There are of course many details and fine print in

There are, of course, many details and "fine print" in the regulations.
MACRA/MIPS Program Incentives
As described in an earlier lecture the MACRA legislation continues to incent the use of EHRs through both the MIPS and
Alternative Payment Models (APMs). The MIPS Promoting Interoperability (PI) requirements replace Meaningful Use. The PI
program is described in Lecture 1. You can learn more – and keep up-to-date with the regulations at
/mips/promoting-interoperability .
The U.S. healthcare system is changing to a new model where providers share in cost reductions and are penalized for
higher costs. This approach has multiple names including shares risk, managed care, bundled payments and accountable
care. In general, these models give providers more revenue if they have better care quality, are more efficient or more
profitable, referred to as "upside risk." They can also have a decrease in revenue if the approach includes "downside risk"
where the provider loses revenue if their quality of care, efficiency or profitability is not as good.
Alternative Payment Models (APMs) are Medicare reimbursements under these new, shared risk models. Under them
providers are impacted by measures of both the effectiveness of healthcare and its costs. Use of an EHR and other
healthcare information systems is essential to success under an APM. There are multiple federal APM models. In addition,
states (who administer Medicaid) are putting in place shared risk, Medicaid APM programs. The details of these Medicare
and Medicaid programs are beyond the scope of this course. But you can keep abreast of the federal APM programs at many
of the information sources we have referred to in this course.
Non-government Incentives from an EHR
Government incentives are not the only opportunities for financial benefit resulting from an EHR deployment. Additional
benefits can be in the form of new or augmented revenue for the healthcare organization or from reduced costs as follows.
Private Insurer Shared Risk/Pay for performance —There are private equivalents of Medicare shared-risk APMs. In
addition, payers such as insurance companies and the government will sometimes pay additional amounts or impose
penalties for achievement of certain healthcare performance goals, sometimes referred to as “pay for performance”
(P4P). Some examples of these goals include reduction of hospital readmissions and improved quality measures. An
EHR system is essential to implement pay for performance programs and shared-risk reimbursement models. An EHR
documents results, manages performance in real time, supports optimal care treatments and provide alerts when
metrics are falling short. The possible revenue impact for an individual provider can easily be tens of thousands of
Module 6
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