Electronic Health Reporter

Guest post by Richard Loomis, chief medical officer and VP of informatics, Practice Fusion.

In 2016 the healthcare industry made a number of meaningful strides on the move to value-based care, culminating in October with CMS issuing the final rule for the Quality Payment Program (QPP). As the largest program of its kind, the QPP will replace existing programs such as meaningful use and PQRS and fundamentally change the way providers receive payment for patients with Medicare Part B coverage.

In 2017, this focus on value will begin to shift to the vast value found in restoring the provider-patient relationship that drives individualized care and best outcomes. Healthcare isn’t ultimately about quality programs, big data or population health management — it’s about improving our shared human experience and to live happier, longer, more fulfilling lives. The healthcare industry will start restoring this humanity by unwinding the complexity of care delivery and supporting individualized care through a number of new and exciting ways in the new year. Below are five themes we’re predicting to see in 2017:

• The year of EHR usability: EHR usability will become a critical success factor for providers as the burden of quality reporting continues to grow in an increasingly fee-for-value world. Practices already spend $40,000 per doctor per year — $15.4 billion nationwide — on collecting and reporting information about their care to Medicare, payers and others. These costs will increase in 2017 and disproportionately affect small practices. It will be financially impossible to practice medicine without a user-friendly EHR. Given this emphasis in usability, more EHRs will turn to offering cloud-based solutions to stay relevant and cost-effective.

• Real world evidence comes of age: Real world evidence (RWE) will increasingly be used to support FDA approval for marketing new drugs, leading to further investigation through one or more RWE studies. Although randomized clinical trials continue to be the gold standard for establishing efficacy and safety, they may not reflect typical patient care or day-to-day experiences. RWE studies can include larger sample sizes and a greater breadth of patient demographics and clinical circumstances, which can help supplement the data derived from clinical trials. The FDA has already signaled their interest in RWE, and in 2017 we will begin to see it come to fruition.

• Small practices recognized for their oversized role: Small independent practices are a cornerstone of the healthcare ecosystem: Independent solo and small practices are shown to have a lower average cost per patient, with fewer preventable hospital admissions, and a lower readmission rate among their patient populations. For CMS to drive additional value through the QPP, they will start to recognize and support small practices in 2017.

• Small practices will receive increased consideration in policy decisions: Small practices will become more influential starting in 2017 as CMS begins to more fully understand how important they are in driving value for care. When the MACRA proposed rule was released in April 2016, the nuances for scoring and compensation were detailed across several hundred pages. The document estimated that 87 percent of participating solo practices will face a negative financial adjustment in year one. For practices with two to nine eligible clinicians, nearly 70 percent will face a negative adjustment. After receiving feedback on how small practices would be disproportionately affected, CMS outlined an expanded range of reporting options for participating in QPP starting in 2017, some of which require minimal effort from a practice. In the final rule released in October, CMS now estimates more than 90 percent of MIPS eligible clinicians will receive a positive or neutral MIPS payment adjustment in the transition year, and that at least 80 percent of clinicians in small and solo practices with one to nine clinicians will receive a positive or neutral MIPS payment adjustment. Additionally, the U.S. Department of Health and Human Services has allocated $100 million over the next five years to help help provide hands-on training for small practices participating in the Quality Payment Program, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas.

• Meaningful measures of interoperability: The way we measure interoperability now is not sustainable for physicians, especially those in small private practices. Rather than try to develop measures for the myriad of ways interoperability may be occurring and/or taking the approach of mandating it, it is more beneficial to explore where interoperability is needed for providers, assess the degree to which that interoperability is happening now, and how it can be expanded and improved to fulfill unmet needs. The most fulfilling measure of interoperability is how much time a provider is able to save finding salient health information to inform clinical decision making across disparate health IT systems.

Just as 2016 was a year of transition in healthcare, 2017 will be no different. We hope 2017’s shift in focus to the humanity in medicine will continue to shape the direction of healthcare for years to come.