Clarification comes just a week after one CMS official had discussed the end of Meaningful Use at a conference in San Francisco
Talk about mixed messages! Is the federal Meaningful Use (MU) program about to end? Or is it going to continue and evolve in significant new ways?
Alert pathologists and clinical laboratory executives may have picked up on the conflicting statements about the future plans for Meaningful Use that have been made in recent weeks by certain officials from the Centers for Medicare and Medicaid Services (CMS).
Because thousands of hospitals and hundreds of thousands of physicians have made substantial capital investments in electronic health records to qualify for federal incentives, any major change to the Meaningful Use requirements will have broad consequences.
Medical laboratories have a big stake in this issue as well, since they must invest substantial money into creating the interfaces needed to connect their labs’ laboratory information systems (LIS) to the EHRs of client hospitals and physicians.
CMS Drops Bombshell at J.P. Morgan Healthcare Conference
The first significant discussion about major changes to the Meaningful Use program came on January 12, 2016. That’s when CMS Administrator Andy Slavitt, MBA, made the surprise announcement during a speech to the J. P. Morgan Healthcare Conference in San Francisco.
“Now that we effectively have technology into virtually every place [health]care is provided, we are now in the process of ending meaningful use and moving to a new regime culminating with the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA) implementation,” declared Slavitt to a surprised audience. “The meaningful use program as it has existed will effectively be over and replaced with something better.”
During his presentation, Slavitt indicated that three provider-reporting programs will be sunset and aligned into a single new program, but he said details of the next stage would not emerge for several months.
Slavitt’s comments about ending Meaningful Use were widely reported. While addressing the group, he said that, by phasing out the MU incentive program this year, the agency wanted to streamline and simplify programs in preparation for the implementation of MACRA, which repealed the Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians. The new legislation also established a timeline for replacing Medicare’s existing fee-for-service payments with two payment tracks:
1. The Merit-based Incentive Payment System (MIPS); and,
2. Alternative payment models (APMs) by January 2019.
Slavitt described the MACRA legislation as a “major item squarely on our punch list [at CMS].”
“The stakes for this program are high,” he told the audience. “As any physician will tell you, physician burden and frustration levels are real. Programs that are designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don’t get it.”
CMS Gave No Warning MU Was Ending
Given the content of Slavitt’s announcement, reaction to his statements about the impending end to the Meaningful Use program as it now exists caused a big stir among healthcare executives tasked with handling information technologies at their hospitals or physician practices.
Apparently officials at CMS noticed the reaction generated by Slavitt’s presentation at the J.P. Morgan 34th Annual Healthcare Conference. About one week later, a blog post titled, “EHR Incentive Programs: Where We Go Next” was published by CMS on its website. The blog’s authors were Andy Slavitt and Karen DeSalvo, the National Coordinator at CMS. It was a message to the healthcare industry that, in fact, Meaningful Use was to continue. What was changing was that Meaningful Use—the measurement of certified EHR technology by providers—would be managed by CMS in a manner that is consistent with the requirements of the Medicare Access and CHIP Reauthorization Act (MACRA) that Congress passed in 2015.
In a related story about CMS’ new direction for Meaningful Use titled, “CMS, ONC: Transition to MACRA Will Not Mean the Elimination of MU, EHR Incentives,” FierceEMR wrote, “The Meaningful Use incentive program is transitioning, but it’s not over, and electronic health record incentives are here to stay, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT clarified on Tuesday [January 19, 2015].”
In their blog comments, Slavitt and DeSalvo also emphasized that CMS is bound, under current law, to continue forward with measuring provider use of EHRs, as required by the Meaningful Use rules. They noted that Stage Three MU would continue. Meanwhile, the agency is moving forward to implement the requirements of MACRA, they said.
Further, the CMS officials noted that the agency had heard the comments and complaints by hospitals and physicians about the burdensome aspect of using EHRs and attempting to comply with the Stage Three Meaningful Use requirements. They wrote, “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 three—are still in effect.”
GAO Report to Congress Questioned Value of Meaningful Use Program
Dark Daily (darkdaily.com) reported earlier this month on the Government Accountability Office (GAO) report on barriers to EHR interoperability and some health IT experts’ calls for patient-centered interoperability, which is the flow of patient information between all systems, regardless of technology or platform. (See Dark Daily, “Federal Government Report on EHR Interoperability Pinpoints Barriers to Information Exchange; Questions Value of Meaningful Use Requirements.”)
Paul Tang, MD, MS, Chief Innovation and Technology Officer at the Palo Alto Medical Foundation (PAMF), and Consulting Associate Professor of Medicine at Stanford University, told Healthcare IT News that healthcare is in the midst of a “natural transition from the carrot-and-push early phases of meaningful use to the payment-for-outcomes” of a value-based payment model.
“The early stages of meaningful use took the country from zero to 60 in five years, a remarkable achievement that would not have been possible without HITECH,” Tang said. “Now it is time for the new payment model that rewards providers for achieving better health outcomes to be the driver of innovation, using the new electronic infrastructure that is now in place. That was the vision for phase three [of meaningful use] from the very beginning.”
“[Meaningful use is] going to be shaped differently with everything we’ve been talking about in 2015 and we’ll hear in 2016 … this year they’re going to be pushing vendors quite hard to integrate their systems or build easier integrated systems,” Adams told Becker’s Health IT & CIO Review. “It’s the reboot of meaningful use.”
Thus, given the comments by CMS officials on this subject, pathologists and clinical laboratory managers can expect to see Meaningful Use Stage Three continue. At least two things will be different going forward. First, federal officials will be tougher on EHR vendors that make it difficult to achieve interoperability between their EHR product and other software systems. Second, expect CMS to evolve Meaningful Use in ways that support shifting providers away from fee-for-service reimbursement and toward Medicare’s legislative requirement to implement value-based payment to hospitals, physicians, and clinical laboratories.
—Andrea Downing Peck