Meaningful Use is not back because it never actually left

Well, that was fast.

The industry barely had time to decipher Centers for Medicare & Medicaid Services Acting Administrator's Andy Slavitt's pronouncement last week that 2016 likely marks the end of Meaningful Use before Slavitt and National Coordinator for Health IT Karen DeSalvo clarified in a blog post January 19 that that's not really what he meant. Time to stop celebrating. Meaningful Use is still here, everyone.

It may sound like Slavitt and DeSalvo are backtracking, but they really aren't. We already knew that Meaningful Use was being deemphasized, with all of the criticism of the program from stakeholders, pundits, legislators and even the Government Accountability Office.

But now that we have the Medicare Access and CHIP Reauthorization Act (MACRA), with its Merit Based Incentive Payment System funneling physicians away from the Meaningful Use program, plus HHS' goal to move increasing amounts of Medicare payments into value based care, clearly it's time for Meaningful Use to evolve. Or, as Slavitt and DeSalvo put it, away from "measuring clicks" and instead to focus on care.

They themselves acknowledged that the program has had mixed results, fostering electronic health record adoption but creating burdens on doctors. The focus will now shift to interoperability, customized health IT, rewarding providers for outcomes and innovation, areas where the Meaningful Use program has fallen short.

But they were also quick to point out the inconvenient truth: Meaningful Use is alive and well.

  • The current law requires the government to measure the Meaningful Use of certified EHR technology under the existing set of standards
  • MACRA doesn't eliminate EHR incentives and payment adjustments, or the "tensions of the current system"
  • MACRA only addresses Medicare payment adjustments. Medicaid and Medicare hospitals are subject to a "different set of statutory requirements"
  • MACRA won't happen overnight; in the meantime, the existing regulations, including Meaningful Use Stage 3, apply

"The challenge with any change is moving from principles to reality," they said. "The process will be ongoing, not an instant fix and we must all commit to learning and improving and collaborating on the best solutions."

This was a helpful clarification, and should quiet--at least for a while--those who are still clamoring for Meaningful Use program to be retired.

But consider what the blog post did not address:

  • Where do hospitals fit in? The blog post was directed mainly to physicians. It mentioned the burdens they've suffered with EHRs, how EHRs are pulling them from patients, that "physicians and innovators" need to work together and that the "important things" were for "physicians and other clinicians" to keep in mind. Is this because physicians have been more critical of EHRs? Because they're seen as having received the short end of the stick? Because their participation is so critical to the success of MACRA and value based care?  Because the hospitals are rather stuck where they are?
  • How will MIPS work? Even CMS doesn't know that yet. Much of the guidance it sought hasn't been forthcoming. And how would it dovetail with the Meaningful Use program that the hospitals are still subject to?
  • What contingencies might be considered during the transition, which no doubt will be rather bumpy? For instance, how will a doctor move from Meaningful Use to MIPS without incurring penalties? Will there be a grace period? Another new hardship exemption?
  • How will doctors keep straight what their obligations are if some are in MIPS, some are in Meaningful Use and some not in any incentive program?
  • Has MACRA made everything too complex? Would it have been better for Congress to start from scratch and create a new, more comprehensive program across the care continuum, not plunk down a new program just for physicians on top of the existing health IT infrastructure?
  • And perhaps the most important, how will CMS/ONC juggle all of this? Will they receive added resources to handle these changes? If not, what will be sacrificed in order to make this all work?      

One thing is certain: Meaningful Use is still the law. The concepts it contains, such as incentives and measurements, are here to stay. - Marla (@MarlaHirsch and @FierceHealthIT)