EHR vendor readiness can be barrier to pay model rollout

Physicians hoping to succeed under new alternative payment models face a significant hurdle, and one that's out of their control: vendor readiness.

Electronic health record vendors' lack of preparedness to help physician practices make the changes necessary to perform well under new payment models can be a challenge, according to Dr. Laura Sessums of the CMS' Center for Medicare and Medicaid Innovation. Since the Comprehensive Primary Care Plus, or CPC+, initiative launched last year, Sessums has noticed that vendor relationships are one of the hardest parts of getting a new pay model up and running.

"Vendors find the work difficult and they have other priorities," Sessums said at a MACRA summit Thursday.

But the CMS has few options to push EHR companies to prioritize new pay model rollouts, she said. That burden falls on the providers.

"We are not the dictator to the vendors," said Sessums, the director of the CMS' division of advanced primary care. "We don't have contracts with them, practices do."

Under CPC+, providers receive a monthly fee from the CMS and other payers​ for patient care-management services. The funds are meant to help bring down healthcare spending for Medicare enrollees and patients on private health coverage too. 

CPC+ participants must meet several IT requirements that help them develop patient care plans, including being able to systematically assess patients' psychosocial needs, document and track patient-reported outcomes, and identify and flag patients with complex medical issues.

It's not the first time EHR vendors have been called out for failing to help providers meet pay model demands. Some physicians have said EHR vendors have impeded their ability to implement MACRA.

Most EHRs were not built to support a clinical-care function and a reporting function, according to Dr. Robert Weil, senior vice president and chief medical officer of Catholic Health Initiatives, based in Englewood, Colo. 

Similarly, Dr. Ken Yanagisawa, managing partner of a surgery group, said working with his EHR vendor on MACRA implementation has been frustrating. 

"The biggest challenge is our EHR vendor, who in my mind is the magic key to success to this whole project," said Yanagisawa, who oversees the Southern New England Ear, Nose, Throat & Facial Plastic Surgery Group in Connecticut. He said he feels ready to implement the Merit-based Incentive Payment System, but his EHR isn't.

EHR vendors maintain that they generally can help practices implement new pay model standards, but outside sources can hamstring their work. Unexpected and sudden CMS rulemakings can introduce many new requirements at once without giving them enough time to implement the changes.

"We receive final rules very late in the game," said Jackie Lichwell, senior manager for quality performance at Athenahealth. "We really wish that they would stick to what they say they are going to stick to so that we can best prepare, so we have the lead time to support our clients."

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