Is Your Statewide HIE the Infrastructure You Need for MACRA?

There is no better time for the health IT community to come together under one umbrella to raise national awareness of the benefits information technology can bring to the US health system. National Health IT (NHIT) Week is a nationwide awareness week focused on the value of health IT. Each year, NHIT Week Partners educate industry and policy stakeholders on the value of health IT for the US healthcare system. Throughout NHIT Week, our valued partners will share their voice and experience on how they demonstrate the value of health IT.

As we approach the final quarter of the first MACRA reporting year, what can you do today if your practice is underprepared for MACRA changes? It’s essential to understand the requirements of the Merit-based Incentive Payment System (MIPS) and how you can best position your clinicians to succeed under the new scoring structure. Moving beyond the MIPS score, the skills and data-driven work your clinical team will do under MIPS will help to ensure you have sustainable business operations as healthcare transitions to rewarding value over volume.

The good news is that there are many resources available to assist you. However, the sooner you begin to work with these entities, the better MIPS outcome you will have. Even though 2017 is considered a transitional year for MIPS, doing nothing under the MIPS program will yield a negative 4% adjustment to your Medicare Part B Payments in 2019.

The following are great opportunities to educate yourself, your practice and your clinicians about MIPS and how to best leverage the tools in your area for success:

1. Review and utilize the official Quality Payment Program (QPP) Resources: Go to and enter your NPI to view your MIPS eligibility and responsibilities.

2. Work with a Practice Transformation Network (PTN): Take advantage of the technical assistance provided exactly for this reason – to train clinicians to develop data-driven clinical improvement practices and do better care, for less resources. PTNs administer the Transforming Clinical Practice Initiative (TCPI), which is a federal contract to ensure clinicians receive assistance to achieve large-scale clinical transformation.

3. Connect with your local Health Information Exchange (HIE): If you are a practice and you are not sharing data with your HIE, take this opportunity to consider this as an option. HIE participation is a measure in the Advancing Care Information portion of the MIPS performance score and is a required element of the base score. HIEs also provide much value for clinicians to complete the coordination of care for patients, being able to more readily access the patient’s history and contribute to the global record.

4. Explore further opportunities your HIE can provide: If you haven’t kept up with your HIE offerings, take another look there has been a good bit of development over the past two years for HIEs across the nation. Inquire how the HIE can assist your MACRA activities, as many have pursued Qualified Clinical Data Registry and Qualified Registry status, have admission, discharge and transmit (ADT) data and have both clinical and administrative data feeds. These offerings could be the comprehensiveness of data that your practice needs to understand where patients are accessing care and could provide a complete picture of performance under MIPS. Remember that the Quality measure performance is 60% of your MIPS performance, meaning this data from your HIE is imperative for your success and foundational for your clinical work to improve patient care.


5. Review your Quality and Resource Use Reports (QRURs): if you haven’t studied your QRUR do that today, contact your local Quality Innovation Network-Quality Improvement Organization (QIN-QIO) if you need assistance in accessing your QRUR. Locate your QIN-QIO here:


These resources will help put you on the path of clinical transformation and help inform the work that needs to be done to prepare for MACRA; and more specifically, the changes that come with preparing for value-based care and risk-based agreements with payers.

A good review of performance criteria for MIPS will lead you to connect with a community of resources and the data needed to impact clinical practices. MIPS success requires a team effort – not only in your clinic but within the community of resources and connectedness of data.