EHR Software Feature Solutions to MACRA

By: on November 8, 2018

In 2018, a full quarter of your overall MIPS Score will be made up of the Advancing Care Information category. Providers cannot earn the 50 base points for this category without a certified electronic health records system, so that alone should be enough incentive to adopt this software.

But that’s not all: Physicians that use EHRs with the right features can earn over 50 points in this category and get a slice of the $500 million “exceptional performance bonus” pie, which is allocated for practices with the highest MIPS composite scores.

The alternative to high performance is, of course, less than desirable, and practices that don’t use EHR systems optimized for MACRA face a higher risk of low composite scores and resulting penalties.

Fortunately, EHR software providers have heard the need for features that make MIPS reporting easier and improve scores, and many have begun implementing functionality that does exactly that. We’ll dive into those specific features below, after we lay out the MACRA landscape.

MACRA Is the New Standard for Medicare Reporting

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the current legislation ruling how Medicare reimbursements are paid out to providers today. This new standard replaced the often-denigrated HITECH Act of 2009 in an effort to improve the treatment of Medicare patients by rewarding a value-based care reimbursement model.

There are a lot of changes to consider with the introduction of MACRA, but the most important for this conversation is the new idea that providers must choose one of two reporting tracks to follow in order to receive Medicare reimbursements: either MIPS or APMs.

You can read more details about those tracks here, but for now let’s focus on MIPS, as this is the track most small practices will opt for.

With this track, providers must report on and earn a score in four performance categories. Those individual scores will be compiled to produce an overall MIPS score, which will determine how much providers receive in Medicare reimbursements. Here are the four performance categories:

MIPS Performance Categories

Performance Category
Percent of Overall MIPS Score in 2018
Quality Report on six measures (one of which must relate to outcomes or another high-priority measure) that most accurately reflect the practice. 50%
Advancing Care Information Use a 2014 or 2015 certified EHR and report on a set of five measures that reflect how the EHR is used in the practice. 25%
Improvement Activities Choose from a list of over 100 improvement activities and incorporate them into daily practices and workflows. 15%
Cost No reporting requirements for providers; CMS will calculate this score based on Medicare Spending per Beneficiary and Total Per Capita Costs. 10%

As I already mentioned, Advancing Care Information is the second largest category for your overall score, and it is extremely difficult to score highly here without using a certified EHR with MACRA-optimized features. Let’s look at what features are important to have in your EHR.

Interoperability Is Imperative for a High Score

The ability to share protected health information (PHI) between unrelated practices is referred to as interoperability, and EHRs with this functionality offer users many options that meet and improve scoring for each MIPS performance category.

Let’s be clear: Physicians are not required by MACRA to use an ONC-ATCB certified EHR for MIPS reporting and scoring—but it sure helps.

At the beginning of this year, only 200 EHR systems had passed the intensive 2015 certification requirements, which included functionality for securely sharing PHI with both patients and other providers.

Every EHR that carries a 2015 certification has been tested for features in the following criteria categories:

2015 ehr certification criteria categories

Using systems that have been through extensive testing ensures you’ll be prepared to implement, meet and report on a variety of measures that will all increase your MIPS score.

How interoperability helps: When you’re looking for EHR solutions to MACRA scoring standards, a 2015 certification is the first box you should check. Having a certified EHR will ensure you’re working with an interoperability-equipped tool, the use of which will automatically increase your MIPS score and result in higher reimbursements.

MIPS Dashboards Provide a Complete Picture

Some EHR vendors have already implemented one or more dashboards that allow users to quickly view how they’re doing with MIPS or Quality Measures reporting.

These dashboards calculate current MIPS scores for each performance category as well as your overall score, but they also provide detailed views for you to see exactly what factors are leading to which scores and where you can improve before submitting the final report.

MIPS dashboard summary view in Practice Fusion (Source)

MIPS dashboards are relatively new, but most certified EHRs should be offering some kind of summary report feature for MACRA. They’re a great solution to MACRA issues because they let you keep a running track of your score, which allows you to make conscious improvements throughout the year before the final report goes out.

How dashboards help: Being able to check both your individual performance category scores as well as your overall MIPS score whenever you want is a huge advantage, and using the deep-dive tools provided in these dashboards lets you see exactly what you’re doing right and what you can change to raise your scores before it’s time to submit final reports.

Measure-Finding Tools Simplify Selection

The largest performance category for MIPS is Quality, accounting for half of your overall score.

This category requires providers to report on six quality measures (one of which should relate to outcomes) they decide to participate in that are meant to improve service. Providers will be able to earn up to 10 points for each quality measure reported on. In 2017, providers were only expected to report on their six measures for 90 days; however, in 2018, reports must encompass an entire 12 months.

It’s safe to say the six measures you choose to report on for your practice are really important.

For that reason, many EHRs are creating tools that help you narrow down your options and choose the most appropriate measures to report on for your practice and specialty. These tools provide access to information about each measure, including the CMS requirements for reporting on it and how prepared the EHR system is to help them implement and report on it.

Quality Measure selection process in Kareo (Source)

Choosing the right measures to report on is the best way to build a strong foundation for your score. It’s crucial to start off on the right foot with this category, so these tools are a great built-in solution for MACRA and MIPS.

How measure selection tools help: There are a lot of different measures to choose from, and it’s entirely up to individual practices to choose which six to report on. EHRs will differ on which measures they’re equipped to help you achieve, though, so your best bet is to run a report of every measure your EHR is optimized for and select the ones you want to report on from that list.

Next Steps: Narrow Down Your Options

Searching through the hundreds of EHR providers out there is daunting, but the good news is you have options. Use these three features as the beginning of a list of requirements you have for your new EHR, and add to it with other functionality you absolutely have to have in your practice.

Once you finalize that list, call our advisors at (855) 998-8505 to discuss your needs and budget, and we’ll create a shortlist of EHR systems that meet those specific requirements.

Note: The information contained in this article has been obtained from sources believed to be reliable. The applications selected are examples to show a feature in context, and are not intended as endorsements or recommendations.

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