Although the Centers for Medicare & Medicaid Services (CMS) recently stated that Stage 3 of its meaningful use program will begin as early as 2017, just this week, Andy Slavitt, acting CMS Administrator, said that might not be the case at all.
According to multiple news media reports, Slavitt dropped the news on Monday evening, Jan. 11 at the J.P. Morgan Healthcare Conference in San Francisco. At the conference, Slavitt reportedly said to mark March 25 as the date CMS would be providing more details on future health IT incentive programs that would focus on patient outcomes rather than using technology. Specifically, according to a Family Practice News report, Slavitt said, “The meaningful use program as it has existed will now be effectively over and replaced with something better.” He continued, per the report, “We have to get the hearts and minds of physicians back. I think we’ve lost them.”
Slavitt seemed to double down on these sentiments on Twitter on Monday evening, and again on Tuesday, Jan. 12.
The industry has already begun to react to Slavitt’s remarks. The Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) said in a Jan. 12 statement, “We are encouraged that Acting Administrator Slavitt and CMS are open to improving the meaningful use program. It is important that we maintain momentum in digitizing healthcare. Robust IT systems are a cornerstone for achieving the Triple Aim.” The statement, from CHIME CEO and President Russell Branzell, continued, “The Medicare Access and CHIP Reauthorization Act of 2015, along with other reforms being pursued by CMS, aim to dramatically shift healthcare toward value-based payment. Through these changes, we’ll see greater alignment between physicians and hospitals. CHIME believes that it is essential that we create more synergy between meaningful use requirements for hospitals and physicians if we are going to fully realize the potential that health IT has in promoting better patient care across the continuum.”
CHIME’s Interim Vice President of Public Policy, Leslie Kriegstein, further told HCI that a “reoriented IT policy program, meaningful use, is indeed needed to acknowledge and accommodate the needs of the new reimbursement structure, and allow innovation to flourish.” Kriegstein says she wouldn’t be so sure that the meaningful use program is over, but rather that it “will take a new face, and be re-driven with a new focus.”
As far as why Slavitt might have said this now, Kriegstein says that pressure has been mounting from a variety of different places such as: the six Senate Health Education Labor and Pensions (HELP) Committee meetings on electronic health records (EHRs) that took place last year; the push from 116 members of the House last full to delay Stage 3 rulemaking; the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 that additionally called for meaningful use changes, and the fact that the industry is “seeing a harmonious message from the provider community.” All of this together, says Kriegstein, “has given CMS an opportunity to step out a ledge further than they have in the past” as far as changes to the meaningful use program.
In October 2015, CMS released both the Stage 3 final rule and the Stage 2 modifications final rule together in a 752-page document. In comments to the federal agency, which were due last month, many health IT stakeholders believed that the required start date of 2018 for Stage 3 of the meaningful use program is too soon. Nonetheless, CMS has stood firm on its timeline, until now, attesting that the program will essentially roll into the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law earlier this year. MACRA requires the establishment of a Merit-based Incentive Payment System (MIPS) and consolidates certain aspects of a number of quality measurement and federal incentive programs for Medicare physicians and other providers into one framework. Kriegstein, however, warns that it’s important to remember that while a lot of this is couched under MACRA, that law that does not address payment models to hospitals. “It would be detrimental to only change the approach to MACRA only for physicians. You need a two-track approach,” she says.
Going forward, Kriegstein says she isn’t sure how the refaced program will look, but that clinical quality measures, e-prescribing and health information exchange (HIE) are the only things in statute from the Health Information Technology for Economic and Clinical Health (HITECH) Act. As far as the March 25 date dropped by Slavitt, Kriegstein notes that CMS is in the midst of promulgating MACRA-related rules, but whether they will be part of the physician fee schedule and the inpatient prospective payment systems (IPPS) rule is not yet clear. Kriegstein says that initially, CMS said Stage 3 changes will come from those payment rules, and her guess is that March 25 will be the release of the new physician fee schedule, “which has to contain the MACRA rules.”
In the meantime, Kriegstein notes that CIOs are still hard at work in the trenches trying to meet the 365-day meaningful use reporting periods currently in place. “It will take some assurance from CMS that they are sincere in the act before the provider community will feel worthwhile to dream about this program in the future,” she says. “Meaningful use for CIOS is very real; it has a day-to-day impact, as providers have purchased these systems to meet their current needs. These changes take months or years to fully develop. If in fact we will see changes, you will have to account for the impact that they have on the current workflows that are in place.”