Realizing Interoperability Value in MACRA Reporting


An overarching goal of MACRA is to achieve the widespread exchange of health information through interoperable certified health information technology. While not explicit, many of the reporting measures in MACRA’s Quality Payment Program (QPP) can be achieved through the electronic exchange of data. When considering these issues, how can a provider or practice adopt specific workflows, or use cases, to help further this goal of interoperability while also optimizing their reporting for MACRA’s QPP?

Across the three active reporting categories, there are over 250 metrics an eligible professional (EP) can report on to meet QPP Performance Requirements. This tool aims to examine how specific interoperability use cases can be implemented in a practice to not only achieve value related to the quality of care and/or patient satisfaction, but also meet an array of these reporting requirements. We hope that Health Information Exchange (HIE) organizations assisting in the achievement of MACRA/MIPS or others working to meet reporting requirements can leverage this tool to demonstrate value in expanding the sharing of information across settings.

How to Use This Tool:

The attached document includes examples of use cases leveraging interoperability functionalities and information exchange that can be adopted in clinical settings and can assist providers in meeting a number of reimbursement metrics.

The tables include the following:

  1. Components required for use case implementation,
  2. Potential value,
  3. Possible Merit Based Incentive Payment System (MIPS) metrics that this use case can help satisfy, and
  4. Additional considerations for review to achieve successful implementation. These use case examples aim to demonstrate that the addition of these types of workflows can provide value through a number of different avenues.

We invite you to leverage this template in your review of the value behind specific use cases. HIE organizations may use this tool to consider and highlight the value of new use cases they can offer to a practice or provider looking to expand HIE capabilities that an organization may integrate into their workflows.

*Note: This document serves as a guideline based on the current version of the Quality Payment Program (as of October 2017). These scenarios are not comprehensive representations; workflows and capabilities are likely to differ by organization. This document does not provide information on how to complete reporting requirements. For more details on these aspects of the program visit the QPP website or check out the resources within the HIMSS MACRA Resource Center.