Meaningful Use must be malleable in the shadow of health reform

The call for change of the Meaningful Use program is taking a new twist, here on the eve of the release of the proposed rule implementing Stage 3.

Stakeholders had been urging that the Meaningful Use program to make a lot of changes, including greater interoperability, fewer burdens and the like.  

But now, the conversation has shifted to money--and not just the costs to providers or the profits of the vendors. Stakeholders and analysts are saying that the program may hurt the economy and efforts to reform healthcare. 

Take a look at this week's health policy brief released by The Brookings Institution. The authors hone right in to how the current health IT and Meaningful Use policies "hinder" payment reform. They assert that the program operates in a vacuum without taking a hard look at what's going on in healthcare, and that the watered down measures and certification requirements don't help clinicians.

They recommend, among other things, that the Meaningful Use program be revamped to tie incentives to relevant outcome-oriented performance measures and to support value based models. They also call for the interoperability road map to be driven by actual "business cases."

This focus on the need for Meaningful Use to change direction from a practical economic standpoint is cropping up in other ways, as well. Five leading Republican senators recently chastised the program for not providing taxpayers with a practical return on investment. A Brookings fellow called the program a "waste," designed with a lack of insight of the market and lack of long term market driven economic incentives.


We won't really know what the proposed Stage 3 rule contains until it's released. But we have a fair idea what measures it will cover and what it will focus on. And it may separate Meaningful Use from EHR certification.  

But will it align with health reform and changes in reimbursement? And will it help or hurt efforts to modernize healthcare payment?

ONC and CMS have made some changes to the program, such as aligning the reporting requirements with other programs, like PQRS. But what about the bigger picture, with CMS moving to value based models and care coordination, and requiring providers to use EHRs to participate? Will the Meaningful Use program adapt to support these economic initiatives?

CMS may take the position that Stage 3 doesn't need to address this, or that current efforts to require EHRs/Meaningful Use in new payment programs is the best way to align health IT and health reform.

Perhaps, but a lot of people are worried.

This money-punch may be the final straw to spur Congress and others to take a harder look at whether the program is addressing these issues, whether the vendors are doing their part and if providers can thrive in the new economic reality. It's not just how expensive the Meaningful Use program has been; it's also about the potential impact on the future of the healthcare industry, as a whole.

Jocelyn Samuels, Director of the Department of Health and Human Services Office for Civil Rights and the opening keynote speaker at this week's 23rd annual HIPAA Summit in the District of Columbia, did not specifically address the Meaningful Use program in her presentation; her focus was on HIPAA.

But what she said was illuminating. She highlighted that "much has changed in the landscape" and HIPAA faces new challenges in light of new technologies and care delivery models. She acknowledged that while HIPAA itself hasn't changed, it needs to adapt and apply to the changes occurring in the industry. She then outlined the steps that OCR was taking to address those developments.      

A good lesson for the rest of HHS, as well. - Marla (@MarlaHirsch and @FierceHealthIT)