Monthly Archives: May 2017

MIPS and the Business of Healthcare


Post by Vicki Harter, BA, RRT


Vice President, Care Transformation

At this year’s Healthcare Information and Management Systems Society (HIMSS) conference, representatives from the Centers for Medicare & Medicaid Services (CMS) held multiple sessions where they reinforced the message that the Quality Payment Program and value-based programs are moving forward. Jean Moody-Williams, deputy director of the center for clinical standards and quality at CMS said “As we build the program, our goal is to achieve a 90 percent participation rate by all clinicians. That includes small practices as well.”[1] Other CMS officials touted tangible results that value-based care has been delivering, such as a “17 percent reduction in hospital acquired conditions across all measures from 2010 to 2013, to savings of $37 million from providers participating in the advanced ACO Pioneer program.”[2]

As about nine out of ten providers are expected to fall under the Merit-Based Incentive Payment System (MIPS) track of the Medicare Access and CHIP Reauthorization Act (MACRA), many providers are asking themselves whether they should fulfill MIPS’ minimum requirements or strive for more. Said another way, should their organization strive to be a MACRA All-Star? Is it worth it to commit the effort and investment required to max out potential bonuses?

There are four main inputs to consider as you create your data-driven strategy for performing under MIPS. The first is the amount of Part B Reimbursements that you are expecting currently, how much you have received in the past, and how much you expect to receive in the future. That is going to drive your bonus potential as a practicing system, which is the second input to consider. Your bonus potential is going to help you understand the amount of resources that you have available to make the necessary changes in your care team. This third factor is critical in driving your organization’s MIPS strategy as you may decide to change the workflows of your nurses and physicians or add a data analyst to help you take care of the populations that are now transforming your practice. And finally, consider the amount of data analytics you have in your practice. In the past, where have you performed? Where do you stand to gain? How much of a gap do you have to close to become a MACRA All-Star?

Providers should think about these key inputs they will need to evaluate for their MIPS strategy. What is my Medicare Part B Revenue today? What impact does MACRA have on it? Do I need to get ahead of payment rates that will remain basically flat? How many resources will be impacted by MACRA reporting requirements this year, next year, in two years? Can I earn a bonus that makes a difference to my business?

If you’d like to continue the discussion, please send a note here.

[1] http://www.diagnosticimaging.com/articles/cms-seeks-make-macra-manageable-small-practices

[2] http://www.healthcarefinancenews.com/news/despite-some-good-parts-ahip-says-gop-healthcare-bill-concerning-insurers

Have You Adopted Electronic Prescriptions for Controlled Substances?


Post by Jaimin Patel


Vice President IAM Program Management, Caradigm

When regulations for Electronic Prescriptions for Controlled Substances (EPCS) were introduced in 2010, more than 12 million people reported using prescription painkillers non-medically, and the number of painkillers being prescribed could have medicated every American adult for a month straight. [1] In response to the volume of both the abuse and prescribing of controlled substances, the Drug Enforcement Agency (DEA) set several regulatory requirements for healthcare practitioners and organizations that want to prescribe controlled substances by electronic means.

Initially, many providers were concerned about the strict security mandates. To be able to prescribe controlled substances electronically, the DEA requires a secure, auditable chain of trust for the entire process. In addition, the financial and IT resources required to implement the appropriate solutions for EPCS can be challenging for smaller organizations.

With only 1% of e-prescribers being enabled for EPCS as of December 2013, adoption was a concern as prescription abuse remained a prominent societal issue. [2] In 2014, almost 50,000 people died of drug-induced causes in the United States. [3] In 2015, opioids alone killed more than 33,000 people. [4] The unavoidable reality of opioid abuse in society led to additional state laws and regulations following the DEA mandate in 2010, which resulted in broader EPCS adoption. As of September 2016, 20.2% of e-prescribing providers were enabled for EPCS. [5]

Caradigm offers an integrated and comprehensive solution for EPCS workflows that is a seamless extension of our industry-leading Identity and Access Management (IAM) portfolio. Caradigm’s Multi-Factor Authentication (MFA) solution for EPCS offers a variety of integrated authentication options ranging from biometric fingerprints, hard & soft token authentication, as well as mobile authentication. These options allow your organization to implement the best authentication solution to meet your prescribers’ needs.

The DEA requires identity proofing for prescribers that access EPCS controls within an electronic medical record (EMR). Caradigm Provisioning Identity Management ensures that appropriate checks and balances are applied for an organization before granting a prescriber EPCS rights within an EMR. Further, when the prescriber no longer needs EPCS privileges, Caradigm Provisioning Identity Management can seamlessly update these permissions in the EMR while notifying appropriate members in the organization. This integrated solution ensures that no unauthorized access is granted for prescribers.

Caradigm’s EPCS solution has been deployed at number of sites where users are benefiting from integrated Single Sign-On for fast and efficient access into their applications and MFA for EPCS workflows.

Overall, it’s hard to argue that EPCS is anything but a positive for the healthcare industry, and any organizations that have not adopted a solution for EPCS should act now. E-prescribing is a tool that increases efficiency, prevents the likelihood of fraud, and reduces the risk of controlled prescription errors. For additional information, please visit our EPCS page.

[1] http://www.cdc.gov/VitalSigns/PainkillerOverdoses/index.html

[2] http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/adoption-of-electronic-prescribing-for-controlled-substances-among-providers-and-pharmacies

[3] https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf

[4] https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

[5] https://www.healthit.gov/opioids/epcs