Don’t walk away from meaningful use quite yet. That’s the message from CMS leaders Andy Slavitt and Dr. Karen DeSalvo.
Mr. Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, announced on Jan. 11 that change would be coming to health care IT. “The meaningful use program as it has existed will now be effectively over and replaced with something better,” he said at the annual J.P. Morgan Healthcare Conference.
In a blog post intended to elaborate on those statements, Mr. Slavitt and Dr. DeSalvo, National Coordinator for Health IT, wrote that “the approach to meaningful use under the [Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)] won’t happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what’s next and to continue to give us input. We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use stage 3 – are still in effect.”
Although CMS had been hinting since late in 2015 that it was considering dropping or modifying the meaningful use program, Mr. Slavitt made it official during the J.P. Morgan conference. The latest announcement asks providers to have patience with this process. “We will continue to listen and learn and make improvements based on what happens on the front line,” Mr. Slavitt and Dr. DeSalvo wrote. “The process will be ongoing, not an instant fix and we must all commit to learning and improving and collaborating on the best solutions.”
Since health IT changes under MACRA apply only to Medicare, the CMS leaders pointed out that electronic health record incentives for Medicaid and Medicare hospitals are unchanged; however, they noted that the agency would seek ways to help health care institutions streamline their IT needs as well.
The blog post also pointed out that late last year, CMS was given the authority to allow groups of providers – rather than individuals – to receive hardship exemptions under meaningful use. “This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon,” Mr. Slavitt and Dr. DeSalvo noted.
The American Medical Association lauded the coming changes to health IT. This is “a win for patients, physicians and common sense,” Dr. Steven J. Sack said in a statement.
But as CMS forges ahead with new tech mandates, others advised the agency not to throw away the good with the bad.
“We are heartened that CMS has its ears to the ground and is trying to shape the program in a way that will be genuinely beneficial for providers and patients,” Ed Park, chief operating officer at AthenaHealth, a Boston-based health IT solutions firm, said in an interview. “With that said, just because providers found meaningful use stage 2 hard doesn’t by itself make it a bad program.”
This latest information out of CMS would seem to reinforce Mr. Slavitt’s promise to the investors at the J.P. Morgan conference that the move away from meaningful use would be to “start small and leave a lot of tool-building opportunities for the private sector.” He told attendees that CMS would level the playing field for start-ups and new entrants into the health IT space who can help providers securely transfer patient data and close the loops on referrals and other essentials of continuous care.
Some are not so optimistic about the private sector’s ability to help make MACRA a sustained reality, however. “As to whether the systems will be ready for the new payment regime, I am not holding my breath,” Johnathan Graham, a health economist and senior fellow at the National Center for Policy Analysis, Washington, D.C., said in an interview.
Even with updated technologies, physician satisfaction will not rise overall, he predicted, because of what he referred to as a too-slow rate of growth in Medicare’s Part B budget.
He also called out MACRA payment adjustments as onerous to physicians: The implementation of MACRA’s range of positive or negative payment adjustments in the MIPS program of minus 3.5% to plus 4.5% in 2019, plus or minus 5% in 2020, plus or minus 7% in 2021, and plus or minus 9% after that, meaning that the more providers who score above the threshold for the positive payment update, the narrower the update will be to each practice.
“I think MACRA will fall apart within 2 or 3 years as practicing physicians learn they are in a dog-eat-dog environment, or zero-sum game. The can will get kicked down the road just like meaningful use was,” Mr. Graham said.
But forcing doctors to face off is the point, according to Mr. Park: “Our health care system is on a transformational journey and we should all expect it to be hard. We want to encourage CMS to continue to keep the bar high on the right things and we hope that CMS doesn’t water down merit-based incentive pay so that the definition of success is that everyone succeeds.”
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