The end is in sight for Meaningful Use

January 16, 2016

CMS head says new program will focus on outcomes, not technology use.

Meaningful Use, the much-reviled government program aimed at encouraging doctors to adopt electronic health records (EHRs), is coming to an end.

Andy Slavitt, MBA, comments on the end of Meaningful Use on Twitter

“The Meaningful Use program as it has existed will now be effectively over and replaced with something better,” Andy Slavitt, MBA, acting administrator of the Centers for Medicare & Medicaid Services (CMS) said earlier this week. Slavitt made the announcement in a speech to an investor’s conference sponsored by the investment bank JP Morgan.

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“Since late last year, we have been working side by side with physician organizations across many communities…and have listened to the needs and concerns of many,” Slavitt said. Details regarding the program’s replacement will be announced “over the next few months,” he said. The new program’s guiding themes will be:

  • Moving away from “rewarding providers for the use of technology and towards the outcome they achieve with their patients,"

  • Enabling provider to customize their goals so vendors can build their products around practice needs rather than the government’s needs. “Technology must be user-centered and support physicians, not distract them,” Slavitt said.

  • “Leveling the technology playing field for start-ups and new entrants” by requiring open application program interface so that apps, analytic tools and other technologies can get data in and out of an EHR securely, and

  • Getting “deadly serious” about interoperability.  “We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging a patient in their care’” Slavitt said. “And technology companies that look for ways to practice ‘data blocking’ in opposition to new regulations will find that it won’t be tolerated.”

​Next: What the future will look like

 

In October, the U.S. Department of Health and Human Services issued a Final Rule for stage 3 of the program that, among other steps, extended the deadline for meeting stage 3 to the start of 2018 and shortened some of the required reporting periods for attestation. But the changes changes did not satisfy MU critics. The American Medical Association, for example, said in a letter to Slavitt that “Stage 3… continues to restrict innovations in technology for patients and physicians” and will impede the transition to the new Merit Based Incentive Payment System slated for 2019.

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Similarly, the American Hospital Association and College of Healthcare Information Management Executives have called for delaying the start of stage 3 until 2019, and then only if at least 75% of eligible professionals have successfully attested to stage 2 of the program.

Launched in 2011 under the auspices of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the Meaningful Use program made funds available to medical practices and healthcare institutions to offset the costs of purchasing and implementing EHR systems. To obtain the funds, however, EHR users had to attest to meeting certain goals such as capturing and sharing patient data, exchanging patient data with other providers, and having patients use an EHR’s patient portal.

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In addition, the program imposes penalties, in the form of reduced Medicare reimbursements, for practices that do not adopt EHRs. Penalties began taking effect at the start of the year for practices that had not adopted EHRs by the start of 2015. According to CMS, 209,000 eligible providers are subject to such “downward payment adjustments,” although most of those will be for $1,000 or less.

Next: Signs of change

 

Almost from the outset, Meaningful Use encountered opposition from physicians organizations, hospitals and other providers who complained that the reimbursements did not compensate for the lost productivity, frustration and additional expenses that result from EHR adoption. Moreover, they say, EHRs can’t meet some of the program’s requirements, particularly in the realm of interoperability.

Recently there have been signs that the program is becoming a partisan political issue as well. The website Politico.com quotes a former official with the Office of the National Coordinator for Health Information Technology as saying, “In the last six months, we were definitely getting more critical questioning from Republican staff than Democratic staff as they were developing their bills.”

According to Politico, Republican lawmakers have sponsored more bills for overhauling Meaningful Use than have Democrats, although that may be because more of them are Republicans.