The Meaningful Use program is ending after all. Sort of.
A new plan to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) would effectively replace Meaningful Use for physicians and other individual providers in Medicare. It does not affect hospitals, though their time is coming, nor does it change the Medicaid side of Meaningful Use.
Under the MACRA legislation — last year’s “doc fix” — the new Merit-based Incentive Payment System and Advanced Alternative Payment Models programs consolidate the Physician Quality Reporting System, Meaningful Use and the Medicare value-based payment modifier. The Meaningful Use framework accounts for 25 percent of the MIPS score.
But the massive, 962-page plan that the Department of Health and Human Services issued Wednesday afternoon calls for some significant changes in IT measurement under the proposed new Medicare Quality Payment Program that would take effect next year. Payment adjustments based on this program would start in 2019.
Notably, the plan would remove some of the most hated elements of Meaningful Use, including the pass-fail nature of reporting on EHR and quality measures. It also calls for reducing the number of EHR measures from 18 to 11 and eliminating reporting on clinical decision support and computerized physician order entry.
“This moves the emphasis away from the use of information technology to one that supports care,” Acting CMS Administrator Andy Slavitt said during a press teleconference. He said that there are “multiple paths” to about half of the goals.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Plus, practitioners would be able to choose whether to attest individually or as part of a group. The group option would include either traditional medical practices or within the construct of Alternative Payment Models entities, kind of the next generation of Accountable Care Organizations.
“We want to focus more on aligning quality and streamlining workflow,” added national health IT coordinator Dr. Karen DeSalvo.
The proposal also would focus on interoperability, health information exchange, security and patient access to their own electronic health records. This is not surprising, given previous statements by the Obama administration about these issues.
On the CMS blog, Slavitt and DeSalvo wrote:
These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.
Left unchanged for now is the EHR certification program, though there is a bit of a catch for some practices. Anyone still using EHRs certified to the 2014 standards would still have to follow Meaningful Use rules in 2017. By 2018, all eligible providers would have to upgrade to EHRs that meet more recent standards.
The proposed rule will appear in the Federal Register on May 9, triggering a 60-day public comment period.
In the meantime, HHS will turn its attention to parallel changes for hospitals. Slavitt said that CMS is already meeting with hospitals on this front and will be announcing some Meaningful Use alternatives “over the next several months.”
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