HHS to Replace Meaningful Use with New MACRA Program Called “Advancing Care Information”

In a joint post on the CMS blog Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services and Dr. Karen DeSalvo, National Coordinator, Office of the National Coordinator for Health IT announced plans to retire the Meaningful Use program in favour of a new program under the Merit-based Payment System (MIPS). The new program, called Advancing Care Information (ACI), is intended to be more patient-centric, practice-driven and focused on connectivity.

This drastic change is part of the shift taking place as the year-old Medicare Access and CHIP Reauthorization Act (MACRA) legislation is implemented.

Meaningful Use, an Electronic Health Records (EHRs) Incentive Program, was originally passed by Congress seven years ago. Meaningful Use helped to spur the country towards digitizing the health care experience for Americans and connect doctors’ practices and hospitals, thereby modernizing patient care through the use of EHRs. This incentive program provided the capital for many providers to invest in health IT, and it’s resulted in nearly 100% of hospitals and 75% of physicians using an EHR system today.

EHR’s offer the promise of more accurate and accessible patient medical records, along with other applications like the ability to send prescriptions electronically to pharmacies, or to make lab results accessible from anywhere. While Meaningful Use was great at enabling the adoption of healthcare technology, it has not translated into a more efficient or reliable means of managing a patient record for providers. On the contrary, a report that AmericanEHR published with the American Medical Association (AMA) in August 2015 demonstrated that EHRs were failing to offer improvements on costs, efficiency or productivity. In fact, as EHR adoption went up under the Meaningful Use program, overall satisfaction and usability declined dramatically.

When asked about the impact of EHR systems on practice, AmericanEHR members reported that:

  • 42 percent thought their EHR system’s ability to improve efficiency was difficult or very difficult.
  • 72 percent thought their EHR system’s ability to decrease workload was difficult or very difficult.
  • 54 percent found their EHR system increased their total operating costs.
  • 43 percent said they had yet to overcome the productivity challenges related to their EHR system.

The CMS blog post seems to share our sentiment: “…as many doctors and patients will tell you (and have told us), we remain a long way from fully realizing the potential of these important tools to improve care and health.”

“We are proposing to replace Meaningful Use with a new effort that moves the emphasis away from the use of information technology to one that supports patient care that is supported by better and more connected technology,” Slavitt said on conference call. “The program, Advancing Care Information, is designed to be more flexible and less burdensome. It will allow physicians and other clinicians to select measures to reflect how technology best suits their day-to-day practice. The proposal eliminates a number of measurements and entirely focuses on patient care and connectivity goals.”

Advancing Care Information will only affect Medicare payments to physician offices, not Medicare hospitals or Medicaid programs. Meetings are also underway with hospitals and Medicaid stakeholders to discuss potential opportunities to align the programs to best serve all clinicians and patients.

The HHS proposal will be available for public comment over the next 60 days.

It is summarized here: http://www.hhs.gov/about/news/2016/04/27/administration-takes-first-step-implement-legislation-modernizing-how-medicare-pays-physicians.html

The full text is available here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10032.pdf

If finalized, this proposal would replace the current Meaningful Use program and reporting would begin January 1, 2017, along with the other components of the Quality Payment Program.


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