Lack of interoperability will hurt hospitals and doctors under MACRA

Posted by Andrew Ninh on June 21, 2017

Interoperability is still an elusive problem in healthcare with almost no hope in sight. Although we are so much closer than we were just a few years ago, from Health Information Exchanges to efforts to consolidate patients’ medical records, we don’t have true interoperability. Fax still remains the easiest way of getting data from one provider to the next (and in some hospitals, even from one floor to the next). Automated patient record updating is a pipe dream.

In the past, interoperability was somewhat of a nice-to-have. It’s convenient to have updated patient information and EHR access for providers across different health systems, but it’s not mission critical to a provider or health system’s ability to function and improve reimbursement.

The lifestyle has come to collect

Today, in the dawn of MACRA-controlled reimbursement and value-based care, interoperability is more important than ever – especially for hospitals – and no one is ready.

Let’s break down the Quality Payment Program (QPP) mandated by MACRA. The QPP’s payment option that will impact the most providers is called MIPS and it requires physicians to report a specified set of quality data through a registry. Doctors are required to report on their entire patient population and, yes, this includes patients they are seeing outside of the walls of their practice.

For example, gastroenterologists who perform colonoscopies in hospitals are on the hook to report their 4 colonoscopy quality measures and potentially even more if they are reporting through a registry like GIQuIC. MACRA poses a dilemma to these gastroenterologists: how will doctors report on procedures performed at several different locations?

Does all that data consolidate in a single practice EHR and allow a doctor run reports willy-nilly on the patient population? No.

No hospital interoperability The typical cacophony of systems gastroenterologists have to deal with.

Following the gastroenterologist example: although GI docs at least have a copy of their procedure notes to scan or upload into their EHR, they still need to generate discrete data from dictated or EndoWriter-generated procedure note PDFs. Doctors are left with a few options:

  1. Request ambulatory surgery centers and hospitals generate reports (God help you if notes are dictated into the EHR)

  2. Export data from every EndoWriter and consolidate path reports

  3. Dreaded end-of-the-year “Chart Review” with back-office staff and do reporting in Excel

  4. Don’t report and take the Medicare penalty

  5. Become a concierge doctor and/or stop seeing Medicare patients

None of these options are ideal and it is nearly impossible for a physician to accurately report his/her entire patient population because there is no way to break down the data siloes that exist inside various hospitals. The cost of extracting data and creating single a report can cost anywhere between $10,000 and $20,000. Not only is it incredibly time consuming and labor-intensive just to get data out, these costs will become insanely burdensome for rural hospitals and hospitals that are already running on a tight margin.

Unfortunately, this is the direct result of medical data being trapped in inconsistent, proprietary siloes that have no interoperability.

And what happens if a physician does not report his/her MIPS quality data? During this first year (2017), not reporting any data will result in a -4% reduction in Medicare reimbursement and reporting a complete year’s worth of data will make a provider elligible for up to +4% incentive in reimbursement. This is a potential swing of 8% in reimbursement for doctors. For an average gastroenterologist, non-participation could be a difference of $16,000 for the first year and potentially more in subsequent years because the penalties will increase.

The nuclear option is to stop seeing Medicare patients all together and/or becoming a concierge physician. Some doctors have already gone down this path. It is important to note that although private insurers do not track MACRA quality measures, they’ve historically followed CMS’ footsteps, albeit slowly.

Sometimes we get asked why we charge so little for Qualoscopy compared to the competition, and it’s because we offer a completely cloud-based and flexible option to help poorer and underperforming hospitals to make their doctors happy in achieving everything they need and then some by re-allocating budgets to buying other necessities such as new scopes.

Qualoscopy: the ideal system An ideal system that does everything you need.

Is there anything that can be done?

The future is not bleak! Industry and providers are still taking baby steps in breaking down siloes. Until there are legal mandates for EHR interoperability, consolidating patient data will rely on the multitude of incentives out there. I’m especially bullish on a combination of EHR RESTful APIs that will inevitably replace HL7 interfaces, chronic care management software (billable under CPT 99490), EHR optimization add-ons, and charge capture apps. Individually, none of these services bring true interoperability to health IT, but collectively, they work on concert to provide the end solution.

This is the exact reason why we developed the single-license version of Qualoscopy that we call Qapture. It is a mobile and web-based application that is designed to be used just like charge capture apps that physicians have been using to capture ICD-10 and CPT codes from patients they see outside of their practice. The difference is Qapture is specialized for ease of MIPS quality data capture as well as additional data required by registries. Qapture is designed to help the busy physician easily track all of his/her quality data and even automatically report to registries. To learn more about Qapture, contact us.

In order to make doctors happy, hospitals will need to make an investment in a system, whether its EHR-lite or an integration engine, that will help them bypass the pain of getting data out of cumbersome EHRs of today. Otherwise, physicians may leave for other hospitals that have made those investments in making doctors happy.

We need true interoperability. We don’t mean simply having a patient’s procedure note accessible to relevant physicians or easily updating problem lists or medication lists across different systems. We need to have consistent, granular information that is easily extractable for analysis and reporting. Having access to thousands of PDF pages of data is meaningless if you can’t do anything with it.

Imagine a world where all of your data is located in a single location, all the discrete data required for MIPS reporting is automatically tracked for you, you can access your data at all times and run analytics on that data, and you can upload data to any registry with a click of a button. This world does not yet exist, but maybe with the right vendor cooperation and market needs, life under MACRA doesn’t have to be so painful. We’re optimistic that providers and patients alike can reap some benefits almost as if there was interoperability.