MAG Applauds Early Adopters Innovative
Patient Data Analytics Solution
Four medical practices in Georgia that have more than 40 physicians who care for thousands of patients have announced that they are now using Health e Paradigm – an innovative health IT solution that enables physicians to generate sophisticated patient data analytics that they can use to improve patient outcomes and meet today’s quality metrics.

The practices include Albany Surgical, PC, Cairo Medical Care, LLC, Griner Medical Group, LLC, in Valdosta, and North Atlanta Primary Care, PC.

“This is a significant development for patients and physicians and Georgia’s overall health care system,” says Frank McDonald, M.D., M.B.A., the president of the Medical Association of Georgia (MAG), which endorses Health e Paradigm. “We applaud these physicians and practices for demonstrating great vision and leadership.”

North Atlanta Primary Care CEP and Medical Director Thomas Bat, M.D., explains that, “There are dramatic changes taking place within the health care system, which means that we need to adapt and evolve as physicians and practices. Having assessed this solution in great depth and detail, we are confident that Health e Paradigm will help us to deliver better patient care in a better and more cost-effective and efficient way –and we are also convinced that it will give us a strategic business advantage.”
Griner Medical Group Chief Medical Officer Brian Griner, M.D., adds that, “Deploying the MAG-endorsed Health e Paradigm across our practices drives the common goal of delivering the best possible patient care and benefits our entire state’s medical community. We are excited to be a part of this physician-led solution.”

North Atlanta Primary Care has nearly 90,000 active patients, while the Griner Medical Group has about 15,000.

Dr. McDonald stresses that, “Health e Paradigm enables physicians to share patient data in a near real-time and seamless way – whether the patient or physician is in downtown Atlanta or a small town in a rural part of the state, 24/7.”

He also notes that, “Physicians can use Health e Paradigm’s data analytics dashboard features to enhance patient care and reduce duplicities and inefficiencies and costs.”

And Dr. McDonald explains that, “Health e Paradigm enables the use of sophisticated analyses across patients’ longitudinal medical records, which includes clinical data submitted by every other participant that is part of the Health e Paradigm health information exchange network.”

Finally, Dr. McDonald believes that Health e Paradigm participants have “additional peace of mind” knowing that its advisory committee consists of physicians from different specialties and practice settings.  

A number of other medical practices are expected to begin using Health e Paradigm in the near future.
Return on Investment for Health Information Exchange Participation
Laura McCrary, Ed.D
Executive Director, Kansas Health Information Network and Senior Vice President, KAMMCO

What is the return on investment (ROI) for participating in a health information exchange (HIE)? As the Executive Director of one of the most successful HIEs in the nation, I am often asked this question. I admit I am challenged to answer, as there are several ways to define ROI, and it can mean different things to different people.

Simply stated, ROI measures the benefit (or return) an investment will generate in relation to the cost of the investment. So, if it costs X to participate in the HIE, what is the financial return to a practice or facility?    

While the ROI calculation for some is framed in strictly financial performance terms, for others it can mean increased productivity and efficiency, minimal disruption to workflow, and improvements in care. As part of an Accountable Care Organization (ACO), or another alternative delivery model, the HIE ROI question will be impacted by resulting improvements in risk adjustment scores and quality metrics. For a payer, the question is whether the HIE will be able to provide data to improve HEDIS scores and STAR ratings. For a patient, the question is simply will the HIE improve my care or my child’s care, and can I access my health records? 

Inherently, the HIE ROI is puzzling because the answer is different for each organization.  I have heard time and again, “why should a health care organization (hospital, physician, payer, therapist, FQHC, mental health provider, post-acute care provider, etc.) pay to provide something of value, such as clinical data, to an HIE?”

This is the “chicken or the egg” question of which comes first. In order for an HIE to have a significant ROI for its members, a certain level of scale or participation by health care providers has to occur. One doctor or hospital participating singularly in an HIE does not create much HIE ROI value, however, when all of the health care providers in a community, region, or state participate in a HIE, the ROI is noticeably impacted.

With robust clinical data available, the basic HIE ROI for physicians starts with reducing the time the physician or staff spend gathering the patient’s medical information from disparate sources. A conservative estimate is at least 15 minutes a day of searching and securing medical records can be saved by using the HIE. This 15 minutes allows the physician to see one additional patient daily. One additional patient per day in a fee-for-service model conservatively results in $10,000 annually ($50 x 5 days x 40 weeks). In a three-physician practice this adds $30,000 annual revenue.

HIE fees for a small practice would be approximately $3,000 annually, with a $10,000 onetime-fee for necessary interfaces. For example, in the first year the practice could realize a $17,000 gain, or an ROI of $1.30 for every $1.00 invested. In the second year and thereafter, the practice could realize a $27,000 gain, or $9.00 for every $1.00 invested.  

The ROI is different for hospitals. For a PPS hospital with diagnosis related groupings (MS-DRGs), the additional information provided by the HIE may significantly increase the hospital’s case mix index (CMI). 

A recent hospital study demonstrated patients receiving care at a small hospital visited 10 other health care facilities in the calendar year reviewed. Analysis of the hospital’s problem list (after de-duplication) indicated only 25% of the total problems found in the HIE were present in the hospital EHR and billing­­­. This finding significantly impacts the hospital’s bottom line. Overall the inclusion of the HIE data resulted in a 227% increase in potential ICD-10 codes over what was available in the hospital’s EHR, with an average CMI increase of .44 and an annual increase in MS-DRG payments of $90,000.

The participation fee for a small hospital HIE is approximately $15,000 annually, with a onetime interface cost of $30,000. This results in a 1:1 first year ROI, with significant returns 5:1 in subsequent years of $5.00 for every $1.00 invested.

If this same hospital also participated in some form of alternative payment model (APM) the ROI example could be even greater. In most APMs, patient risk scores and the associated payments are based on the complexity of a patient’s health conditions. Each patient is assigned a risk score. This score is based on the problem list for the patient that is included in the billing submitted to the payer. If the problem list is incomplete and reflects only 25% of the total problems patients have been diagnosed with, then the hospital may receive a significantly lower level of reimbursement.
Utilizing the same small hospital example with Medicare Advantage patients only, the risk adjustment factor (RAF) score increased by 75% when the HIE problem list data was added into the claim. The overall population RAF score increased by 88%. Based upon an estimated monthly $600-$800 risk bonus premium, this results in an overall revenue opportunity of $350,000-$500,000 annually per 1000 Medicare Advantage patients.   

An ACO or Advanced APM may realize a similar ROI on a larger scale. 

Finally, the ROI for patients cannot be evaluated through the same financial performance lens the provider community applies. If the available HIE data saves a patient’s life, either by informing care or preventing a medical error, it may be impossible (or inappropriate) to calculate a traditional ROI, however, the benefit returned has immense value. This is the core patient safety imperative delivered by HIEs across the nation.   

Health e Paradigm recognizes this opportunity, and offers a free personal health record to all Georgia patients through myGAHealtheRecords. The personal health record is connected to the HIE which allows patients to have simple and secure access to all of their health information in one location. In addition, there is ROI for patients in the value of time and money saved when eliminating duplicative testing and the re-creation of patient history for providers.

Health e Paradigm   is a physician-led health information network offering a suite of health information technology tools to help Georgia health care and health care professionals CONNECT. ANALYZE. TRANSFORM. Visit or call 877.921.7196 to learn more.
New Resources Available From CMS
CMS has posted new resources on to help eligible clinicians and groups understand their Merit-based Incentive Payment System (MIPS) final score, performance feedback, and payment adjustment, as well as the targeted review process.

The new resources include:
MIPS Performance Feedback Fact Sheet: Offers an overview of what performance feedback is, who receives the feedback, and how to access it on the Quality Payment Program website.
Targeted Review of the 2019 MIPS Payment Adjustment Fact Sheet: Details what a targeted review is and when and how to request a targeted review
Targeted Review of the 2019 MIPS Payment Adjustment User Guide: Provides an overview of the targeted review process, and how to access and complete the targeted review request form.

For More Information: Visit the Quality Payment Program Resource Library on to review new and existing Quality Payment Program resources. Contact the Quality Payment Program at or 1-866-288-8292 (TTY: 1-877-715-6222). 

Just a reminder CMS reporting for the Quality Payment Programs can be simplified using the tools and resources of Health e Paradigm. For more information on Health e Paradigm, contact Susan Moore at or visit .
Visit the QPP Website to View MIPS Performance Feedback and Final Score
If you submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website , you can now view your performance feedback and MIPS final score

Access your performance feedback and final score by:

  • Going to the Quality Payment Program website
  • Login using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data

If you don’t have an EIDM account, refer to this guide and start the process now. In the coming weeks, CMS will provide additional guidance to help walk through how to review your feedback and to assist in answering your questions. 

Please note: The final performance year for the Value-Based Modifier and Physician Quality Reporting System (PQRS) programs was 2016; therefore, CMS will no longer provide PQRS Feedback Reports or Quality and Resource Use Reports (QRURs). The final reports under these programs were provided in September 2017 and remain available for download through the end of this year.  

Likewise, if you participated in a MIPS Alternative Payment Model (APM) in 2017, specifically in a Medicare Shared Savings Program (Shared Savings Program) or Next Generation Accountable Care Organization (ACO), your performance feedback is now available to your ACO (APM Entity) via the Quality Payment Program website . Participant TINs in Shared Savings Program will be able to login to the Quality Payment Program website directly to access final performance feedback. Participants in Next Generation ACOs will need to request feedback from a representative (such as a security official) within their APM Entity.

Please note: Because all clinicians in the Next Generation ACO Model were Qualifying APM participants, performance feedback for the 2017 performance year will not be provided.

Under the MIPS APM Scoring Standard, the performance feedback, accessible to the APM Entity, will be based on the APM Entity score and is applicable to all MIPS eligible clinicians within the APM Entity group. This feedback and score does not have any impact on the Shared Savings Program or Next Generation ACOs’ quality assessment. 

Questions?  If you have questions about your performance feedback or MIPS final score, please contact the Quality Payment Program by: 

  • Phone: 1-866-288-8292/TTY: 1-877-715-6222 or
  • Email:
Upcoming Event
Quality Matters: The New Data Dilemma
August 29, 2018
Webinar, 12 - 1:00 P.M.
Come and See Us!
August 20 - 22, 2018
Public Health Informatics Conference
Hilton Atlanta Downtown
Atlanta, GA

Susan W. Moore
Medical Association of Georgia
Director, Strategic Programs and Initiatives