The transition to the Medicare Access and CHIP Reauthorization Act (MACRA) and the associated Merit-Based Incentive Payment System (MIPS) will have a significant impact on health care providers who treat the more than 55 million Americans served by Medicare, and technology will play a major role in helping providers make that transition.

It’s a big job. In many cases, physicians will have to accommodate new business processes and a new focus on value-based care that will be necessary to receive the maximum reimbursements under MIPS. They will almost certainly have to embrace new tools. As these regulations put increased focus on patient engagement and satisfaction, providers will also need to find effective ways to give patients relevant information in intuitive and useful ways.

The need to make a smooth transition is especially pronounced in high-cost areas such as orthopedics, and the changes have to start now. Performance data submission for the first reporting period is underway now and runs through March 31, 2018.

A daunting challenge

Physicians recognize the challenge in front of them. In its 2016 State of the Industry Survey, Managed Healthcare Executive found 36.3 percent of their readers believe complying with new government mandates is the biggest industry challenge, while 25 percent believe implementing value-based care is the biggest challenge.

And, admittedly, there is still much work to be done. In the Managed Healthcare Executive survey, 68.6 percent of physicians said they had done little to nothing to make the transition to value-based care and 46.4 percent said their organization had started only a few initiatives toward the transition.

Finding the way forward

So, what’s the next step? As providers respond to these changes, their focus will be squarely on the consumer. New rules under MIPS depend on patients being more engaged in their treatment and more informed about the decisions they are making. One way to accomplish this is with interactive technology that allows providers to customize patient education and provide timely, personalized reminders and care instructions that engage patients over time.

There is evidence that increasing patient engagement on this level can make a difference. Early outcomes from providers using interactive platforms to educate patients and help them manage their care led to a 60 percent decrease in same-day surgery cancellations, a 57 percent decrease in emergency department readmissions and a 15 percent decrease in routine phone calls to a physician’s office.

That kind of improvement can make a big difference. Consider orthopedic care. With a population that is aging rapidly, orthopedic procedures such as hip and knee replacements are becoming increasingly common. They also have the potential to be expensive. In fact, orthopedic surgery cancellations are among the 10 most costly for all specialties.

The providers who are best able to reduce those cancellations and improve the care experience in other ways stand to benefit under new regulations.

Change will require optimized health records

The changing landscape will require adjustments in all areas of a hospital’s operations. Providers must transform from a clinical and technological standpoint to manage the health of defined populations and to foster interoperability across departments and locations. Meanwhile, patients should have access to information that allows them to make informed decisions about health care, in the same way they would when purchasing a new car or computer.

This requires a fully optimized electronic health record, or EHR. In fact, meaningful use of an EHR is a significant requirement of MIPS. Although this can be a challenge, changes to federal regulations encourage greater interoperability, and technology like SMART on FHIR is being adopted by forward-thinking organizations that recognize the need to break down silos in health systems.

Such solutions exist, but many providers find them lacking. They do not offer enough opportunities to customize content, nor the kind of interactive experience patients and families have come to expect. Providers want the ability to track and demonstrate outcomes, and they want it integrated into their regular workflow.

A solution that meets the needs of the modern audience can offer a significant advantage. With at least 50 percent of traditional Medicare payments scheduled to flow through alternative payment models by 2018, the patient experience will become more important than ever.

By ensuring orthopedic patients are informed about their care and following instructions both before and after surgery, providers can:

  • Reduce costs for surgical procedures,
  • Improve patient care and safety,
  • Improve patient acquisition, and
  • Reinforce the hospital and health system brand.

Those changes can have big impact on the bottom line. According to a survey by Merritt Hawkins, orthopedic surgeons generate more revenue for their hospitals than any other specialists. On average, a full time orthopedic surgeon generated $2.7 million in revenue in 2016. It’s clear solutions are needed that address this high-profile area of clinical care. 

The right information, in the right way, at the right time

The way we access information has changed. Patients increasingly want information electronically and on the go. A population that has gotten used to consuming content — including health content — on YouTube is looking for video and online, interactive tools, rather than brochures. Providers must be prepared to meet these needs.

An effective EHR can also improve data storage and handling, and offer insight into patient utilization patterns. Thus, fully optimizing your EHR can help with MACRA compliance.

More than just record keeping

MACRA and MIPS will also drive other changes. According to a Deloitte survey:

  • 80 percent of physicians believe MACRA will drive physicians to join larger organizations,
  • 70 percent said it will cause physicians to stop accepting Medicare patients, and
  • 69 percent believe it will make it more difficult for patients to access the care they need.

Recent surveys have shown that providers recognize the importance of increasing communications with patients, and they have some lofty goals when it comes to increasing engagement, including:

  • 3 percent want to improve/increase patient outreach;
  • 4 percent seek engagement for wellness incentives or programs; and
  • 4 percent aim to increase use of remote patient monitoring or mobile health.

To accomplish those goals, providers will need tools that allow them to easily customize messages for individual patients. To be sure, change will be a constant as we move forward in this new health care paradigm. Getting the best possible results under MACRA and MIPS will require preparation, and a fresh perspective, not to mention the right technology solutions to ease and support this ongoing evolution.


About the author

Nicole Latimer is CEO of The StayWell Company, LLC, a health solutions company that helps its clients engage and educate people to improve health and business results. StayWell develops interactive patient education and engagement solutions that are in use at hospitals and health systems across the country. StayWell is a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (“Merck”). Contact Nicole at