Last week active CMS Administrator, Andy Slavitt, announced the phasing out of Meaningful Use “as we know it.” This week ONC National Coordinator for Health IT Karen DeSalvo and Andy Slavitt have expanded on plans for upcoming changes to the Meaningful Use program on the CMS blog.
While many media outlets (AmericanEHR included) reported that Meaningful Use was going the way of the dodo bird, it now appears that the plan is to phase in incremental changes as opposed to an abrupt abolishment of the current Meaningful Use program.
In spite of the renewed support of Meaningful Use, it is still likely a lame-duck program as it was intended to encourage technical adoption and sharing, whereas the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is shifting to a focus on quality care. There are also a number of growing barriers for Meaningful Use that have effectively made it necessary to overhaul.
For starters, it was recently reported that 257,000 Medicare eligible professionals (EPs) would be hit with a 1-2% penalty to their Fee Schedule payments for failing to meet Meaningful Use in previous years. This situation is bound to create widespread backlash as providers already report reduced productivity and increased administrative workloads under the Meaningful Use reporting requirements. Hitting that many providers in the pocket book could be viewed as adding insult to injury, and will add another nail in the Meaningful Use coffin.
Here are details on the expanded CMS / ONC plans laid out by Slavitt and DeSalvo:
The new roadmap is primarily influenced by two initiatives taken by the Administration and Congress last year to shift to results-based incentives:
- The Administration set a goal that 30 percent in 2016 and 50 percent in 2018 of Medicare payments will be linked to getting better results for patients, providing better care, spending healthcare dollars more wisely, and keeping people healthy.
- Congress advanced this goal through the passage of MACRA, which considers quality, cost, and clinical practice improvement activities in calculating how Medicare physician payments are determined. While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where ONC & CMS want to go next.
As MACRA rolls out it will be guided by several critical principals:
- Rewarding providers for the outcomes technology helps them achieve with their patients.
- Allowing providers the flexibility to customize health IT to their individual practice needs. Technology must be user-centered and support physicians.
- Levelling the technology playing field to promote innovation, including for start-ups and new entrants, by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications. This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care.
- Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care. We will not tolerate business models that prevent or inhibit the data from flowing around the needs of the patient.
What this Means for Providers:
- The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system. But we will continue to listen and learn and make improvements based on what happens on the front line.
- The MACRA legislation only addresses Medicare physician and clinician payment adjustments. The EHR incentive programs for Medicaid and Medicare hospitals have a different set of statutory requirements. We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program.
- The approach to meaningful use under MACRA won’t happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what’s next and to continue to give us input. We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect.
- In December, Congress gave us new authority to streamline the process for granting hardship exception’s under meaningful use. This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon.
In the words of DeSalvo and Slavitt, they are transitioning from “Measuring Clicks to Focusing on Care.” On the surface MACRA appears to provide a framework that would allow practices to shift their focus back to being patient-centered while utilizing technology based on their specific needs, as opposed to a one-size-fits-all approach to EHRs. I anticipate that EHR vendors that don’t take steps to dramatically improve the usability of their products now, will see a mass exodus if (or perhaps when) Meaningful Use reporting and certification requirements eventually get retired.
How do you think these changes will affect your practice?