The government’s role in the health IT industry has dramatically increased since the 2009 passage of the American Recovery and Reinvestment Act, which included incentives for adoption of EHRs. In the years since, as the regulatory programs have evolved from the Meaningful Use program to the Merit-based Incentive Payment System (MIPS), also raising up Accountable Care Organizations and programs like Comprehensive Primary Care, requirements for both Altera Digital Health Inc. and the clients we serve have become more stringent. HHS has pushed, particularly, for the increased exchange of health data among industry constituents, and they continue to implement regulations that use both incentives and penalties to do so.
Altera's broad product portfolio continues to evolve to meet demanding requirements from the government, both through delivery of certified EHR technologies (CEHRT) and support of programmatic elements our clients are aiming to meet. This means that understanding the criteria and processes is critical, as is selecting the right technology partner. We are that partner.
MIPS or Advanced Alternative Payment Models (APMs)?
With Congress’ passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, replacing the maligned Sustainable Growth Rate, CMS was directed to largely move away from the Meaningful Use program and instead create a new structure to incite providers in maximizing health IT capabilities for improved patient care. Healthcare professional in ambulatory environments are now deciding whether there are Advanced APMs that fit the structure and goals of their organization, knowing that not all programs are available in every region, or whether reporting against MIPS requirements is the better choice for them. Whatever the decision, we work regularly with clients to ensure you meet the necessary requirements of the many programs that are out there.
Hospitals, health systems and physician practices now all have an opportunity to participate in accountable care organizations (ACOs), working within the structure of increased financial risk to improve population health and the patient experience while better managing costs. While CMS is the dominant source of ACO options, commercial payers have also rolled out a variety of programs for the healthcare providers in their network, leading tens of thousands to take a chance on the risk-based model.
Similar to ACOs, Bundled Payment models draw providers together in care teams who agree to better coordinate care while sharing money received from the payer across the team. There are a variety of options, many specific to certain commonly-delivered healthcare procedures, such as joint replacements, or management of high-cost patients, like diabetics. There has been vacillation from CMS on whether bundled payment models should be voluntary or mandatory, though the Trump Administration has indicated intent to shift towards requiring participation for certain specialists.
Primary Care elevation
Recognizing the relationship between effective primary care services and the health of the nation, a series of programs oriented around further rewarding them at high quality delivery levels. Starting with the Comprehensive Primary Care Initiative (CPCi) and most recently transitioning to the Primary Care First program, CMS has increased financial incentives for practices willing to report on and satisfy certain clinical quality measures, though only in approximately half the states. Given the breadth of the Altera's ambulatory client base, we are a leading provider of health IT support to CPC participants.
Following increasing frustration with the slow uptake of interoperability solutions and lower-than-desired volumes of information exchange between clinicians, Congress included within the 21st Century Cures Act components addressing what was termed “information blocking”, or intentional withholding of patient data from others appropriately requesting it. Accordingly, CMS and ONC have both promulgated regulations outlining rules to be considered by virtually every sector of the healthcare space, from hospitals to labs to software developers. The rules will have a measurable impact on the information exchange behaviors exhibited by stakeholders, and Altera is committed to full compliance and support of our clients during the change.
Altera in D.C.
Altera takes seriously our commitment to work with Congressional offices and different agencies within HHS on laws and regulations that will efficiently continue health care’s movement towards a value-driven care payment structure while also being mindful of the impact on care delivery and the experience of our clients and their patients. We welcome input to help us advocate on their behalf as effectively as possible.
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