The Surescripts Blog

Preparing for MACRA: Technology’s Role in the Quality Payment Program

By: Paul Uhrig, Chief Administrative, Legal & Privacy Officer, Surescripts

As 2016 comes to a close on the heels of a historic presidential election, it’s a good time to take stock of the current state of health IT policy, and in particular, physician readiness for the value-based shift under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

What’s the latest with MACRA?

MACRA was recently adopted with significant bipartisan support, and the regulations under MACRA became law last month. The Office of the National Coordinator (ONC) has based all of its plans and policies on four key initiatives:

  • Moving from paper to electronic transactions
  • Improving/enabling data sharing
  • Using population health analytics
  • Better engaging patients and their families

However, like technology itself, the healthcare landscape has evolved in recent years. Holistic interoperability and data exchange are still top goals, but care quality and patient outcomes matter most. And with MACRA-driven measurement/compliance mandates beginning in 2017, providers need to make sure they are prepared.

In listening to feedback from the physician community, per the Final Rule, MACRA and its Quality Payment Program (QPP) provided more flexibility in terms of the time, training and tools necessary for physicians to make the transition. Additionally, many small practices with low Medicare patient volumes—those that stood to struggle most with compliance—are now exempt from the program. And clinicians can choose one of two paths toward the value-driven reimbursement framework: Advanced Alternative Payment Models (APMs) or the Merit Based Incentive Payment System (MIPS).

In order to give physicians time to become familiar with the program, 2017 is officially a “transition year.” Eligible clinicians can submit their data to MIPS or participate in Advanced APMs to ensure they will not receive a negative payment adjustment in 2019.

In terms of the technology, Certified Health IT must be used. In 2017, eligible clinicians can use a 2014 or 2015 Edition Certified EHR Technology. Beginning in 2018, clinicians must use 2015 Edition Certified EHR Technology. This means that providers’ readiness to comply is directly linked to their EHR's current certification level.

Changes Under MACRA's Final Rule


Will the election impact MACRA?

President-elect Trump has not stated his position on MACRA, but there does not appear to be any appetite in Congress to repeal a bipartisan bill where both parties were largely responsible for the major components. Further, it is unclear who might be the next CMS administrator, National Coordinator at ONC, or the head of the U.S. Food and Drug Administration (FDA). Thus, it isn’t prudent to over-speculate what implementation changes may occur. It is possible that some implementation of the law may change under Trump’s leadership, but the move to value-based care will continue.

Mr. Trump recently "back peddled" from his campaign pledge to overturn the Affordable Care Act (ACA), popularly known as Obamacare, by stating that he likes some of its provisions. However, we predict the administration and the Republican-led Congress will attempt to repeal or make major changes to Obamacare, but this likely will take one to two years to accomplish.

What about the 21st Century Cures Act?

It is possible that Congress could vote on the 21st Century Cures Act as early as this week, including a number of health IT provisions that could impact our business. Stay tuned to the Surescripts blog for further updates once Congress takes action.

How can Surescripts help?

As the leading health information network in the country, Surescripts transmits 3,000 electronic prescriptions every minute. We provide the tools that physicians need to meet their goals and thrive in a value-based care environment. Our connected network ensures that data flows freely, so providers have access to critical patient information when they need it most. For example, since launching in early 2016, the Surescripts National Record Locator Service has received more than 4.5 million provider requests for patient locations and returned more than 890,000 locations of care summaries. Additionally, increased use of our Medication History service saved hospitals more than $400 million and could have prevented more than 25,000 readmissions and 15,000 adverse drug events in 2015 alone.

MACRA and the QPP may not satisfy everyone, but they are a step toward achieving interoperability and better quality care. Government mandates, however, can’t be the only facilitator. Technology developers and solutions providers need to continue bringing the best services to market—ones that provide value and improve care regardless of whether there are regulations driving their adoption. This will allow value-based care to move from an ideal state to the industry standard.

For more information about how Surescripts is connecting clinicians, EHRs, pharmacists, pharmacy benefit managers (PBMs) and others in order to make interoperability and value-based care a reality, please see our latest National Progress Report.

Be sure to follow @Surescripts on Twitter and connect with us on LinkedIn and Facebook.

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