Today’s kids seem to know exactly how they want to contribute in the world. An online search of “What do you want to be when you grow up?” nets many very prescriptive answers – “a Lego master,” “a fighting ninja,” “a spider who learns how to spin” and “a ‘positive’ rapper,” to name a few. There are even multipotentialites, those whose career dreams combine multiple diverse skill sets and creative pursuits.

In a time when aspiring doctors, lawyers and firemen ruled, our colleague, Ben Wilson, may have been ahead of the curve.

“My mother was a teacher, so I grew up valuing public service,” he says, “but I also had an interest in business.” After college, a stint at an entrepreneurial medical technology company led Ben to an important realization. “If I worked in certain areas of the US healthcare industry,” he explains, “I could have a career that bridged both public service and business. That was compelling.”

Today, as a Citrix Healthcare Evangelist, Ben has found himself on that bridge between the worlds of business, healthcare and technology. Twenty years in the healthcare industry, an MBA and a masters degree in public health from UC Berkeley position him perfectly to answer questions about Meaningful Use and MACRA. In this, the first of two blog posts, he will touch on the basics of MACRA, its measurements and its potential for popularity. In the second, he will dive a bit deeper and make the tie between MACRA and Citrix. Here is what he had to say:

Kathy: Given what has been in the press lately, how do you see Meaningful Use changing?

Ben: Meaningful Use, ACOs and the Shared Savings Program were implemented to encourage the adoption of electronic medical records (EMRs) to improve healthcare delivery in the United States. Now that the goal largely has been met, there is an effort underway to unify those programs under a single simpler program: Medicare Access and CHIP Reauthorization Act of 2015, otherwise known as MACRA.

It is anticipated that MACRA will be implemented in January 2017. At the heart of it is something called Merit-based incentive Payment Systems, or MIPS. With MIPS, providers will be paid for how they deliver care using a simpler set of outcomes. The focus of the program is to do three things: to make healthcare delivery patient-centric, practice-focused and simpler.

The Department of Health and Human Services instigated this change. The Center for Medicare/Medicaid Services (CMS) is part of that group. CMS is the entity that administers Medicare.

It’s important to note that the MACRA program is focused on physicians that deliver Medicare services in the United States — rather than on hospitals or on Medicaid itself. That constitutes a large portion of the reimbursements that the government is providing, accounting for approximately 40% of spending in the U.S. overall.

Kathy: Tell me more about how things will be measured.

Ben: Physicians now will be measured against a simpler group of outcomes. The big difference between Meaningful Use and MACRA is that MACRA won’t just be focused on the use of electronic medical records (EMRs). (Remember that meaningful use put $72,000 per year toward paying physicians if they met criteria regarding using EMRs in a meaningful way. However, it did not measure improvements in the delivery of care, patient satisfaction or reductions in cost.)

Kathy: It didn’t measure risk either, right?

Ben: “Right. Meaningful Use was entirely focused on the adoption of electronic records (EMRs). Today, 75% of physicians — and almost every hospital in the U.S. — have an electronic medical record in place. That the goal was achieved.

Now things need to go a step farther – toward improvements in care delivery and reductions in cost using those electronic medical records. Now, approximately 50% of the measures for outcomes will be based on quality. There’s also a cost reduction component focused on quality. Finally, only 10% [of the measurements] will be based on whether physicians are using technology in a good way.

Exchange of data with other organizations and care coordination across organizations will also become crucial. This will be good for the healthcare IT world because Meaningful Use stifled innovation. It commoditized electronic medical records because providers had to meet certain criteria in terms of what their medical records could do, but they had no incentive to go beyond that in terms of how the records were used.

What’s more, electronic medical record software developers had no incentive to build new functionality to help improve practices or reduce costs. Software companies were not putting resources into innovating and creating or into investigating new ways to use their software. Likewise, they didn’t consider new ways to improve patient outcomes. This should change now that physicians are being incentivized to find tools that will help them to improve delivery of care and reduce costs.

Kathy: Do you think physicians will embrace MACRA?

Ben: Because it’s simpler and there’s less reporting than was involved with Meaningful Use, MACRA is less prescriptive in terms of how physicians must meet goals. Physicians are going to love it compared to Meaningful Use. They’ve really had to get engaged in the last five years in order to get the reimbursements or the incentives. Also, the American Medical Association played a large role in the original draft of the regulations. Already, the instigators of MACRA have received feedback from healthcare providers that this has been very positive.

There was a lot of backlash from Meaningful Use from the provider community, which was neither positive for the administration nor for HHS. The MACRA team has tried very hard to make this provider-friendly. They also have expended a great deal of effort to get feedback along the way and integrate that insight into the development of the policy.

MACRA gives physicians more freedom. It allows them to choose a subset of quality measurements on which they would like to be assessed. Doctors can choose the measurements that best highlight the improvements they have made — based on their particular specialties or on the specific types of practice they manage. For example, a rural doctor has different concerns and challenges in serving patients than an urban physician.

The fact that physicians have this ability to select the particular measurements on which they will be scored allows for a much more customized program for each doctor. It makes it much more likely that clinicians will be successful in meeting the requirements of the MACRA program. And most important, it gives them the latitude to innovate and design how they will better serve their patients.

There’s much more to learn about MACRA. Watch for the second blog in this series. It’s coming soon!

Follow Ben on Twitter at @bwilson_mhealth, or find him on Linkedin at

Follow Citrix Solutions for Healthcare on Twitter at @CitrixHealth.

Follow the author (that’s me!) on Twitter at @techiewahoo.

*If you are in the healthcare industry, we invite you to begin a dialogue with us. You can share your thoughts on the topics in this blog or any other healthcare IT issue with a Citrix researcher by clicking here.

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