Policy & Regulation News

How Do Health Leaders View MACRA’s Patient Engagement Efforts?

Patient engagement proponents must submit their MACRA public comments in order to ensure priority on patient-centered care going forward.

By Sara Heath

- Industry stakeholders and proponents for patient empowerment must comment on the MACRA provisions for patient engagement, says one healthcare expert.


In an op-ed recently featured on the website for the Society for Participatory Medicine, president of Health Quality Advisors, LLC, Michael Millenson explains some of the potentially adverse effects the proposed MACRA rule may have on patient engagement should clarification questions not arise during the public comment period.

According to Millenson, there are aspects of the MACRA proposed rule that not enough industry stakeholders are paying attention to. While CMS touted the highly patient-centered nature of the rule, Millenson says some of the rule’s contents are actually concerning for the patient engagement movement.

“But in the section entitled, ‘Coordination of Care Through Patient Engagement,’ the standards related to use of certified electronic health record (EHR) technology are startling in their laxity,” Millenson writes.

He specifically points toward a set of provisions which require certain patient engagement activities with a minimum of one patient (emphasis Millenson’s):

  • During the performance period, at least one unique patient (or patient-authorized representatives) seen by the MIPS eligible clinician actively engages with the EHR made accessible by the MIPS eligible clinician.
  • For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the…EHR….
  • Patient-generated health data or data from a non-clinical setting is incorporated into the certified EHR technology for at least one unique patient….

Requiring providers to engage with “at least one” patient may not be enough, especially considering the calendar year reporting period on which the program will operate. Considering the amount of time providers have, these requirements may not push hard enough for expansive patient-centered care.

“But here’s a different perspective. Monday, Jan. 2, 2017 is a federal holiday. That gives doctors four days to send and receive three emails before checking off the tough regulatory burden of electronic patient engagement until the first week of 2018,” Millenson posits.

Millenson also grapples with the phrase “unique,” which CMS uses frequently in its proposed rule to describe the number of patients with which providers must engage. Providers must engage in three separate acts of patient engagement with at least one unique patient; however this information may be somewhat confusing.

“I’m not a lawyer, so I don’t know whether ‘unique’ patient means three different individuals or if three interactions with the same person – a designated ‘e-patient’? – would count,” Millenson states.

Millenson did take a moment to recognize some of the more innovative patient engagement strategies included in the MACRA proposed rule. For instance, the rule calls for a measure of the percentage of patients informed by their surgeons of their postoperative risks. This is an example of a highly specific rule which Millenson calls “remarkably progressive.”

Throughout his op-ed, Millenson does not claim that the MACRA legislation will be the end of patient engagement measures. Rather, it serves as a sort of call to action for industry stakeholders to ask questions of CMS and to clarify certain provisions.

Millenson encourages various leaders, particularly those attending the Health Datapalooza, to ask critical questions of the law’s proponents, ensuring that patient-centered care will continue to be a priority going forward.

“Perhaps some pointed questions might be asked by attendees at this year’s Health Datapalooza, where a host of senior Obama administrations will provide preening perorations on their commitment to open data and patient empowerment,” Millenson concluded. “If we in the patient community do not raise questions and objections to this critically important MACRA rule, you will definitely not believe what happens next.”

MACRA’s comment period will follow the proposed rule’s official publication on May 9, and last until June 27.


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