Is Meaningful Use still meaningful?

February 12, 2016

If you have not been reading industry social media sites lately, you missed a big announcement from the Centers of Medicare and Medicaid Services (CMS) to end Meaningful Use.

If you have not been reading industry social media sites lately, you missed a big announcement from the Centers of Medicare and Medicaid Services (CMS) to end Meaningful Use.         

Andy Slavitt, the acting administrator of CMS, stated on January 11, 2016, “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better. Since late last year, we have been working side by side with physician organizations across many communities-including with great advocacy from the AMA-and have listened to the needs and concerns of many. We will be putting out the details on this next stage over the next few months, but I will give you a themes guiding our implementation.”1

Although this seems extremely relieving because you do not have to attest for Meaningful Use Stage 3 in 2016, it does not mean that the protocols can be thrown out completely and to start over from scratch. To eliminate the program completely, Congress would have to make a call to action. And if that was not difficult enough, there are other programs that are tied to the protocols of Meaningful Use, such as Merit-based Incentive Payment System (MIPS), Value-Based Modifier (VBM), and the Physician Quality Reporting System (PQRS).2

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What’s next?

We need to wait to see what Slavitt and CMS decides, but in the meantime, eligible physicians, including ODs, have the flexibility to participate in two programs: MIPS and the Alternative Payment Model (APM).

CMS is betting that these programs will deliver quality of care, better resource use, Meaningful Use of certified EHRs (meaning EHRs that have the necessary technological capability, functionality, and security to allow eligible physicians meet the Meaningful Use criteria), and clinical improvement activities.

Once enrolled, providers are scored compositely from 0-100 based upon four performance categories (PQRS, VBM, EHR MU, and Qualified Clinical Data Registries), in which scores are compared to specific performance benchmarks for particular periods. During the transition timeline from 2015-2018, providers are not penalized, but starting 2019, reimbursements will be subject to penalties if performance measures are not met.

MIPS and APM programs were designed to replace Sustainable Growth Rate’s (SGR) integrated current incentive programs. SGR has been used to determine Medicare reimbursements for healthcare providers, incentivized additional-and sometimes unnecessary-care, which does not lead to lowering healthcare costs. It also lacked measures to evaluate quality of care.

What does this mean for you?

 

What does this mean for you?

Being part of the list eligible physicians, optometrists can expect to be pleased by Slavitt’s announcement. However, he states only that CMS will end the Meaningful Use program and it would be replaced-so the program is really not going away, rather changing the focus from the adoption of technology to patient outcomes.

As frustrating and inefficient as the experience was of attesting Meaningful Use, ODs should still expect to still comply with Stage 1 and 2 and incorporate their practices’ to focus on more quality reporting requirements. Use this time to make sure your practice is following the MIPS protocols, including that your EHR is capturing quality measures accurately and efficiently. Although the timeline was not announced, the expectation is that patient outcomes, workflow, and interoperability will be the main focus.

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Slavitt recognizes the challenges of providers and claims to be committed to simplify the system. As he stated in his blog, he will be working with the AMA, physician organizations, and technology companies to focus specifically on how:

• Use of technology achieves the outcomes with patients

• Providers can customize goals so that IT companies can build around practice needs

• Level the playing field for technology start-ups and new entrants

• Focus on interoperability by eliminating data blocking, all with the collaboration of physicians and patients2

How we got here

 

How we got here

With mixed results of medical outcomes and healthcare costs escalating at unsustainable rates during the early 2000s, the idea of using metrics to reduce medical errors was born, which slowly evolved to what we now know as Meaningful Use. 

At the 2004 State of the Union address, President George W. Bush announced plans to connect the U.S. healthcare system and allocated $42 million to begin the project.4 Technology was primed with the advent of the standardization of languages and protocols (TCP/IP) of the Internet. With the help of consultants-both IT and healthcare-the $3 trillion U.S. healthcare system was a challenge to connect collectively, so in 2008 when Congress passed the stimulus package to rescue the U.S. economy, the budget of $42 million to make healthcare digital was increased to $30 billion.4

The government wanted to ensure stimulus incentives for hospitals and physicians were utilized correctly and created a set of regulations, which dictated how IT companies, hospitals, and doctors built their EHR systems. The systems were required to incorporate technology to:

• Improve quality, safety, and efficiency of data

• Have the ability to engage patients with providers and hospitals

• Improvement of the coordination of care and reduce the redundancy of testing

• Maintain patient privacy

Ultimately, this would lead to increases in clinical and population outcomes and increased efficiencies ad transparencies, while empowering patients. Thus we have Meaningful Use.

Because technology changes at least every 18 months, three stages were developed to bring the U.S. Healthcare system digital. Incentives were put in place to assure physicians and hospitals were conforming to the standards set forth by the Centers of Medicare and Medicaid Services (CMS):

• Stage 1 (2011-2012) aligned EHR systems to be capable of capturing and sharing data

• Stage 2 (2014) was put in place to assure the advancement of clinical processes, where 17 core objectives have to met (such as e-Rx, vital signs, demographics, smoking status, more than five percent of patients utilize the EHR portal, etc.)

• Stage 3 (2016) was put in place to improve clinical outcomes5

While this all sounds great in theory, tactfully, this was extremely aggressive. Because the adoption of Meaningful Use soared, the integration of the basic technology of Stage 1, while capturing and sharing the data of Stage 2, created a lot more stress with providers and hospitals than expected. Additionally, a new coding protocol of ICD-10 was thrown into the mix, which created many frustrated, skeptical providers and patients.

But aside from the aggressive and overpromising Meaningful Use protocols, the healthcare landscape added more frustration with lowered reimbursements and Medicare penalties for “no pay for errors,” value-based purchasing, and not using Meaningful Use.6 As an accidental system whose goal was improve efficiencies and increase clinical outcomes-ultimately to lower healthcare costs-had lost faith with hospitals and providers, along with their associations.

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References

1. The CMS Blog. Comments of CMS Acting Administrator Andy Slavitt at the J.P. Morgan Annual Health Care Conference, Jan. 11, 2016. 2016 Jan 12. Available at: https://blog.cms.gov/2016/01/12/comments-of-cms-acting-administrator-andy-slavitt-at-the-j-p-morgan-annual-health-care-conference-jan-11-2016/. Accessed 02/09/2016.

2. CMS. The Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html. Accessed 02/09/2016.

3. Michigan State Medical Society. Current Medicare Incentive Programs to be Replaced by New Quality Initiatives-Physicians Must Act Now to Sustain and Grow Fee Schedule. 2015 July 22. Available at: https://www.msms.org/AboutMSMS/News/tabid/178/ID/2637/Current-Medicare-Incentive-Programs-to-be-Replaced-by-New-Quality-Initiatives--Physicians-Must-Act-Now-to-Sustain-and-Grow-Fee-Schedule.aspx. Accessed 02/09/2016.

4. Wachter R. Meaningful use: Born 2009-died 2014? Healthcare IT News. Available: http://www.healthcareitnews.com/blog/meaningful-use-born-2009-died-2014. Accessed 02/09/2016.

5. HealthIT.gov. EHR Incentives and Certification. Meaningful Use Definition and Objectives. Available at: https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives. Accessed 02/09/2016.

6. CMS. Payment Adjustments and Hardship Exceptions Tipsheet for Eligible Professionals. Available at: https://www.cms.gov/Regulations-and-guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf. Accessed 02/09/2016.

 

 

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