The Role of HIM in MACRA

By Debi Primeau, MA, RHIA, FAHIMA

As providers gear up to meet reporting requirements under the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) new Quality Payment Program (QPP), health information management (HIM) stands to play a prominent role in the transition to value-based care.

Success under MACRA relies heavily on the capture and maintenance of trustworthy clinical and financial patient data sets. HIM professionals will undoubtedly face increased pressure to maintain coding accuracy standards that support new quality and reimbursement objectives going forward.

Given their role as stewards of healthcare information, HIM professionals are also poised to assume an even bigger role in the areas of patient data analytics and quality reporting. HIM has a unique opportunity in MACRA’s inaugural year to help establish data management protocol in physician practices and medical groups embarking on QPP adoption. HIM can lead efforts to identify, trend, track, and submit pertinent data under MACRA.

New Challenges and Opportunities

As value-based payment models cement over the coming years, HIM professionals could see increased opportunities for leadership roles in:

  • Information governance
  • Analytics
  • Electronic health record (EHR) selection and implementation
  • Quality documentation and reporting

While opportunities to lend patient data expertise may be rising for those in the HIM space, they won’t come without challenges. Provider hesitancy with MACRA and reluctance to collaborate may pose hurdles for HIM professionals who wish to engage.

Physician practices also have fewer coding and technology resources on hand than their acute care counterparts. While the absence of dedicated data resources is typically a clear indicator that physician practices could benefit from HIM assistance, budget constraints have held some providers back from securing both expertise and technology infrastructure.

HIM directors in hospitals that own or manage physician affiliate facilities have an opportunity to extend resources across care settings. They can get ahead of new challenges and better understand the interplay of data between the two sides (inpatient and outpatient). HIM jobs lost due to market consolidation in the acute care setting could represent a talent pool for physician practices where patient data expertise will be in growing demand.

Three Areas for HIM Expertise

From standardization of data sources to quality metric report submission, patient data objectives will be manifold under MACRA. Ensuring access to the right clinical and financial data from the right systems or repositories will be a crucial foundational element in an effective data management strategy. Data integrity will also be top of mind in value-based care monitoring and reporting, which should spur increased attention to HIM roles in three areas.

1. Clinical Documentation Improvement (CDI): CDI programs for physician practices and medical groups will expand under MACRA. HIM professionals can assist by bringing the CDI program framework traditionally found in the acute care setting into the practice environment to help ensure a high level of specificity in physician documentation.

2. EHR Workflow: HIM professionals may also represent a first line of defense when it comes to EHR workflow best practices in medical groups. Partnership between physicians and HIM stakeholders can help streamline the coding process, which can have particular impact in practices where physicians are coding for themselves. Ample room for growth in the area of EHR implementation and fine-tuning will emerge as physicians and HIM leaders learn more about the intricacies of reporting under the specifics of their QPP.

3. Data Integrity: Increasingly granular dissection of patient data in physician practices will drive market demand for data expertise, and the HIM market is well positioned to respond. HIM’s unique fusion of patient data expertise and technical adaptability can help practices:

  • Determine the different places pertinent data may be kept
  • Understand what data elements need to be reported
  • Address issues related to incomplete or inaccurate data
  • Get the ball rolling on MACRA preparations sooner rather than later

The data-driven approach of new performance-based payment models will bring an unprecedented degree of visibility into provider operations. To successfully manage under MACRA, stronger physician-practice business leadership is also required—and HIM professionals may be the perfect fit.

HIM’s Role in Practice Management

HIM professionals working within physician practice settings have a unique opportunity to lean in and help drive facilities forward under value-based reimbursement. Those considering career moves may find new success in the underserved practice area as physicians come to understand the growing role of HIM in practice management.

The time is right for HIM professionals to claim their place at the table as leaders in value-based care. From AHIMA’s new Certified Health Data Analyst (CHDA) credentials and applied informatics coursework to vendor-specific EHR training, taking advantage of learning opportunities is important to gaining traction in physician-practice careers.

Data-savvy HIM professionals can capitalize on the MACRA transition year to reinvent their roles and focus on helping providers meet reporting objectives as well as tackle patient-data pain points. HIM collaborators could become physicians’ greatest allies in the near future.

Debi Primeau ( is president of the Primeau Consulting Group.

via The Role of HIM in MACRA


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