Table 3.

Steps Taken toward MACRA, Variation by Practice Ownership, Heart of Virginia Healthcare, 2018 (n=16)

Practice Ownership
IndependentHospital Owned and Health-System Affiliated
Steps toward MACRA[I1]: “It’s [MACRA reporting] through our EHR. We have to do an annual risk analysis. And it has to be uploaded and sent to the EHR to verify that we did it. Yes, they send us alerts going, Hey, where are you. This needs to be done. Or this needs to be uploaded.”
[I6]: “We are building templates in our EMR that captures all the tick marks [related to MACRA] you have got to meet for meaningful use. So, we are working on that right now.”
[I3]: “I think if you know how to use your EHR system, it makes it better [for MACRA quality measure reporting]. Because if you are afraid of it, and don’t know how to use it, and you know, as with anything, you walk into it saying, Oh, I don’t want to do that [extract quality measures and report]. I don’t know how to do that. But if you are understanding the complexity and you know how to use it, it works for you instead of not working. ”
[H7a]: “They [corporate] will tell us what to do, and we will do it, ‘Yes, sir.’ [We will try] to the best of our ability [to comply with MACRA requirements”
[H7b]: “To the best of our ability. I don’t expect them [corporate] to give us the freedom to either participate or not participate in MIPS.”
[H5]: “It’s [MACRA preparations] coming from above [corporate], yes. We have not, the three of us, come up with our plan. It comes down…That is one thing that we don’t have to worry about. Now we end up with unnecessary work sometimes.”
[H3]: “I’m sure they [corporate] have, I can’t answer that 100%, from an organizational standpoint, I feel like that they [corporate] will have us prepare for whatever we need.”
[H6]: “We also, the health system has a list of board approved goals that come down from the health office that are recommendations, goals that we target [for MACRA] so we try to meet.”
[H1]: “But in order, [larger health system] to just, is wanting us to kind of wait on it [on MACRA] until it rolls out to all the care centers. Because I guess they’re [corporate] going to be giving out their own, you know plan for that. Right now, we haven’t really done anything toward it, because [larger health system] doesn’t want us to yet.”
Analytic Themes“Focus is on the EHR capability for MACRA reporting”“Corporate Dependency”
  • n = 16 (Independent = 8; Hospital owned and health-system affiliated = 8).

  • MACRA, Medicare Access and CHIP Reauthorization Act; EHR, electronic health record.