The Medicare Access and CHIP Reauthorization Act (MACRA) included funding for organizations to provide support and technical assistance to small and rural practices to help them successfully participate in the Merit-Based Incentive Payment System and alternative payment models. TMA and the American Medical Association have continued to push for this assistance, and the Centers for Medicare & Medicaid Services (CMS) responded to that call by awarding about $20 million to 11 organizations.
The grants cover the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 or fewer clinicians. CMS intends to invest up to an additional $80 million over the remaining four years.
TMF Health Quality Institute is one of the 11 organizations.
The organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. The training and education resources will be available immediately nationwide and will be provided for free to eligible clinicians and practices.
"Clinicians in small and rural practices are critical to serving the millions of Americans across the nation who rely on Medicare for their health care," said Dr. Kate Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality. Congress "provided the funding for this assistance, so clinicians in these practices can navigate the new program, while being able to focus on what matters most — the needs of their patients."
The technical assistance, for example, will help clinicians choose and report on quality measures. It will include guidance with all aspects of the program, including supporting change management and strategic planning, and assessing and optimizing health information technology.
TMF will provide technical assistance and services in a region comprising Texas, Arkansas, Colorado, Kansas, Louisiana, Mississippi, Missouri, Oklahoma, and Puerto Rico. Customized assistance will include:
- Evaluating practice readiness for participating in a new payment model,
- Engaging practices in continuous quality improvement,
- Assessing and optimizing health information technology, and
- Supporting change management and strategic planning.
Additional federal training on the new Quality Payment Program includes:
In addition to TMF, CMS awarded contracts to these organizations:
- Georgia Medical Care Foundation (GMCF),
- Health Services Advisory Group (HSAG),
- Network for Regional Healthcare Improvement (NRHI),
- QualisQuality Insights (West Virginia Medical Institute), and
For more information on the Quality Payment Program, visit the TMA MACRA Resource Center or the CMS website.
The potential for electronic health records (EHRs) to transform health care remains constrained by the lack of effective health information exchange (HIE) technology, TMA says in a letter to U.S. House Ways and Means Committee Chair Kevin Brady (R-The Woodlands).
Matt Murray, MD, chair of TMA's Ad Hoc Committee on Health Information Technology, writes that EHRs have failed to transform health care "primarily because most patient health information is still 'locked' inside the physician's office." TMA's top concerns are lack of EHR interoperability and data security and liability.
Committee Chair Brady requested TMA's assessment to help his committee draft needed reforms.
Dr. Murray explains to Congressman Brady that interoperability problems are due to "the actual movement of data between systems (i.e., an interface)." Interfaces are typically implemented through:
- Connecting multiple EHRs to a single HIE organization (e.g., the Houston or San Antonio HIE);
- Making a direct connection between the computers of two organizations without an HIE (e.g., a laboratory interface to a hospital);
- Sending information one episode at a time through secure email (e.g., the DIRECT system);
- Retrieving single pieces of information through a special query (e.g., using the Fast Healthcare Interoperability Resources [FHIR] standard, which is in development and can be useful in some cases where specific information is needed); or
- Using the "Blue Button" or the equivalent to provide patients a copy of their own data and allowing them to provide it to the next physician/care location. This is rare and sometimes is supported by an HIE or by using the DIRECT email system.
In terms of data security and liability concerns, TMA's letter states: "Physicians are concerned about the security of health information exchange and need protections to avoid being inappropriately penalized or held financially liable for breaches and other problems that are inherent with electronic data exchange between health care entities."
Until these problems are addressed, the letter concludes, "TMA feels it is not appropriate to penalize physicians who do not participate in health information exchange because of these concerns."