Can technology increase MACRA reimbursements?

Four years after its rollout, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), continues to change and evolve. Initiatives to optimize the patient experience and outcomes through quality care and cost efficiencies often focus on eliminating unnecessary procedures and not over-treating patients. However, one area that is often overlooked is using technology to improve patient satisfaction, speed of treatment, and accuracy, which can positively impact patient outcomes. 

For healthcare organizations, there’s a lot on the line. If healthcare professionals do not meet MACRA’s requirements, organizations run the risk of losing up to 7 percent of Medicare reimbursements. Knowing that they will receive only 93 percent of the total reimbursement incurred for every Part B service billed motivates organizations to participate in the quality payment incentives to increase their payment adjustments. 

However, CMS predicts organizations that do it right may be eligible to receive up to a 3.58 percent exceptional performance bonus for the 2019 performance year paid in 2021. With an estimated total of 11 percent in reimbursement influx, integrating digital technologies and applications will play a major role in helping organizations increase their return on investment, and more importantly, increase the quality of care for patients.

Using composite performance scores determined by one of the two Quality Payment Program paths under MACRA, the Merit-based Incentive Payments (MIPS) scores will be based on quality (45 percent), promoting interoperability (25 percent), costs (15 percent), and improvement activities (15 percent). 

How technology impacts care

Often scattered among many decentralized sources, patient information can be hard to find, can contain inaccuracies, and sometimes just doesn’t make it to the intended destination. This results in increased treatment times, reduced availability of clinicians as they wrangle with these systems, and delayed care-and ultimately a reduction in the overall number of patients that can be handled. And delayed treatment can negatively impact patient outcomes, which factors into the quality of performance scoring in MIPS. 

Because the EHR typically is the nexus of patient information for providers, evaluating interoperability is an integral aspect of the MIPS Quality Payment Program. Under MACRA, in order to qualify for positive Medicare reimbursement, certified EHR technology must meet the 2015 Edition Health IT Certification, which heavily underscores the use of application programming interfaces (APIs) for non-primary uses of clinical health data. 

So, what can organizations do to avoid penalties, increase their reimbursements, and provide a better quality of care for patients?

Adopt solutions to automate business processes

Healthcare organizations that successfully integrate disparate clinical data sources into their EHRs simplify and improve the quality of the patient journey. Fast, secure, and reliable communications enable automated workflows and increase efficiencies, e.g., sharing information that contains patient history and diagnostic data to support preauthorization with payers helps patients quickly get the care they need. 

Strengthen care coordination and communication 

In many cases, attending physicians must collaborate with specialists to treat a patient. Using reliable and secure applications for document delivery and messaging enables care teams in different locations to quickly share information, such as lab test reports, high resolution radiographs, and MRIs. 

Additionally, implementing secure patient messaging solutions can help facilitate and enhance the patient-caregiver relationship. For example, after a patient has left a facility, providing them with the ability to communicate with the physician securely can help the patient easily report new symptoms or issues, as well as better coordinate any needed follow-up appointments, prescriptions, or additional care. 

Invest in solutions that work 

Digital technology applications and integrations that support secure document transmission solutions within EHRs not only help provide the best patient experience possible, but also give back more time to the caregiver to spend on determining quality and effectiveness of care for patients. Better technology can lead to greater reimbursements when it clearly shows efficiency gains, minimizes disruptions to existing processes, and is accepted and adopted by the end users.  

With a true focus on improving the quality of patient care under MACRA, we’ll see effective physicians and healthcare organizations benefit from improved technology applications and integrations that will ultimately get patients the quality of care they need faster. 

Bill Ho is CEO of Biscom.