IT Adapts to MACRA, ONC Final Rules

While providers praise flexibility, work is just beginning on which technology will work best, and whether regulations are too little or too much.

As the final days of the Obama administration tick down, a flurry of final rules from CMS and ONC promise to reduce the reporting burden which the meaningful use program imposed on providers.

The final rule on MACRA and Merit-based Incentive Program legislation provide more flexibility on how physicians enter the value-based payment world of CMS' new Quality Payment Program.

John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center, praised the final outlines of the Merit-based Incentive Payment System and Advanced Alternative Payment Models (APM).

MACRA: Physician Groups Praise Flexible Reporting Options

"In the final rule's technology area, called Advancing Care Information (which replaces meaningful use for physicians), CMS reduced the number of [quality] measures from 11 to 5," Halamka wrote in an October 19 blog post.

"CMS recognizes that technology, infrastructure, physician support systems, and clinical practices will change over the next few years, so over reliance on a highly prescriptive and broadly scoped certification rule must be avoided."

A final rule on the Medicare Outpatient Prospective Payment System (OPPS), due within days, may provide some meaningful use relief on the hospital side as well, says Mari Savikis, vice president of federal affairs at the College of Healthcare Information Management Executives (CHIME).

"They did propose to make a 90-day OPPS reporting period for 2016, but they didn't propose it for future years," Savikis says.

"We really want to see them extend that 90-day reporting period for at least 2017 and hopefully later years. That would sync up more nicely with MIPS and MACRA, so hospitals have a little more breathing space."

Hospitals and health systems that employ physicians and thus must report under MACRA will have to install updates from EHR vendors for their clinical quality reporting, while continuing to report meaningful use quality measures for an entire year. "It's a lot," Savikis says.

The ONC final rule gives the office direct oversight and review of information blocking issues, but limits the ONC's role to any blocking that could affect patient safety, Savikis says. "We were pleased to see them walk back some of their pretty big list of items. Focusing on safety is much more reasonable, and we supported that."

ONC Chief Talks MACRA, Meaningful Use

The rule requires healthcare providers to attest they did not knowingly and willfully take actions, such as disabling features or functions in its technology, to limit or restrict compatibility or interoperability of certified EHR technology.

Providers also must attest they responded in good faith and in a timely manner to requests to retrieve or exchange electronic health information, including from patients, other healthcare providers, and other persons, regardless of the requester's affiliation or status as a technology vendor.

ONC clarified that it doesn't plan to hold providers accountable for technology pieces that are outside their control, says Savikis. "We're going to have to wait and see how that plays out."

Micky Tripathi, head of the Massachusetts eHealth Collaborative (MAeHC), points out that the MACRA final rule still leaves a great deal of work on the technology side for providers—particularly those connecting information in multiple vendors' EHRs—to achieve the desired outcomes of MACRA.

"There's no standards for the integration of a population health management solution with an EMR or certain types of transactions," Tripathi says.

This leaves a large opening for the panoply of population health vendors and service providers to engineer the necessary bridges between the many EHRs in use across ACOs and the other strange bedfellows thrown together by MACRA.

"Right now we've got a lot of experimentation going on," Tripathi says. For instance, MAeHC provides the data warehouse powering Aledade, a health consultancy focused on helping ACOs succeed in the MACRA era.

"Until we've seen a few months of MACRA and MIPS in action, it will not be possible to pick any emergent technology winners out of these final rules," Tripathi says.