Healthmonix Advisor

But why would they care? If a clinician moves to a new practice, wouldn’t they receive the score, and adjustment, for that new practice? Unfortunately for clinicians looking to start fresh, the answer is no.

The Second National MACRA MIPS/APM Summit is the leading forum on MACRA, MIPS, APMs, and other Value Based Payment Models. With no fee increases across-the-board for physicians from 2020-2025, value-based payment is going to become key for any health system's viability. Healthmonix was pleased to attend this summit and see MACRA policy and perspective in the making, with thought leaders in the medical, research, and business fields convening to break down MACRA and it's implementation now, as well as look towards the future of what MACRA can and should be.

We put together a brief list of takeaways from this event.

With the beginning of June came the half-way point for the first year of MIPS reporting. While many providers haven't started reporting yet, a good number of clinicians have started early. We interviewed clinicians and practice administrators who have reported PQRS in the past via registry, are currently reporting through the MIPSPRO registry, and that represent a diverse demographic of MIPS eligible clinicians. 

HIMSS is the seminal event in healthcare technology each year.  This year it grew to 45,000 attendees and literally a mile of exhibit hall.  We logged miles of walking in one day just to cover the exhibit floor, and still did not see it all.  At this pivotal time in healthcare information technology, there were many important themes that were covered.

Early on the morning of February 10th, the Senate approved the nomination of now-former Rep. Tom Price to be the Secretary of Health and Human Services.  While some say his chief priority is “dismantling of the Affordable Care Act”  (Sen. Maria Cantwell of Washington), the tasks that will be put in front of him also include five major health IT initiatives:  appointments to ONC and other agencies, the future of MACRA and Meaningful Use, the enforcement of interoperability, telemedicine, and cybersecurity. 

Nearly 90 percent of healthcare organizations suffer data breaches according to the Ponemon Institute. ^[1] The level of data breaches is predicted to continue to grow.^[4] What if there was a technology to better encrypt our health data, while also providing improved access to comprehensive health data for a patient? The quality of healthcare would rise, patient satisfaction would increase by leaps and bounds and costs would likely fall.  Sound idylic?

Thanksgiving is almost here! For me, this means reflecting on the things in my life that I am thankful for. Along with the tasty food I am about to consume with my loved ones, this year I am grateful for the MACRA Quality Payment Program. This may sound perplexing to you, as the MACRA Quality Payment Program has been causing a lot of alarm in the healthcare industry since the Notice of Proposed Rule Making (NPRM). However, with the release of the final rule came many provisions that I believe will improve the ease of reporting for clinicians while continuing to improve the quality of care for patients.

To briefly refresh before jumping in, the MACRA Quality Payment Program is split into two paths: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). MIPS streamlines pre-existing CMS quality initiatives (like PQRS and Meaningful Use), while Advanced APMs are designed to encourage innovative value-based payment models.

Evolving Medical Education is not Without Controversy

Competency Based Medical Education (CBME) Is clearly an area of discussion and controversy worldwide. Medical education is in the middle of a paradigm shift from the old style of medical education, referred to as “Structure/Process” education, initiated in 1910, to CBME. To learn about CBME, a good starting point is AM Rounds. During the AMEE conference, some cynical delegates stated that ‘Competency Based Medical Education’ (CBME) could be misinterpreted as ‘Checklist Based Measurable Education’.

Nevertheless, the paradigm shift is well underway and one aspect of evaluation is the discussion of levels of competency as they align with the physician’s career and practice of medicine.



At AMEE, the question was posed as “do you want to be treated by a competent doctor or an excellent doctor?” Clearly the level of competency needs to be set a particular level and may take some learners longer to achieve than others.

There was a tension across medical educators and at the conference between the idea of "striving for excellence" versus "aiming competence." Pose yourself the following question: Which one of these ‘competent‘ pilots do you want to land the plane?

Medical education is not straightforward. At a meeting of over 3,500 healthcare educators from around the world, there were theories and approaches put forward about the best way to education of physicians and there were debates around these. I’ve been attending these meetings for almost ten years, and the conversation is continuing and evolving. It’s never without controversy. Some of the comments I heard this year:

“Embrace complexity but act with simplicity.”

“If you torture data long enough, it will confess to anything.”

“Learning is not knowledge transmission but knowledge reconstruction.”

The opening plenary at AMEE 2016 was delivered by Graham Brown-Martin, an innovator in education. Graham’s talk was focused on education in the school sector, leaving it to us, the audience, to translate into the implications for medical professional education. We also heard that the idea of teaching critical thinking, one of my personal passions, gets lost in teaching facts needed to pass a test or get to the next course. Sound familiar? Graham highlighted how schools need to equip children with the knowledge and skills to reimagine society, to meet the challenges of their generation. Surely this is true for medical education as well.