While CMS’s Acting Administrator Andy Slavitt said earlier this week that the meaningful use program will soon be replaced with something better, health IT leaders seem uncertain on if momentous changes are indeed in store.
Slavitt dropped the news on Monday evening, Jan. 11, at the J.P. Morgan Healthcare Conference in San Francisco, and then reiterated on his Twitter account that the focus will move away from rewarding providers for the use of technology and towards the outcomes they achieve with their patients. He officially announced that changes will be coming in a Jan. 12 blog post on the Centers for Medicare & Medicaid Services’ website. There, Slavitt 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.” After having a few days to digest the information, however, health IT leaders do not seem as surprised as one might imagine given the boldness of Slavitt’s statements.
For one, Ferdinand Velasco, M.D., chief health information officer at Arlington-based Texas Health Resources (THR), notes that it’s premature to interpret Slavitt’s comments or tweets without looking at the regulatory process and diving into the details. The legislation part of meaningful use is embedded in the American Recovery and Reinvestment Act of 2009 (ARRA), and is baked into the law, Velasco says, adding that it’s important not to overreact to Slavitt’s remarks. “That puts limits as to what an agency like CMS can do without going back and having Congress change things through legislative action. Even if CMS can make the changes, it has to happen through legislation,” he says.
The fact that CMS does not have the authority to remove meaningful use without an act of legislation is something that cannot be understated, agrees Naomi Levinthal, senior consultant, research and insights at Washington, D.C.-based The Advisory Board Company. “What is misunderstood from what Slavitt said is that meaningful use is ending. It’s not ending,” Levinthal attests. The requirement that CMS evaluates an eligible professional (EP) who is operating under the Merit-based Incentive Payment System (MIPS), within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law earlier this year, is something that is a non-negotiable under the law, she says. “Providers have to be evaluated on whether they are a meaningful EHR [electronic health record] user or not. That construct is already in place,” Levinthal says. “What it takes to evaluate whether a provider has met that is a huge unknown still.”
Levinthal further notes that there is currently nothing up for vote, nothing in committee status, and nothing that’s anywhere near the President’s desk that says meaningful use will be wiped out. “MACRA was a perfect opportunity to wipe this program from the books if that's what they wanted. That law is effective until 2024 and meaningful use is a part of that. People have an interest in keeping it around,” she says.
Beginning in 2019, physicians, depending on how much risk they are taking on, will either participate in the MIPS model or be able to opt for an alternative program involving slightly higher payments in return for participation in certain alternative payment models, or APMs. Within both payment tracks, meaningful use is engraved in some way, shape or form, Levinthal says. “Under MIPS, it’s clear where it says ‘meaningful EHR user’, and for APMs, there are two things that are necessary—one is that a provider has a certain amount of claims in risk-based models, and the other part that there is that a provider is using CEHRT [certified EHR technology]. Those words are in there. CMS doesn’t have the opportunity to say ‘we won’t do it,’ or else they won’t be following what the law says,” Levinthal says.
What’s more, according to Velasco, Slavitt “is not your typical bureaucrat,” in that he came from the private sector. “I wonder if he’s intentionally being disruptive with his comments,” Velasco ponders. “Executives from the private sector will often hint at things vaguely and then get to more explicit announcements later on. He is challenging us, and this makes us want to pay attention to not just meaningful use, but what’s coming down the line. It’s an innovative approach by Slavitt to get our attention,” he says.
Ferdinand Velasco, M.D.
At the end of the day, Velasco agrees with Levinthal in that meaningful use is not going away. “This is not big news; CMS has been foreshadowing it for some time as part of the SGR [Sustainable Growth Rate] reform and passage of MACRA,” he says. “They want the healthcare industry to move towards alternative payment models. Part of that will be how we leverage technology to deliver value for our patients. Meaningful use will be part of this ongoing reform.”
Another notable health IT leader who has been vocal with his thoughts on the meaningful use program is Marc Probst, CIO at the Salt Lake City, Utah-based Intermountain Healthcare. More than once in the last 18 months, Probst has said that “it’s time to declare victory and move on from meaningful use.” In an interview this week with HCI, Probst says it’s encouraging that CMS understands that there isn’t enough value coming from the program, but remains somewhat skeptical as to what will indeed come from Slavitt’s remarks. When asked if he needs to see more than just words coming from the agency, Probst says that “CMS has earned its stripes” in regards to the provider community needing to see more action from the feds.
Probst adds that when you look at the program’s origins, promises about doing certain things in relation to payments and penalties cannot be ignored, and that plans that are already in place for 2016 certainly won’t be affected. That being said, he applauds the idea that moving forward, meaningful use will be more about outcomes rather than usage of technology systems. “Hopefully now it’s not just about getting 60 percent of my people to use a portal. There is a big difference between using a portal and managing a chronic disease using a portal. That whole attitude makes a difference,” Probst says.
Velasco agrees that the ever-changing nature of CMS’s rules and regulations makes it extremely difficult for providers to get comfortable under the confines of the program. “It’s a two-edged sword,” he says. “On the one hand, CMS is being responsive—they get industry feedback on the regulations because of the complexity and the unrealistic expectations embedded in them. Then they release modifications to the regulations that we have to again react to. We can’t ever seem to get to a stable state,” he says.
Business as Usual
As such, despite the boldness in Slavitt’s claims, at Texas Health Resources, not much will change going forward—for now, Velasco notes. “We have always taken the long view at THR. Even before the [meaningful use] program came out, as a large community health system, we recognized the need and value in investing in EHR technology—not because of the incentive program, but because we recognized that it was the right thing to do,” he says. “You always have to keep going up that escalator to implement technology that improves interoperability, gives us a mechanism to engage patients, and enables us to do quality measurements. Those are the foundations that have never changed and will be critical to the future,” Velasco says.
To this end, another notable health IT figure, John Halamka, M.D., CIO of the Boston-based Beth Israel Deaconess Medical Center, recently posted on his blog, “Life as a Healthcare CIO,” a letter signed by several major health systems that asks Department of Health and Human Services (HHS) Secretary Sylvia Burwell “to reconsider Stage 3 and refocus the Administration’s efforts on the infrastructure needed to promote adoption, enhance interoperability and improve usability.” The letter continues, “We are of the collective mindset that this is an opportunity to improve the current trajectory of EHRs and the MU program to best support technical innovations and outcomes-based care.”
Levinthal adds that CIOs need to stay focused and do what needs to get done to earn incentives and avoid penalties. “From a strategic standpoint, for any provider, even if meaningful use as its own program went away tomorrow, the key hallmarks of the program will remain,” she says. Those fundamental cores are health information exchange (HIE), care coordination, and patient engagement, she notes. “If you weren’t doing those things and focusing on them as a strategic standpoint, the fact that you don’t have to check a box for meaningful use won’t mean anything, because you won’t be competitive in this landscape.”