Healthcare organizations feel IT staffing void as MACRA takes hold

As first-year reporting for the Medicare Access and CHIP Reauthorization Act (MACRA) pushes on, healthcare organizations feel understaffed when it comes to health IT. Many are struggling to figure out how to align with the Act's Quality Payment Program (QPP), which streamlines and increases provider accountability for quality outcomes and cost reduction.

As many have learned already, success under the program will take far more than just passive submission of claims data. It will take coordination between IT and other departments, as well as a comprehensive understanding of the long-term goals.

Yet as Stoltenberg Consulting's fifth-annual Health IT Industry Outlook survey reveals, the majority of respondents from provider organizations (64 percent) reported being either unprepared or very unprepared for managing and executing MACRA initiatives. These feelings are understandable, given the magnitude of the changes: MACRA replaces the outdated sustainable growth rate (SGR) formula in the transition from fee-for-service to value-based care. Under MACRA's QPP, reimbursement is now centered on patient care and quality outcomes, enabling providers to comply based on practice size, specialty, location or patient population in one of two tracks: Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS).

Due to its industry significance, reporting burden and financial impact on physician reimbursement, many providers banked on the program's delay, or they simply haven't grasped how to align data with reporting measures. For hospital and physician organizations lacking a full complement of internal IT resources, this remains an issue.

As a result, many practices are only starting to realize they need external resources to meet MACRA reporting requirements. Understanding the ways that MACRA challenges healthcare providers is key in finding the most qualified, applicable IT staffing services for reporting success.

An Inside Look at Health IT Staffing Challenges

As healthcare providers consider new ways to leverage health IT aid to collect, maintain and analyze data for value-based care measures, the survey sheds light on their IT staffing concerns and perceived shortcomings.

More than eight out of 10 respondents to Stoltenberg's survey, taken at the 2017 HIMSS conference, admitted that finding qualified health IT support is a challenging task: 54 percent of survey respondents described the process as difficult, while 28 percent went further to call it very difficult. The root of these difficulties, according to survey respondents, largely stems from budgetary limits (44 percent) and a lack of qualified, experienced candidates (43 percent).

In considering this data as well as anecdotal evidence, it becomes clear that finding the right health IT support, who understands that today's providers face complex, multifaceted healthcare issues and reporting requirements, is essential, yet not always easy to do. The HIT talent pool is dwindling, as effective IT consultants require skill sets that span clinical, financial and operational understanding. Few HIT professionals possess this breadth of skills.

Therefore, those individuals with an initial clinical background who have successfully migrated into IT serve as ideal partners. Creating internal training programs that utilize professionals with deep critical thinking, creative problem solving and strong communication skills will enable the best means for collaboration across multi-disciplinary teams.

Making MACRA a Team Effort with IT Staffing Support

When asked how they plan to outsource/hire additional IT support in 2017, the largest number of respondents cited clinical application/implementation support (37 percent), followed by help desk support (19 percent) and financial application/implementation support (16 percent) as their most pressing concerns.

The right IT staff holds a skill set spanning all three areas. They understand that while IT departments serve as the foundation for compliance with any regulation such as MACRA, addressing QPP reporting requirements is not a responsibility that can be siloed to a single department within a larger healthcare organization. A majority of survey participants (68 percent) agree, supporting the notion that MACRA compliance should be a combined initiative across clinical, financial and IT departments.

However, the act of taking a multi-departmental, team-based approach raises other challenges, according to survey respondents. These include revising data management/reporting mechanisms to meet new reporting requirements (31 percent), motivating the entire organization to collectively work together to achieve program goals (29 percent) and identifying the appropriate team to champion MACRA-based initiatives (25 percent).

Moving Forward

It's imperative that providers grasp the requirements of MACRA now, to ensure they put the right strategy in place, since the pace of the program will only accelerate after 2017. More pressing, the QPP requires data collection to start between January 1, 2017, and October 2, 2017. For this first reporting year, whenever providers choose to start, they will need to send in performance data by March 31, 2018. First payment adjustments based on performance go into effect on January 1, 2019.

Strategy should begin with a cross-disciplinary governance committee that will gain a solid understanding of MACRA, assess current reporting mechanisms to meet program requirements and identify reporting gaps and mitigation processes. From there, the committee should create a strategic roadmap that includes potential alternative MACRA path decisions for any changes in subsequent years, while indicating the potential expected impact of each on reimbursement. The roadmap should contain specific objectives and milestones for the remainder of 2017 and the next two years with reporting gap analysis.

Choice in reporting measures can differ in later years, just as provider groups evolve with physician staffing adjustments. A roadmap will help navigate changes to come, while pushing providers to be more conscientious of data for evolving patient needs.
Here are best practices to better support internal staff during the initial reporting period for MACRA.

a) Invest in focused training of employees for quality work at a lower cost. Expanding the skill set of your most reliable staff through additional training offers multiple benefits to your organization. For starters, it offers in-house growth opportunities; in this way, a provider organization can gain a lower-cost way to maximize existing resources. For example, if a trusted clinician can be trained simultaneously to work with a new technology system and help the entire organization get up to speed with a regulation, everyone benefits.
b) Rethink existing positions to broaden responsibilities. Electing a portion of your staff to champion new legislation and take on new responsibilities will help to ensure greater buy-in by all employees.
c) Outsource work where appropriate. Partner with organizations that can support multiple roles at one price. IT consultants with the ability to work multiple disciplines concurrently for a client bring greater value to all organizations. Utilize consultants who can offer insight and guidance across the full continuum of care from both a financial and clinical perspective, completing projects from beginning to end. Experience and depth of knowledge allows them to do this, and that saves hospitals time and money. It also not only affords immediate focused response, but also provides for solid transition across project phases.

The goal of improving operations is to find ways to help all departments perform their best, so they are better positioned as a team to move forward. For organizations that feel understaffed when it comes to health IT, and unsure of how to align with MACRA's QPP, figuring out the best approach to this challenge is essential.

Healthcare leaders should take the time to assess where internal staffing frustrations are coming from—e.g., is there a lack of IT leadership or communication between departments? Is existing technology outdated? Then, they must determine the extent to which these challenges can be addressed in-house. Otherwise, it may be best to look for partners who truly understand regulatory changes and staffing challenges, and can help an organization grow.

Survey background
The HIT Industry Outlook Survey was conducted at the 2017 Health Information and Management Systems Society (HIMSS) annual conference in Orlando. More than 300 HIMSS attendees participated, representing practice management, project management, director and C-suite roles. IT professionals (53 percent) led survey participation while executive/C-suite representation (42 percent) followed closely behind.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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