CMS Promises Meaningful Use Replacement This Year

January 14, 2016

For physicians clicked off by Medicare's meaningful use incentive program for electronic health record (EHR) systems, a tweet by a senior official in the Obama administration on January 11 sounded like sweet music.

"In 2016, MU (meaningful use) as it has existed — with MACRA — will now be effectively over and replaced with something better," tweeted Andy Slavitt, the administrator of the Centers for Medicare & Medicaid Services (CMS).

The provocative tweet condensed what Slavitt said that day about the meaningful use program at a healthcare conference in San Francisco, California, sponsored by investment banker J.P. Morgan. Slavitt said CMS was in the process of making the much-reviled program more physician-friendly, with EHR technology built around "individual practice needs, not the needs of the government."

"We have to get the hearts and minds of the physicians back," he said. "I think we lost them."

Slavitt's statements don't mean that the incentive program is screeching to a halt this year, relieving physicians of reporting obligations and financial penalties. However, they could portend major changes in meaningful use as early as next year, according to medical society leaders interviewed by Medscape Medical News. The changes come in conjunction with a massive overhaul of how Medicare pays physicians.

Launched in 2011, the EHR incentive program uses bonuses and penalties to encourage physicians to use the technology in "meaningful" ways, such as prescribing electronically, implementing drug-allergy alerts, and communicating with patients online. The ultimate goal is to improve care and lower costs. However, medical societies have protested that increasingly rigorous program requirements are oppressive, turning physicians into bureaucratic box-checkers, and clinically irrelevant in many cases.

Slavitt said at the San Francisco healthcare conference that on the basis of consultations with the American Medical Association (AMA) and other physician groups, CMS was drafting meaningful use reforms that it would disclose over the next several months. The focus, he said, would move from rewarding physicians for using EHRs to rewarding them for patient outcomes. And EHR technology would be user-centered and interoperable — no more programs that can't swap data.

Meaningful Use, MACRA, and MIPS

In one sense, talk of the program's transformation comes as no surprise, given the passage last year of the Medicare Access and CHIP Reauthorization Act (MACRA), which repealed the sustainable growth rate formula for physician pay. MACRA shifts Medicare compensation from fee-for-service to pay-for-performance (PFP), also known as pay-for-value.

Under MACRA, physicians choose between two PFP models. The alternative payment model (APM), which is more advanced, is for physicians participating in patient-centered medical homes, accountable care organizations, and Medicare shared-savings programs. The less advanced model is the Merit-Based Incentive Payment System (MIPS). It will incorporate and align EHR meaningful use and two other incentive programs — the Physician Quality Reporting System and the Value-Based Payment Modifier. Medicare will increase or decrease a physician's fee-for-service reimbursement in MIPS according to his or her quality of care, use of medical resources, clinical practice improvement, and meaningful use of EHRs.

Physicians will begin to get paid through MIPS and APMs in 2019.

How the two new payment models under MACRA will operate exactly — and what will become of meaningful use — is still a matter for CMS to decide. The agency expects to issue proposed regulations fleshing out MIPS and APMs sometime this spring and, after mulling over public comments, release a final version later in the year.

For one thing, CMS needs to determine the performance period that forms the basis of MIPS payments in 2019. That decision will have a lot to do with the timing of meaningful use changes promised by Slavitt, said Robert Tennant, director of health information technology policy at the Medical Group Management Association (MGMA).

Tennant told Medscape Medical News that CMS traditionally issues bonuses or assesses penalties in its incentive programs on the basis of performance 2 years earlier, or what policy wonks call a 2-year look-back. For example, some 209,000 clinicians will see their Medicare pay reduced by 2% this year for flunking meaningful use in 2014.

The MGMA and other medical societies have asked CMS to close the time gap for simplicity's sake. "We would like the performance year and payment year to be the same," said Tennant. However, he expects CMS nevertheless to stick to a 2-year look-back when it comes to determining MIPS compensation in 2019. The agency contends that it needs 2 years to analyze all the claims and quality data, according to Tennant.

Slavitt may have had such a 2-year look-back in mind when he tweeted that CMS would replace the meaningful use program with something better this year, said Tennant. He and other agency watchers say that proposed MACRA regulations coming out this spring probably will rewrite meaningful use requirements for 2017, the likely performance year for MIPS payments 2 years later.

"This Is a Win"

The MGMA is cautiously optimistic that the promised changes will indeed make EHR meaningful use more physician-friendly, said Tennant. "The change in tone (for CMS) is important," he said, referring to Slavitt's mea culpas. "We hope that CMS reinvents the program and makes it more clinically relevant and less onerous to participate in."

Slavitt's announcement about the sunset of the current meaningful-use program won applause from the AMA.

"He [Slavitt] listened to working physicians who said the meaningful-use program made them choose between following byzantine technology requirements and spending more time with their patients," said AMA President Steven Stack, MD, in a statement issued to Medscape Medical News. "This is a win for patients, physicians, and common sense."

Another medical society encouraged by Slavitt's comments this week is the American Academy of Family Physicians (AAFP). "We're hopeful," said AAFP President Wanda Filer, MD, in an interview with Medscape Medical News. "We like programs that improve the quality of care, but the meaningful use program is dysfunctional. It doesn't add to a doctor's ability to care for patients. If anything, it detracts from that."

Like the MGMA, the AAFP is not crazy about 2-year look-backs in Medicare incentive programs. Dr Filer said that in regard to MIPS payments in 2019, her association would prefer the performance year to be 2018, not 2017, which would cut it too close. "We need time to get physicians trained [on the requirements] so they understand what it means to them," she said.

Tennant pointed out that if new CMS regulations make 2017 the performance year for MIPS bonuses or penalties in 2019, EHR vendors may not have enough time to tweak their programs to help physicians meet the new meaningful-use requirements. He noted that CMS took until October 6 last year to release its final regulations on how physicians could achieve meaningful use in 2015. The late date didn't give physicians the prerequisite 90 days to measure up that year, forcing Congress to allow mass exemptions from the penalty. CMS can't afford to wait until late 2016 to issue final regulations for meaningful use changes in 2017, Tennant warned.

"Our advice to the administration," he said, "is to make your decision as quickly as possible."


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