Although the Centers for Medicare & Medicaid Services (CMS) recently stated that Stage 3 of its meaningful use program will begin as early as 2017, Andy Slavitt, acting CMS Administrator, now says that the program might not be around even that long.
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. 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 noted that the focus will move away from rewarding providers for the use of technology and towards the outcomes they achieve with their patients.
Slavitt seemed to double down on these sentiments on Twitter on Monday evening.
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.”
Andy Slavitt
UPDATE: In a Jan. 12 blog post on CMS’ website, Slavitt went into greater length on why the agency is looking to end the meaningful use program so soon. He wrote, “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 few themes guiding our implementation.”
In the blog post, Slavitt continued that “providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government. Technology must be user-centered and support physicians, not distract them.” He said this will be aided “by leveling the technology playing field for start-ups and new entrants. We are requiring open APIs in order to the physician desktop can be opened up and move away from the lock that early EHR decisions placed on physician organizations so that allow apps, analytic tools, and connected technologies to get data in and out of an EHR securely.”
The post finalizes its thoughts on meaningful use by noting that the agency is “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. And technology companies that look for ways to practice “data blocking” in opposition to new regulations will find that it won’t be tolerated.”
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 to allow innovation to flourish.” Kriegstein says that Slavitt's words might get misrperesented, in that she wouldn’t say that the meaningful use program is actually 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 last fall from 116 members of the House 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 for hospitals. “It would be detrimental to 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. 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," Kriegstein says.
