King MU is dead. Long live King MIPS.

In early January, the impending end of the Meaningful Use (MU) program was announced by Andy Slavitt, acting administrator for the Center for Medicare and Medicaid Services (CMS). Physicians and health information technology (HIT) experts recognize that MU is now in hospice care before its expected demise later this year. Through their tears of grief and joy at the approaching death of MU, doctors and health system administrators wonder, “What’s next?” as the son of MU, the Merit-based Incentive Payment System (affectionately nicknamed MIPS,) prepares to follow in his father’s footsteps in the coming years.
King MU lived a short but controversial life. During his infancy (stage 1), MU pushed software companies, clinicians and consultants to bring medicine and its supporting technology rapidly into the 21st century. Indeed, King MU transformed the way medicine is practiced.

The golden lure of MU’s gleaming money pile to defray the costs of technology rapidly motivated many clinicians to purchase or upgrade complex EHR programs. It was only after choosing and using a system, especially when facing audits for stage 1 and new requirements for King MU’s turbulent teen years (stage 2), that many professionals understood how radically they needed to adjust workflow and maximize staff training and teamwork to successfully achieve all required MU benchmarks and pocket some of the coveted cash.

It was a daunting and too-often unsuccessful task, especially for small-practice, independent doctors who had never been trained in team-building, computer system security or complex project management and documentation. As MU’s life moved quickly through adolescence to adulthood (stage 3), change swept the healthcare landscape. Some EHR vendors emerged as clear leaders and others fell along the roadside. Medical informatics arose as a new specialty. Swift consolidation of clinical practices and hospital systems occurred as clinicians and healthcare executives pooled resources to succeed in meeting MU’s tough standards.

So what will MU’s legacy be? On the positive side, most doctors now have access to EHR systems that can meet MIPS’ future demands for data collection and managing populations of patients with chronic conditions. However, a major criticism of MU was its all-or-nothing requirement for achieving benchmarks that seemed irrelevant to specialty or small primary care practices.
With King MIPS ready to assume the mantle of supreme ruler of healthcare reimbursement, uncertainty and fear grip many who embraced MU but were disappointed by the costs and difficulty of achieving MU’s demands. Will MIPS set such unreasonable hurdles that most doctors are left in the dust? To cynical clinicians weary from the pace of change during MU’s reign, “value” has come to mean “Do more, faster, with less.” MU’s former subjects will be anxiously watching the new goals set by payers, aware that MIPS will bring major redesign of physician compensation, in transition from a productivity-based to a value-based paradigm.
So as we prepare for the approaching quiet funeral of King MU, we wonder breathlessly what adventures and changes our new sovereign, King MIPS, will bring.