Uncertainty ahead for meaningful use and physicians

After seven years of requirements driving for high adoption rates for electronic health records (EHRs), the federal government is planning to put an end to its Meaningful Use program- at least as it exists today.

            The government instead will implement programs that focus less on how physicians’ use EHRs and more on their patients’ health outcomes.

Andy Slavitt, MBA, acting administrator of the Centers for Medicare & Medicaid Services (CMS), said recently the agency will fold Meaningful Use into a new system implemented under the Medicare and CHIP Reauthorization Act of 2015 (MACRA).

“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 we want to go next,” Slavitt stated in a Jan. 19 blog posted along with Karen DeSalvo, acting assistant secretary for the Department of Health and Human Services.

According to CMS, MACRA “also makes it easier for more healthcare providers to successfully take part in our quality programs in one of two streamlined ways: Merit-based Incentive Payment System (MIPS) [and] Alternative Payment Models (APMs).

            The new MIPS program will combine the Medicare EHR Incentive Program, its Meaningful Use of certified EHR technology, and parts of the Physician Quality Reporting System and the Value-based Payment Modifier to determine payment to physicians

            CMS is expected to release more details in the coming months on the new programs and how they’ll be implemented. Some details, though, have already been released, including the fact that Meaningful Use compliance will make up 25% of the MIPS program calculations.

            Still, there’s concern about how all that will play out, particularly considering that even as Slavitt talks about the end of the program, CMS continues to move forward with Stage 2 and proposed Stage 3 requirements for Meaningful Use.

            The upcoming presidential election further adds to the climate of uncertainty, healthcare leaders noted, too, as regulations released around elections typically get put on hold as government agencies wait to see whether the incoming administration will support, stop or change established programs.

“I think this is going to be the most tumultuous years in American healthcare,” said Patricia Wise, RN, FHIMSS, vice president of healthcare information at the Healthcare Information and Management Systems Society (HIMSS). “We don’t know what MACRA will say. When organizations get the MACRA draft and the final regulations, then people will make decisions because the Meaningful Use requirements might be different for MACRA vs. what they have under the program we have right now.”

Mari Savickis, vice president of federal affairs for the College of Healthcare Information Management Executives (CHIME), agrees: “There’s a level of uncertainty that’s not good for providers, and that has created a lot of challenges.”

In fact, Savickis questioned whether the changing requirements and all the confusion surrounding them have actually hindered more innovation in heath IT.

“When you have a situation where technology is driven by a discreet set of requirements by the federal government, it does make it harder for vendors to innovate. And then the providers are required to use that technology in a certain way, so the bandwidth to adopt more innovation is less,” she said.

            But Savickis also added this perspective: The HITECH Act has indeed helped drive adoption of EHRs, and providers - who always have been prolific users of technology - will continue to use health IT to improve the quality of care they provide. And that technology innovation, to coordinate care and drive improvements, will be key as the healthcare community moves toward new delivery models of care based on outcomes.