MGMA’s Robert Tennant: ‘Targeted’ interoperability may show its true value

The medical practices represented by the Medical Group Management Association (MGMA) want to have more input on health IT requirements under the new administration, not a repeat of “being told what to do” as they felt with meaningful use, according to the MGMA’s director of health IT policy, Robert Tennant, MA.

Tennant sat down with HealthExec to discuss how recent regulations may impact IT investments at physician practices, as well as who should be taking the lead on promoting interoperability without it being subsidized by government.

HealthExec: What are physician practices most worried about in the immediate future when it comes to health IT?

Robert Tennant, MA: The Advancing Care Information (ACI) component of MIPS (Merit-based Incentive Payment System) is clearly going to be a challenge. It’s an extension of meaningful use. We thought meaningful use would be going away and it really didn’t. We were very pleased to see in the proposed rule that 2015 CEHRT (certified electronic health record technology) will be an option, not a requirement. I’m assuming that’s going to be finalized. In 2019, it’s still going to be a requirement going forward with MIPS so we’ll be watching that very carefully.

The whole interoperability world—the theory is so wonderful that we’ll be able to share data seamlessly between care settings. We haven’t achieved that yet. There’s a lot of issues around data blocking, but also cost issues—who should be responsible for paying interface fees between hospitals and practices? The true beneficiaries of interoperability are of course the patients, but also health plans. If you can keep patients from going back to the hospital or into the (emergency room), that’s savings for them. So we’re hopeful that the plans will see this as an opportunity to reduce their costs by supporting practices in their efforts to acquire and use health IT.

There’s also the new Medicare Beneficiary Identifier. You’re simply switching out from the old Social Security-based number to a new Medicare ID, but it has all sorts of implications on health IT. You’ll have to have your practice management system and your EHR capable of accepting this new number. It’s not required on Medicare claims until 2020, so practices think they have all this time, but they really don’t. All new Medicare beneficiaries will come in with the MBI starting in April. So your system has to be ready and, as we know, switching systems take time. Especially smaller vendors who aren’t cloud-based, it’s going to take time.

Speaking of MIPS, how are the raised exemption levels in the proposed rule affecting IT investments at practices which may be on the borderline of needing to participate?

We haven’t done surveys, but you can look at it two ways. A group of practices will say, “I don’t want to do anything. It’s a waste of time. Thank God we have these higher thresholds. I’m done. I can focus on other things.” But you’ve got another group which says “I wanted to score really high and earn a bonus and that might have defrayed some of my IT costs.”

Our position is allow those folks which want to opt out to do so, but if you’re at $85,000 (in Medicare Part B charges) and you’re looking for that bonus, allow them to voluntarily participate in the program. That solves that issue, but IT is expensive. If you have to spend $100,000 to make a $10,000 bonus, there’s no return on investment there. What we tell practices to do is look at technology as a series of buckets. One bucket is clearly MIPS, Advanced Alternative Payment Models, government programs, but that can’t be the reason you’re moving to new technology. Where’s the value to the practice? MIPS and government reporting is important but it shouldn’t be the driving force behind the practice acquisition of technology.

Should practices think twice about holding off on IT investments they may be required to get in the future for MIPS—like if that low-volume threshold is lower in 2019?

I wish I knew. You may have seen that the Medicare Payment Advisory Commission (MedPAC) recommended doing away with MIPS. So I think the jury’s out on all of those issues. It’s difficult from the vendor side, think of the uncertainty. Do I invest in 2015 CEHRT upgrades when maybe they never mandate it? It’s difficult for practices and vendors, so the MGMA has encouraged the government to be definitive. Listen and learn from the industry. Build a program that works, that’s clinically relevant, that doesn’t require enormous output of money in order to be successful, that is scalable for different sizes of groups. Set the rules of the road.

On interoperability—it seems the whole industry agrees that it’s not there yet. Where’s the onus to change that? Is it on vendors or providers or regulators—or as you suggested, is it payers?

All of the above. The first thing we have to recognize is where’s the value point for interoperability. With an iPhone, you don’t need to read the owner’s manual before using it. It’s simple technology. Could you do that with an EHR? No, you need weeks of training. The fact we haven’t made the tech user-friendly is a big part of the problem.

But on the business drivers—who should pay for interoperability? Who benefits from it? Health plans clearly do, providers get better data and patients get better care. Is it fair to charge an interoperability surcharge of $50? No, they’re not going to pay that. Should it be a government utility that everyone pays? We tried that with HIE (health information exchanges) and the ones that have been heavily subsidized, if that money dries up, out goes the HIE.

My thought is targeted interoperability. Create some use cases that have some ROI, target it towards things like diabetes that we know are high cost drivers that require care coordination and get it right. So if a diabetic patient has home monitoring and the glucose levels go directly into primary care, there’s an alert if there’s an issue, they can follow up. If the patient ends up in the ER, let’s get that discharge notice to primary care and follow up and get them into a program.

If we can do that, it will show a broader value. We’ve sent men to the moon. This isn’t that difficult. The fact that we haven’t suggests there isn’t the ROI we think there is. Do I need my high school immunization to flow around the country? Of course I don’t. We can always expand the use cases.

What about the proposed budget cuts for the Office of the National Coordinator for Health IT (ONC)? Should the industry be concerned about the agency having $22 million less to work with than the year before?

The money from the HITECH Act has dried up. I was just in to see Don Rucker a few weeks ago and they’re struggling to figure out their priorities. You have the 21^st Century Cures Act and that has a litany of requirements for ONC. Or how about getting patient matching off the ground to help interoperability?

There’s a lot of issues that ONC needs to address, and our pitch to Don Rucker was you can’t do it alone. You’ve got to engage industry for a couple of reasons. You don’t have the resources to do it on your own, but also we don’t want to be told what to do. We were told what to do with meaningful use, and that drove health IT development and deployment. For the better? I don’t know. Vendors were focused on certification requirements rather than usability or interoperability. If the tech isn’t friendly, it’s not going to be used or used effectively and no one truly benefits.