Under Pressure, Physicians Get Ready For Healthcare Changes | Geneia

Under Pressure, Physicians Get Ready For Healthcare Changes

February 18, 2016
Mark A. Caron, CHCIO, FACHE / Chief Executive Officer, Geneia

The demise of the Sustainable Growth Rate (SGR) and, most recently, the announcement about transitioning of Meaningful Use 3 has many physicians and administrators celebrating. But, before the party goes on too long, it is worth noting that Medicare is still expecting you to embrace value, quality and innovation – or you can expect shrinking reimbursements.    

New Quality Measures

The primary driving force behind Medicare’s changing structure is MACRA – Medicare Access & CHIP Reauthorization Act, which passed in April 2015. In addition to repealing the SGR, MACRA changes the way Medicare measures and rewards value over volume.  It combines, modifies and transitions several existing value programs into something new, with the goal of putting the patient at the center of care and care payment.

Accelerating The Pace

Most importantly, you need to know that there is no holding on to the status quo. The Centers for Medicare and Medicaid Services (CMS) has set two clear objectives: to link 30% of Medicare payments to quality in 2016; and 85% in 2018. Further, you need to know that 2017 is the measurement year for 2019 reimbursement adjustments, and, unless you are in an eligible Alternative Payment Model (APM), you will have your rates adjusted. Physicians must make every effort to understand how to improve quality performance and avoid penalties under this new system.

The stakes are higher than ever.

On Your Marks, Get Set

Prepare. Improving your performance begins with understanding where you are now. Learn the guidelines and apply them to your practice today. Two key components are your ability to share data across care settings, and making your performance demonstrable. Start thinking about how you currently collect, store and share data and how you measure and show performance.

Choose. The CMS has laid out clear reimbursement paths. Analyze your current performance and choose which path will provide your practice with the most opportunity for maintaining and increasing reimbursements and for avoiding penalties.

Match. Coordinate your practice workflows to match your chosen reimbursement path. Structure your practice accordingly in order to maintain and grow reimbursement while avoiding costly penalties.


Recall that the overall objective is to transform healthcare and to reward providers who give better care, not just more care. We can all agree that better care is ultimately a good result for the healthcare system as a whole. This new fee schedule sends the message that providers who embrace and act toward value will have their successes rewarded. Those that don’t will find their Medicare reimbursements virtually frozen in time for the next decade.

The time to act is now. Physicians must carefully (but quickly) consider their path to value and get busy making it happen. Measurement Year 2017 is nearly upon us. Providers with substantial Medicare patient populations must embrace innovation and the quality measures that provide the best opportunity for maintaining and growing their reimbursement structures.

Ignore At Your Peril

Physicians have become numb to the transformation news that relentlessly crosses their desks. Many are struggling with a high level of professional dissatisfaction -- 87% of physicians say the ‘business and regulation of healthcare’ has changed the practice of medicine for the worse.

It’s exhausting. We understand. Last year, Geneia’s Physician Misery Index revealed just how fatigued America’s healthcare providers are.

We are sorry to say, however, that the time to ignore reform is not now. Physicians need to take action today – and throughout this year – or be left wondering why Medicare reimbursements have dried up.

How Geneia Can Help

The CMS has stated their belief that the transformational process will “be most successful when physicians and innovators can work together directly to create the best tools to care for patients.”

We are healthcare innovators committed to developing solutions that help physicians and others at the heart of healthcare transformation.

Geneia’s vision for improving lives of physicians and the patients they serve is grounded in our commitment to the Quadruple Aim – better outcomes, lower cost, improved patient experience, and higher physician satisfaction. We understand that addressing physician satisfaction in a way that truly restores the Joy of Medicine means the software, process and workflow must reconnect physicians to patients and reduce administrative burden.

In the words of Dr. Richard Parker, then Chief Medical Officer of Beth Israel Deaconess Care Organization, “Theon® [Geneia’s advanced analytics platform] allows physicians interested in individual patients or population health to look at data in a quick and easy-to-navigate manner. Most importantly, it allows one to drill down into the information in an intuitive fashion.” 

Even more importantly, hospitals and physician-led systems at Geneia client sites are positioned to reduce administrative time by 90 minutes for every provider, every day. This is helping to restore the Joy of Medicine.

We can help you navigate these changes and prepare for Measurement Year 2017.  We can work with you to analyze your current practice utilizations and develop a strategy that puts your patients at the center of care and payment of care in a way that enables you to demonstrate clearly your dedication to value, quality and innovation.

Stay tuned for more in-depth insights on MACRA and other market forces that are changing the shape of healthcare and what you can do to prepare.

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