MACRA(&)Me: Our Thots from the North Carolina HMISS 2016 Annual Meeting

Greg Nelson Analytics training, Events, Our Thots

By Monica Horvath, Director of Health Intelligence

The best conferences are those where there are a lot of stories.  At this year NC HIMSS Annual Meeting, the stories people tell revolve around how healthcare organizations are grappling with the many unknowns in the future and walking a fine line between due diligence and paternalism for both patients and staff.


MACRA and Me

The Advisory Board gave one of the best talks of the event– discussing the latest MACRA legislation and what that means for Meaningful Use.  I was pretty familiar with it, but I learned a number of additional details that are suitable to scare CMIO’s around the campfire.  The goal of MACRA is to make a new framework for rewarding care providers for giving better care.. not just ‘more’ care.  It combines existing quality and reporting programs into one new system– a system whose rules are still pending.  Meaningful Use will be replaced by MACRA for providers, who then will have to participate in a Merit-Based Incentive Program (MIPS) or an Alternative Payment Model (APM), each of which have their own nuanced requirements.  From my perspective, it seems like this is taking all of the undesirable items from the various programs and adding a lot of uncertainty. 

  • MACRA has little relevance to the Medicaid Meaningful Use programs, which can be tailored by each state.  So all of those provisions still apply to Eligible Professionals (e.g. providers).
  • MIPS metrics still need to be defined.  Definition of what payment models quality as APMs still need to be defined (but the Medicare Pioneer ACOs won’t be among them).
  • Attestation processes and the reporting window calendar is very unclear yet.
  • The program is revenue neutral.  So if some providers receive bonuses, that means others are getting penalties.  Does this mean not everyone can succeed?

 I think we are going to see more providers opting out of CMS, if they can, as this gets very complicated.

 The speaker, Naomi Levinthal, recommended that each care organization dedicates an individual to monitor and interpret these new rules go forward. 


Population Health

There are a lot of definitions that float out there for population health.  What area of medicine is not somehow relevant to population health?   Much like the term ‘Big Data,’ it has sort of lost its specificity.  Logicalis shared a definition that while it doesn’t exactly ‘roll off the tongue’, it is pretty comprehensive:

On-going and evolving strategies to deploy all available scarce resources and tools as best as possible to improve individual well-being and increase personal health mastery– to reduce the need for, and unnecessary use of, the healthcare system and to reduce the total burden of poor health on society

Isn’t this really private sector public health?


Innovative Technology

Scott Hondros, Associate Director of Enterprise Visibility at Wake Forest Baptist Medical Center, discussed how his organization has leveraged RTLS (real time location system) technology to tag the flight paths of people, equipment, and patients across the organization.  They collect data across 40 buildings that add up to 100M data points per day.  While researchers are keen to analyze these data, they maintain a strict rule that staff identity remain masked.  Their goal is to reduce staff concerns about being watched by ‘Big Brother’ which is not good for morale.  The only department who can access staff movement is HR.

His team has been able to demonstrate a $10M ROI.  He noted that he only has two data analysts that massage the raw data and create reports.  If you can show such value on investment for new technology, I really think the C-levels should pause and take a step back to consider how to divert a small portion of the savings to analytics training and talent development.  So often savings are absorbed into the enterprise and not made visible at the executive level. 



Chuck Kessler, CISO of Duke Medicine, shared some stories around phishing scams and how Duke protects itself with two-factor authentication.  A few years ago faculty and staff from the university side were targeted by a scam around Christmas where they were prompted to log into a fake site to address their payroll information.  Ten people lost paychecks. 

 This is sad but not unusual as we hear such stories often in the news.  What surprised me, however, was that only after this event (which coincided with the Anthem breach) was the Duke Board of Directors warm to the idea of two-factor authentication to protect against future similar incidents.  Considering that banks have used such methods for years, should a Board-level decision be required to enable a common sense method of protection?    Regardless, as a Duke patient I appreciate that Chuck pushed it through.


Data Literacy

Finally, I was happy to present our talk ‘Growing Health Analytics Without Hiring new Staff’ which I hope convinced many the need to create data champions to get real traction in health analytics.  We had some great conversations– see our slides below.