A key reason some are struggling to be ready to implement MACRA's Quality Payment Program is that EHR vendors have not been ready to make the changes, some users say. Most EHRs "were not built to support a clinical-care function and a reporting function," said Dr. Robert Weil, senior vice president and chief medical officer of Catholic Health Initiatives, Englewood, Colo.
Similarly, Dr. Ken Yanagisawa, managing partner of a surgery group, said working with his EHR vendor has been frustrating. "The biggest challenge is our EHR vendor, who in my mind is the magic key to success to this whole project," said Yanagisawa who oversees the Southern New England Ear, Nose, Throat & Facial Plastic Surgery Group in Connecticut. He said he feels ready to implement MIPS, but his EHR isn't ready to track and report on the quality measures he chose to comply with in the program.
He declined to name his vendor in hopes that things will turn around.
EHR companies reject the notion that they are a stumbling block to the industry and say that generally they are ready to help their customers comply with the law. However, if there are instances where that it's not the case, it is because the CMS releases new rules that have tight implementation timelines. "We receive final rules very late in the game," said Jackie Lichwell, senior manager for quality performance at Athenahealth. "We really wish that they would stick to what they say they are going to stick to so that we can best prepare, so we have the lead time to support our clients."
Dr. Ashwin Gowda, who has a solo practice in sleep medicine in Austin, Texas, said that he is relying on Athenahealth to make sense of the CMS regulations.
"We get told what the requirements are, but CMS doesn't really provide us the resources to go about meeting them," Gowda said. "I don't feel supported by them. I'm basically told what I need to do to get paid."
For others, the issue isn't whether their vendor is ready, it's if they can afford one in the first place. Costs have been such a concern nationally for small practices that the CMS cited it as a reason for allowing as many as 800,000 clinicians to not participate. The CMS is now proposing that physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year be exempt from the quality reporting system under MACRA. The current threshold was $30,000 or fewer than 100 Medicare patients.
"We have heard from small and rural practices that the current threshold is too low and that they are still struggling to purchase EHR systems," Dr. Kate Goodrich, chief medical officer at the CMS, said at a bundled-pay summit earlier this summer. "They don't see enough Medicare beneficiaries to make it worth that cost."
The cost of implementing an EHR system in an average five-physician primary-care practice is about $162,000 with an additional $85,500 in maintenance expenses during the first year, according to an Agency for Healthcare Research and Quality analysis.
Because so many providers have been given an out, the CMS feels that those that remain should be prepared to comply with the law. It estimates that at least 418,849 providers will still report under MIPS and up to 245,000 will meet the requirement for an Advanced APM.
"Based on the flexible policies for the transition year, we anticipate that most practices are ready to at least meet the minimum requirement to avoid a MIPS negative payment adjustment," an agency spokesman said.