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The Upside of MACRA: Closing “Dark Spaces” in Healthcare


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"Healthcare has created giant dark spaces, there is no air traffic control system in healthcare, CareSync’s @travislbond"

Consider all the technology that pilots have to navigate from one airport to another, safely and efficiently. Contrast that with the tools and technologies for patients, who are expected to navigate their healthcare journey between visits. Healthcare is filled with “dark spaces.” Here, Travis Bond, CEO of CareSync, a personal health record company, explains how MACRA will incentivize providers to serve as the air traffic controllers that were previously missing from the healthcare journeys of Medicare chronic care and transitional care patients. MACRA, combined with innovative technologies, chronic care and transitional care management programs can help close those dark spaces and bring value to practices and patients alike.

On the way home from a business trip recently, I started thinking about the intricacies of air traffic control and its essential nature to aviation.

Air traffic controllers track planes between airports to help them stay on their flight plans. They light up the routes for pilots to navigate accurately from one destination to the next, making airline travel safe and efficient for everyone. Without air traffic controllers and radar systems, airplanes around the world would be navigating the skies alone, even in the midst of storms or darkness.

If you stop and think about it, healthcare is much like aviation; hospitals, doctors’ offices, and other providers serve as airports, and patients are the many airplanes, continuously traveling to and from various airports at all hours of the day and even night.

Unfortunately, there is no air traffic control system in healthcare, especially with respect to chronic care or transitional care patients, who require coordination between multiple providers and specialists for safe and efficient delivery of care. While these patients sometimes receive instructions at each provider visit, they are mostly left to navigate to the next stop on their healthcare journey entirely on their own, with little confidence that their path is correct.

Hospital patients typically feel safe and confident for the short period of time they are in the facility. But when discharged with instructions to follow up with a specialist, it’s not unusual to encounter a wave of questions: “When? How? Then what? Will you two doctors talk to each other? Do I come back to you? What do I do?”

Patients are not always certain if they should navigate back to the first “airport,” stick with the second one, or take an alternative action. This is why healthcare, as traditionally practiced, has created giant dark spaces, leaving patients to navigate with either great anxiety or complete passivity. As a result, many patients have gotten lost in the dark spaces of healthcare, risking worse outcomes, higher cost, and less engagement.

Thankfully, new technologies and regulations are pushing the market to provide more traffic control and consumer-centric direction and guidelights.

New initiatives

Last year, Congress adopted the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which aims hasten the transition from volume-based healthcare to the value-based era of medicine.

Specifically, MACRA authorized the Centers for Medicare & Medicaid Services (CMS) to establish the Merit-based Incentive Payment System (MIPS). The new payment system encourages all physician practices to provide higher quality care through programs such as chronic care management (CCM) and transitional care management (TCM) for their Medicare patients with two or more chronic diseases. MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-Based Modifier (VBM) and the Medicare Electronic Health Record (EHR) incentive program into one all-encompassing program measuring physician practices on quality, resource use, clinical practice improvement, and meaningful use of certified electronic health records technology.

Under MACRA, physician practices must be able to create a comprehensive care plan for each Medicare patient, be able to share that plan with each patient in print or electronic form, and give 24/7 access to the plan to each patient and all of his or her other providers and designated caregivers. Providers must also demonstrate patient engagement and care coordination capabilities, as well as the ability to communicate with other doctors, demonstrate interoperability with other systems, and leverage their electronic health records systems to their patients’ benefit.

MACRA doesn’t take full effect until 2019 in terms of financial impacts, but the performance measurement period is scheduled to begin January 1, 2017. Physician practices that do not have the performance measures in place will be penalized financially in 2019 for each day they fail to have the measures in place. On the flip side, providers that successfully adapt to the new system will see rewards: For every Medicare patient with two or more chronic conditions that a practice enrolls in a CCM program billed to CPT 99490, a practice can realize Medicare reimbursements of about $41 per month.

New technologies

Adapting to the new MACRA age will be no small task. Fortunately, innovative social media, cloud and other new technologies are emerging to make it easier to build and carry out effective, comprehensive CCM and TCM programs to manage patients between visits and post-discharge. Patient-centered technologies that store, organize and share patient data longitudinally, including the places patients have visited before, such as hospitals and prior physicians, are generating truly personalized medical records. Additionally, smartphones, tablets and other mobile technologies are allowing patients and their caregivers to remain online all the time, providing real-time access to patient data and potential treatment without necessarily having to wait for their next appointment.

Meeting MACRA

Here are some steps that can make it easier to create a patient-centered TCM or CCM program at your facility:

  • Talk to your electronic health record (EHR) vendor. Consult with your current EHR about potential solutions they may be working on to help you communicate with your patients across and between different points of care.
  • Work with experts. Work with an organization or consultant that has specific experience in TCM and CCM. They should truly understand what it's like for patients to be in the dark space between providers, current and emerging technologies and the many Medicare initiatives that now finance the monitoring of these dark spaces.
  • Talk workflows. Meet with your staff and other providers to discuss how to address the dark spaces of your mutual patients’ healthcare journeys between each provider and specialist. Healthcare organizations should ensure they have workflows established internally to expand tracking methods for patient monitoring and to understand the nuances of engagements outside of its practice. Open communication must also be established between providers to coordinate at the point of care to ensure they both receive information and share it with its patient.

Healthcare organizations need their leadership to recognize that they are now responsible for patients where they live, work and play. Creating an environment that works as a cohesive unit between a patient, their family, caregivers and other providers is the first step in making this a reality.

The dark spaces in healthcare need to be taken seriously, and with the help of MACRA, healthcare organizations now have the opportunity to not only earn additional revenue, but also eliminate these dark and dangerous places to create a safer environment for patients. 


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