Meaningful Use not working? Demote it

For Meaningful Use, 2015 has not been the best of times.

A recap of what's happened to the electronic health record incentive program so far includes:

  • The Medicare Access and CHIP Reauthorization Act (MACRA) siphoned off the entire physician component of the Medicare Meaningful Use program into a brand new merit based incentive payment system (MIPS).
  • The reported Stage 2 attestation numbers are lackluster, with about 40 percent of hospitals and just 10 percent of physicians successfully attesting in 2014, despite the fact that 2014 was the same year that penalties for not attesting kicked in.
  • Noted scholars and the Robert Wood Johnson Foundation determined that the program has fallen short of its goals.
  • The program has been blamed by some for hindering health reform.
  • A controversial Government Accountability Office report noted that some feel the program is a barrier to interoperability.

So what's a poor agency to do?

Hundreds of lawmakers, provider groups and others urged the Department of Health and Human Services to pause and delay Stage 3 so that the program could be evaluated.

But HHS has a mandate. After all, the program wasn't made out of whole cloth. It was created by statute in 2009.

So it didn't delay the Meaningful Use program. Instead, HHS demoted it.

Look at the final rules issued this week softening the requirements for 2015-2017 and implementing Stage 3 of the program. In three years, the program pretty much gets folded into a larger focus on health IT in general.

"By 2018, these rules put an end to stages of Meaningful Use so that the Electronic Health Record Incentive Program can become a part of the larger physician, clinician, and hospital quality and value programs over time," said Patrick Conway CMS' acting principal deputy administrator and chief medical officer, in a media call announcing the rules.

HHS (and its sub agencies, CMS and ONC) instead will work on bigger issues, such as the final interoperability roadmap, which probably not coincidentally was released the same day.

The fact sheet explaining the new rules alludes to the sunset of Meaningful Use as we know it, saying that the rules "shift the paradigm so health IT becomes a tool for care improvement, not an end in itself." 

Yes, the new rules include a 60-day comment period on what direction the program should take in the future. But the Meaningful Use program is, in many respects, being downgraded.

Need more evidence? Take a look at ONC's most recent data brief. The brief, on physician data sharing, reports that 57 percent of doctors electronically shared health information with patients in 2014, up from 46 percent in 2013. Fifty-two percent exchanged secure messages with patients, up from 40 percent in 2013; 47 percent had patients view, download and/or transmit data in 2014, up from 33 percent.

Data sharing also increased from provider to provider, with 42 percent of physicians electronically shared patient information with other providers, up from 39 percent in 2013.   

But for the first time, the Meaningful Use program doesn't get the credit for the increases, even though everyone knows it's the reason for them. Instead, ONC attributes the upward trend to payment reform, with the support of the agency's interoperability roadmap. 

What's more, the data brief doesn't even mention the Meaningful Use program.

There's nothing necessarily wrong with demoting Meaningful Use. If it isn't working the way it should, changes should be made. The 60-day comment period indicates that HHS is willing to make further changes. And no one would be surprised if Congress steps in and tweaks it some more.

But people should understand what's going on here. I've questioned before whether some of ONC's more recent projects were intended to distance itself from Meaningful Use and maintain relevancy beyond the program's expiration date.

There's no doubt about that now. - Marla (@MarlaHirsch and @FierceHealthIT)