CMS Reveals Successor for Meaningful Use Program

Ken Terry

April 27, 2016

As part of the proposed rule on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the meaningful use electronic health records (EHR) incentive program will be folded into the Merit-Based Incentive Payment System (MIPS), effective January 1, 2017, Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), announced at a news conference today.

The successor to meaningful use, known as Advancing Care Information, will include fewer measures than the current program, will provide more flexibility in meeting those criteria, and will stress the use of information technology to improve patient care, Slavitt said.

Eligible professionals (EPs) will no longer have to meet every requirement, as they do under the current program, he emphasized. The proposal allows physicians and other EPs to get 50% credit just for reporting on the measures, which no longer include clinical decision support or computerized physician order entry. The other 50% of the score will depend on the EPs' performance on those measures, and clinicians can choose the metrics that are most meaningful to their practices. The number of measures has been reduced to 11 from the current 18.

The three priorities for this program are improved interoperability to facilitate health information exchange, increased flexibility, and "user-friendly" technology, according to a blog post by Slavitt and Karen DeSalvo, MD, national coordinator for health information technology (IT) and assistant secretary of health.

Slavitt and Dr DeSalvo both emphasized that the government wants developers to use open application programming interfaces that the Office of the National Coordinator for Health IT will soon publish. One of the goals for Advancing Care Information is to provide the means for patients to access their health information through such interfaces. At the press conference, Dr DeSalvo said application programming interfaces would also help developers meet providers' expectations for more usable health IT systems.

Meanwhile, EPs need EHRs that are capable of meeting the criteria for Advancing Care Information. Dr DeSalvo notes that the proposed rule is "aligned" with the 2015 edition of certified EHR technology, but because that version is not mandated until 2018, the new criteria were tweaked to fit the 2014 versions of EHRs most providers are using, said Kate Goodrich, MD, director of the Centers for Medicare & Medicaid Services Center for Clinical Standards and Quality. EPs can use the 2014 EHRs until 2018, she said.

Media reports state that the reporting period for Advancing Care Information will be the full calendar year, although the subject was not discussed at the news conference.

"Listening to Physicians' Concerns"

The new program does not affect hospitals or Medicaid providers, because neither is mentioned in the MACRA law. Both will continue to be subject to the current meaningful use program, although Slavitt said the Centers for Medicare & Medicaid Services is conferring with hospitals about changes to that program. Similarly, Dr Goodrich said, "We're in the process of engaging with states and Medicaid providers to understand areas where they'd like to see changes in the [meaningful use] program."

EPs who participate in the Medicare meaningful use program will continue to be subject to penalties for not attesting to meaningful use through 2018, Dr Goodrich explained. That is because the payment adjustments occur 2 years after the "performance year" in which EPs must attest. This is the final performance year for meaningful use, and 2017 will be the first performance year for the Advancing Care Information program. EPs' performance in 2017 will affect their payments in 2019, the year MIPS and MACRA become effective.

Advancing Care Information will determine 25% of the overall MIPS score that will be used in calculating whether an EP receives a negative or positive payment adjustment. The other components of the MIPS score will include quality (50%), which replaces the Physician Quality Reporting System; clinical practice improvement activities (15%); and cost (10%), which will be based on Medicare claims data. If a physician chooses not to report about his or her use of information technology, he or she will receive a zero score in that category, Dr Goodrich noted.

In a statement, American Medical Association President Steven J. Stack, MD, commented, "Our initial review [of the MACRA proposed rule] suggests that CMS has been listening to physicians' concerns. In particular, it appears that [the Centers for Medicare & Medicaid Services] has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens."

However, Dr Stack noted, "today's draft rules are only a first step in the rulemaking process." He urged physicians to offer comments on the rule during the upcoming 60-day comment period.

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