The ACA in 2018, Patients Over Paperwork, MACRA Changes and Women in HealthIT: Your #KareoChat Recap

As 2017 comes to a close, we look ahead at what’s in store for the healthcare industry. The past few weeks of #KareoChat focused on preparing for changes in the ACA and MACRA coming 2018, while also taking a good look at how to enhance patient care through various initiatives. To round out the topics, we were inspired by the #MeToo movement to look inwards at our own HealthIT industry: What are we getting right? What in the industry can be improved? Thank you to our hosts for moderating the insightful conversations!

What To Know About the Affordable Care Act in 2018

Host: Dr. Tom Giannulli @drtom_kareo

As 2018 creeps closer, what will be the provider impact of the changes to ACA? How will the patient-physician relationship be affected? These are just a few questions we sought to answer during this #KareoChat hosted by Kareo’s own Dr. Tom. As he wrote in his recent blog on the topic of the ACA’s open enrolment: “The ACA is still the law of the land. Although it may continue to undergo incremental change in the next few years, it is still in effect and operational.”  Here’s what we covered in the #KareoChat:

What are the estimated cost changes for reference plans and subsidies?

Te costs are up given the low usage by low risk patients, via the indv mandate not being enforced #kareochat

— Dr. Tom Giannulli (@drtom_kareo) November 2, 2017

Much like auto ins, if we mandate a min level of ins for anyone with a heartbeat then we can keep rates low for all simple math #kareochat

— Dr. Tom Giannulli (@drtom_kareo) November 2, 2017

What are the plan/insurer coverage differences from last year?

Q4: Increased patient financial burden will necessitate even more creative approaches to collect co-pays & keep patients engaged. #kareochat https://t.co/STz4Ay5KPB

— Stephanie Crabb (@stephaniecrabb) November 2, 2017

What are the patient payment issues and tech that apply?

A5: Recently saw a provider who sent me text apt reminders with pertinent info incl. POS payment due. They got paid  #kareochat

— Heera Kang (@heerakang2) November 2, 2017

A5 Hope providers are prepared & willing to work w/patients re payment options as patient burden increases  #kareochat

— Melissa VanHouten (@melissarvh) November 2, 2017

Q5: 1/1 Need multipurpose #tech that creates value for pts (engagement in all aspects of care to include $ responsibility). #kareochat https://t.co/8XBp2diExH

— Immersive (@ImmersiveLLC) November 2, 2017

Thank you, Dr. Tom, for driving this conversation, and all for helping shed some light on what we can expect from the ACA in 2018.

Meaningful Measures and Patients Over Paperwork

Host: Stephanie Crabb @stephaniecrabb

As our host Stephanie Crabb explains: “CMS recently announced two significant initiatives aimed at addressing the regulatory burden for healthcare providers. These efforts advance CMS’s “patients first” focus, under the working premise that the regulatory burden has a negative impact on the provider-patient relationship.

#PatientsOverPaperwork is geared toward scrapping or reducing regulations while lowering healthcare costs and enhancing patient care. CMS has signaled the intention to review “all” of their regulations to retain or improve only those that advance the goal of putting “patients first.”

#MeaningfulMeasures is CMS’s comprehensive initiative on quality measures to reduce the burden of reporting such that only those core issues that are the most vital to providing high-quality care and improving patient outcomes are required for assessment and reporting. “Meaningful Measures” draws upon advice and input from the LAN, the National Academies of Medicine, the Core Quality Measures Collaborative and the National Quality Forum.”

In this #KareoChat, we discussed these two initiatives and the implications for the modern physician practice.

T1: The Annals of Internal Medicine 2016 study cited that, on a typical day, primary care MDs spent 27% of time on meaningful care and 49% on admin. Clearly not the right ratio. #kareochat

— Immersive (@ImmersiveLLC) November 9, 2017

T4: some orgs are arguing to completely scrap the Advancing Care Information framework and just require use of EHR. Thoughts?  #kareochat

— Stephanie Crabb (@stephaniecrabb) November 9, 2017

T4 We need to know if patients & providers were more satisfied 20 or 30 years ago B4 so many regulations existed. If so, there's a major lesson in that.    #KareoChat

— CP Nerve Center (@Cpnervecenter) November 9, 2017

A5 Providers need the freedom & flexibility to design & offer new approaches to delivering care. CMS now recognizes this #KareoChat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 9, 2017

T5: CMS has called out: #consumerdriven care, #medicare advantage plans, #opioid tx, models for primary/specialty alignment #kareochat

— Stephanie Crabb (@stephaniecrabb) November 9, 2017

A5 I think precision-directed programs will be benefitted with a new CMS revamp. Imagine being able to design opioid addiction programs that are embraced by CMS #KareoChat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 9, 2017

Thank you, Stephanie, for guiding us through this chat! This would be a great topic to revisit in 2018 as we continue to see what plays out.

2018 MACRA Rule Changes and What They Mean for Small Practices  

Host: Shereese Maynard, MS/MBA @ShereesePubHlth

Reaction to MACRA rule changes have been mixed, but believe it or not, there are some bright spots in MACRA for small providers and Shereese was excited to let #KareoChat know where we could find them! Can small practices maximize revenues under MIPS? Read on to find out answers to that and more.

We kicked off our chat on a positive note:

What are some MACRA advantages / allowances for small practices?

A1 There are some allowances that are impacting providers. Ex. Small providers impacted by H.I.M. hurricanes. There's a hardship exemption #KareoChat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 16, 2017

A1- Also, there's an allowance to use 2014/2015 versions of #EHR tech in yr 2 but I'm not a fan of this. There's a 10% bonus for CEHRT (15) #kareochat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 16, 2017

How can eligible clinicians maximize revenue under MIPS and where can clinicians find MIPS reporting support?

A3 87% of practices want to use existing staff for MIPS but as I travel around the country, I can tell you, it's not always the best strategy #kareochat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 16, 2017

A3 You need the right ppl in place. Ideally you want a physician-lead team but again, Its a problem. Small practices should consider hiring a physician consult (informaticist) #KareoChat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 16, 2017

How can smaller practices leverage the MIPS reporting flexibilities to maximize their composite performance scores and avoid penalties?

A4 In 2018, if practices have been diligent w/ ongoing data requirements, they should be able to report for the entire year, thus optimizing bonuses while insulating from pay adjustments #KareoChat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 16, 2017

How can small practices identify branded #MIPS compliance #technologies, in lieu of current #EHR vendor capabilities?

A5 @Capterra is a great resource if providers want to research & ID branded vendors. I stress this b/c there are a lot of EHRs that are currently failing practices. Find 1 that works #KareoChat

— ShereeseM, MS/MBA (@ShereesePubHlth) November 16, 2017

Thank you, Shereese, for hosting this thoughtful #KareoChat! You always come prepared with excellent advice for our attendees! 

Women in HealthIT 

Host: Janae Sharp, @CoherenceMed

As host Janae Sharp wrote in her blog post to accompany this chat: “With recent culture shift and #metoo leading to the firing of high profile men in Hollywood it is a topic of discussion in many industries. What is happening in HealthIT?” Are the healthcare and HealthIT industries like others? Read our recap below:

What examples are out there of women promoting women in HealthIT?

I've seen women in healthcare promote each other- recently @annewellpepper told someone about what I'm interested in and it was awesome. I've seen women stand up for each other. #WomenInHIT #KareoChat

— janae sharp (@CoherenceMed) November 30, 2017

So many lately! Was happy to be a part of @HIMSS inaugural #WomenInHIT Award last year. Gratifying as a judge to see TONS of nominations. #KareoChat

— Jennifer Dennard (@JennDennard) November 30, 2017

Does news about workplace harassment impact women working in HealthIT?

We have seen women make great progress in HealthIT - maybe not all #metoo stories will change things but people are hearing. It is a start. There are many stories that haven't been shared. HealthIT is more supportive than before.@WomenInHealthIT #KareoChat #WomenInHIT pic.twitter.com/u3cyzE4znn

— Stellicare (@stellicare) November 30, 2017

Why do some leave the HealthIT industry to go to others?

The hurdles can be so high in health/IT - man or woman. I imagine some people leave b/c of all that red tape that prohibits them from making a difference quickly #KareoChat

— Jennifer Dennard (@JennDennard) November 30, 2017

What would be your wish list for women in HealthIT?

T4 My wish is that everyone has a voice in their own healthcare, women, POC, the differently abled, everyone #healthIT #KareoChat

— Melanie Hilliard (@social_melanie) November 30, 2017

A4 wishing and hoping that Women in Health IT continue to make strides and strive to profoundly impact the lives of people who need them to improve the patient experience. #KareoChat

— Amanda (@LAlupusLady) November 30, 2017

Here is a Wishlist for Women in Health IT from earlier this year #WomenInHIT #KareoChat https://t.co/STQ3udJ06N

— janae sharp (@CoherenceMed) November 30, 2017

As we move from managing sickness in traditional ways to wellness, women drive the market > men, their leadership is needed #kareochat

— Dr. Tom Giannulli (@drtom_kareo) November 30, 2017

What unique contributions can women give in improving #informatics and #EHR development?

T5: Would seem to me that if want good tools and resources, should listen to all voices. Homogeneous development doesn't capture diversity. #kareochat

— Matt Fisher (@Matt_R_Fisher) November 30, 2017

Women do a great job innovating for women. Like @Estrellajrios and others- They can help optimize EHRs for women's health and move forward health policy. #KareoChat Question 5 #WomenInHIT

— janae sharp (@CoherenceMed) November 30, 2017

Thank you, Janae, for encouraging a discussion around this topic, and for coming to the table with anecdotes and advice that we could all relate to and learn from. We hope this is an ongoing discussion online and offline!

Which topic stood out to you the most? And which topics would you like us to add into the mix moving forward? Tweet us @GoKareo #KareoChat and join us every Thursday at 9 a.m. (Pacific time) for our weekly forum on healthcare, technology and practice management topics facing independent practices. If you’re interested in hosting, we’d love to hear from you as well!