Upcoming MACRA Requirements for Patient Engagement

Steven E. Waldren, MD, MS


January 05, 2018

Editorial Collaboration

Medscape &

The AAFP Physician Health First portal provides numerous online resources to support physician well-being.

Hello. I'm Steve Waldren, a family physician informaticist with the American Academy of Family Physicians (AAFP). I direct our Alliance for eHealth Innovation, which is responsible for all of the health information technology advocacy and activities of the AAFP.

I want to talk to you a little bit about a piece of technology that you may be using in your practice but will have to start to use with new requirements. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation put together a program called the Quality Payment Program (QPP). You may have been participating in the Meaningful Use program for the last several years, which started in about 2011, but this has now transitioned to a program inside the QPP called Advancing Care Information (ACI). In that program, there is a requirement to start to electronically engage your patients by "using a patient portal" or by "integrating with an API." API stands for application program interface, but first, I will talk a little bit about patient portals.

Patient Portals

Not only are [patient portals required] for the ACI part of the QPP, they are also a valuable asset that you can deploy in your practice to help you deliver better care and for your patients to achieve better health. We know that behavioral modification is one of the most challenging tasks for managing chronic disease that we deal with in our patient populations. The patient portal allows you to extend your access to patients outside of the four walls of your practice. It is a way for you to engage patients and to think about how they would be able to work with you and your staff.

"It can be hard to get patients engaged in patient portals, so you have to think through a long process about how you are engaging patients in patient portals."

Today, we have the fee-for-service program where you almost have to have an office visit to get paid to take care of patients. With the QPP and the movement toward value-based payment, you start to have prospective payments that allow you to think about different ways to take care of your patients. While today you may be required to do the patient portal, there may be some value from a clinical or professional viewpoint in driving portal use by your patients. As we move forward, I think there will be value on the performance or financial side for your practice because you are able to really take care of patients and extend the amount of services you can provide.

It can be hard to get patients engaged in patient portals, so you have to think through a long process about how you are engaging patients in patient portals. We have resources at the AAFP to help you do that. We also have some information about ACI if you go to MACRA resources on the AAFP website. There you have all the resources that you need to understand the entire ACI as well as the patient portal piece.

Advancing Care Information

One piece of the new generation of the technology that you will be required to use is called a "2015 edition certified product." (Currently, the regulation is saying that this requirement will take effect in 2019.) You will need a 2015 certified electronic health record (EHR) to participate in the QPP. Right now, you can use the older 2014 edition. The new item in the 2015 edition that relates to patient portals is what is called an "open API." Your EHR program will have to allow access to the data inside the EHR through a third-party application. If your patient wants to be able to access data for a program that they are using to manage their care, the EHR must be able to provide access to those data. This will allow the patient to have access to their medication list, their allergy list, etc.

Thus, you do not have to maintain a patient portal on your side, but you are allowing your patients to have access and use the programs that they want to use. It's another way to fulfill the requirements of the ACI piece without having to have a patient portal. It also allows EHR companies and patients to be able to use whatever product they want to access the EHR.

These are some new technologies that are coming down in the next couple of years relative to the APIs and what is currently being implemented on patient portals. I think this will have a really valuable place in your practice and help you take care of your patients.

If you need any more information on patient portals with Advancing Care Information, you can always come to the AAFP website. Or you can call us at the AAFP at 1-800-274-AAFP (2237) and ask for Steve Waldren, and I'd be happy to talk with you.

Follow Dr Steve Waldren on Twitter.

Follow Medscape on Facebook, Twitter, and Instagram.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: