, the language surrounding it quickly got pretty straightforward.

It began in the first third of the hour-long conversation. Sriram Bharadwaj, Chief Information Security Officer and Director of Information Services at UC Irvine Health, was speaking about some of the burdens that exist for physicians that are only becoming heavier with MACRA’s mandatory reporting.

“It’s a nightmare,” he said. “Every EMR sucks,” noting that his job in the technology end of healthcare was to make the EMRs “suck less.” Indeed, a major stumbling block the group reiterated was the volume of data entry demanded of doctors by new MACRA reporting requirements. Bharadwaj stated that an important goal was to “get physicians home by dinner,” to keep them from having to fill out EMRs all night.

Anne Docimo, Chief Medical Officer at Jefferson Health System, tried to comfort the health IT community by addressing Bharadwaj.

“It’s not your fault that EMRs suck, she said, “There’s only so much that we’re going to get by IT. Some of it we’ll have to get there through workflow, some of it we’ll have to see what patients can enter themselves. Some of the things, the patients could answer themselves in a survey.”

Stevens took hold of the mood, escalating the panel quickly. He posed that EMRs weren’t the only unfortunate aspect of the situation, but that the situation itself was. “MACRA sucks too, right?” he opened the second half of the conversation.

The panel mostly disagreed that MACRA was all terrible, or even bad: it wasn’t the vision or intent or spirit of the legislation that created difficulties, but rather the complexity and implementation.

“I have spent the last 2 years telling physicians that this is the biggest change in physician reimbursement that any of us have met in our lifetimes, and usually I am met with blank stares,” said Katherine Schneider, CEO of Delaware Valley Accountable Care Organization. She expounded that a startling number of physicians that she works with in her ACO capacity do not even have a good sense of what MACRA is.

“In the academic medical center,” Docimo said, “The employed physicians assume that it’s someone else’s job to figure this out.” Community physicians, she believes, are a bit more engaged in ACOs and practice-planning around MACRA.

“If you’re not at the table, you’re lunch on the table,” Schneider concurred, echoing the theme that those providers who failed to improve value for their patients would soon enough be paying out fines for it.

Bharadwaj did pose that technology can, in ways, help, but that it isn’t a silver bullet by a long shot. Analytics and better systems can only go so far, but engagement is the true test.

The group did see some silver lining in the situation, concurring towards the end that the spirit of MACRA was in the right place, and that the imperatives it was creating were causing a lot of innovation and increased engagement.

“The folks that are writing these regulations and making these rules cannot do it in their government silos,” Schneider said, saying that she had recently hosted senior CMS officials to show them the work that her ACO is doing and how MACRA will impact them, and she found their willingness to listen encouraging.

“For the first time we are seeing specialists actually coming, with the reason of MACRA, to join the ACO,” Docimo concurred, highlighting that the regulations will be easier to tackle in a collaborative atmosphere rather than individually. “That’s a good thing…In general, everybody wants to do a good job, so they’re going to be taking a look at the outcome metrics, and if they change their practice to take better care of patients, that’ll be a win.”

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