The new approach is expected to focus on reporting more closely tied to quality and stimulating interoperability.


Jan. 13—In a sharp departure, the Centers for Medicare & Medicaid Services (CMS) is altering the focus of the federal electronic health record (EHR) incentive program.

The program, launched as part of the HITECH Act included in the 2009 stimulus law, was structured to provide bonus payments and then to phase in potential payment cuts based on providers’ “meaningful use” (MU) of EHRs. But the existing MU structure is about to change.

“The meaningful use program, as it has existed, will now be effectively over and replaced with something better,” said Andy Slavitt, acting administrator of CMS, in an address this week during the J.P. Morgan Healthcare Conference in San Francisco.

The announcement represented a big change for an agency that was signaling as recently as the fall that it was staying the course in the MU program.

“It did surprise people—in a good way, but it surprised people,” Kristine Martin Anderson, an executive vice president for Booz Allen Hamilton, said in an interview. “It was an important moment because he acknowledged the industry consternation about the meaningful use program. Many providers have had difficulty complying with Stage 2 and Stage 3 raises the bar.”

Just this week, an agency report revealed 209,000 eligible providers face Medicare payment cuts in 2016 under meaningful use.

Slavitt said that since late 2015 CMS has worked with physician organizations, including the American Medical Association, to understand “the needs and concerns of many.”

The MU changes, which will be released over the next few months, will move away from rewarding providers for the use of technology and toward rewarding patient outcomes, Slavitt said.

The changes also aim to allow providers to customize their goals so technology companies can build around individual practice needs.

“Technology must be user-centered and support physicians, not distract them,” Slavitt said.

A third objective of the changes will be to level the technology playing field for start-ups and new entrants.

Slavitt said CMS is “deadly serious about interoperability” and will launch initiatives with physicians and consumers to move technology toward “closing referral loops and engaging a patient in their care.” He warned technology companies engaging in “data blocking” in opposition to new regulations that such a practice won’t be tolerated.

The MU changes come as CMS moves to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which designated a new Medicare physician reimbursement system, one-quarter of which would be based on MU compliance.

However, the MU changes do not appear solely tied to MACRA—in part because regulations implementing that law are not expected until the summer, according to industry observers.

Possible Changes

The original HITECH legislative language defining MU lacked detail and simply required EHRs to have three functions: computerized physician order entry (CPOE), health information exchange, and quality reporting.

“My understanding is that as long as certified EHRs do those three things and you pay physicians for using those systems, that would be consistent with HITECH,” Julia Adler-Milstein, an assistant professor at the University of Michigan who has testified before Congress on health IT, said in an interview. “And you could effectively get rid of all the detailed criteria and staging and structure of MU, and that would be allowed.”

Adler-Milstein expected the MU changes to focus on interoperability and quality reporting, which most fit with the core objectives of MACRA.

On interoperability, CMS may choose between coming down hard on vendors that limit interoperability or pushing providers to send and recieve information.

“There’s just no question that they are going to be a lot more flexible in meeting that MU component and try to allow providers to qualify for it by doing activities that are much more closely tied to value,” Adler-Milstein said.

Very prescriptive criteria will likely be more clearly tied to value than are existing requirements, such as patient visit summaries.

“It’s just much less obvious how you draw a direct line from that to better care,” Adler-Milstein said.

She expected CMS to simplify MU and focus on “just a few steps that will make care better.”

“As opposed to all of these other criteria that may be helpful in certain situations, but you could also imagine in a lot of other situations it is not helpful at all,” she added.

Why the Change?

The impetus for the CMS course change was likely the large and growing provider pushback on the MU program, according to industry experts. But MU concerns also were drawing increasing attention from Congress, which cleared legislation late in 2015 giving CMS authority to grant large numbers of hardship exemptions from 2015 Stage 2 MU requirements.

The College of Healthcare Information Management Executives (CHIME) issued a statement after Slavitt’s announcement urging CMS to better align clinical quality measures and adopt enforceable standards.

“We also believe that we need a laser-like focus on interoperability to improve health information exchange across the continuum of care,” Russell Branzell, president and CEO of CHIME, said in a written statement. “Central to that is finding a safe, accurate, and private methodology for patient identification. Interoperable systems, a bigger focus on outcomes, and less prescriptive use of how technology is used will better position providers for success in new payment and delivery models of care, and ultimately benefit patient care.”

Only 12 percent of physicians and 40 percent of hospitals have met Stage 2 reporting requirements, according to a letter from the GOP Doctors’ Caucus, which had urged action on the issue.

“There’s just indications in general that Congress, the industry, and CMS all agree that they need to go in another direction, and that CMS will figure out how to do that in a way that still reaches those strategic-planning goals,” Anderson said.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, January 13, 2016