Electronic Health Records

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Industry Experts Back EHR Meaningful Use Overhaul

“Patient-centered quality and value measures should be the primary drivers of how EHRs and other health IT are used.”

By Sara Heath

- Over the course of the past week, several healthcare industry experts have expressed support for ending the Centers for Medicare & Medicaid Services (CMS) EHR meaningful use programs, stating that the program may have run its course.

meaningful use ehr incentive program

For example, this past Monday, CMS’s acting administrator Andy Slavitt addressed a crowd at the JP Morgan Healthcare Conference stating that the meaningful use program as it has existed before will no longer exist. According to Slavitt, CMS will completely restructure the program along three guiding themes.

First, the focus of the program will transition from heavy government regulations to the needs of the provider. Second, these customized provider goals will be used to influence vendor developments. Rather than inhibiting EHR innovation because of prescriptive government regulations, vendors will be able to customize software to serve their clients’ actual needs.

Third, CMS will put a heavier emphasis on interoperability and will take action to put an end to intentional data blocking.

“[W]e’re deadly serious about interoperability,” he asserted. “We’ll begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging a patient in her care. And technology companies that look for ways to practice data blocking in opposition to new regulations will find that it will not be tolerated.”

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In essence, these changes aim to put physicians back in the driver’s seat.

“Our role is actually much more minor,” Slavitt explained. “Our role is simply to say, ‘for the things that you want to accomplish, if you accomplish them on behalf of our beneficiaries, you ought to get rewarded.’ So we’re not the driver; we really are there to reinforce the things physicians should want to do.”

Several industry experts have shown support for these kinds of actions. For example, in a recent HealthAffairs.org post, Peter Basch, MD, FACP, and Thomson Kuhn, state that due to newer and potentially better government regulations, the meaningful use program no longer makes sense. They state that they agreed with Slavitt’s announcement to radically change the programs.

“We argue that, rather than tinkering around the edges, CMS should completely reconceptualize the program,” the pair say. “A new MU program should focus on specialty-specific measures of quality and be based in normal clinical work patterns, rather than rewarding clinicians for meeting artificial “one size fits none” threshold requirements for specific functional uses of electronic health records (EHRs) and health IT.”

The problem with the Stage 3 requirements, Basch and Kuhn explain, is that they were announced prior to the announcement of the Medicare Access and CHIP Reauthorization Act (MACRA), which combined three government programs to support value-based payment models. Meaningful use is one of those programs.

The pair maintain that in order for MACRA to function properly, it needs meaningful use. This is because MACRA includes specific provisions regarding meaningful use, and because they believe there should be some government regulation of health IT – just in a different form than what is currently practiced in meaningful use.

To that end, Basch and Kuhn suggest that meaningful use needs a complete overhaul from its original form.

“That said, we do believe that a stand-alone MU program should end in 2018 (if not before), and a very different and more appropriate MU program should emerge in 2019 for those clinicians participating in the MIPS program,” they explain. “Our recommendation is thus not a delay in finalizing Stage 3, but rather a transition from Stage 2 to implementation of MIPS in 2019, with a more appropriate and integrated MU component.”

Thus, the two suggest a new kind of meaningful use that provides for flexibility and innovation. These principles are on the same wavelength of what Slavitt suggested by giving more control to providers.

“MU should follow its own advice and avoid requiring duplicative activities. Patient-centered quality and value measures should be the primary drivers of how EHRs and other health IT are used,” Basch and Kuhn confirm. “A new MU within MIPS should aim only to fill in key gaps and strive to incent optimization of value from health IT (based on specialty and setting of care). MU must permit and even encourage flexibility and innovation.”

Specifically, Basch and Kuhn offer seven suggestions for a new and improved meaningful use. Several of these suggestions overlap with the goals Slavitt illustrated in his address on Monday, including improved interoperability and encouraging clinician engagement.

Basch, Kuhn, and Slavitt all also underscore the importance of regaining physician buy-in and trust in these programs, stating that a program overhaul could be what physicians need to want to work within a government program with their EHR.

“[W]e have to get the hearts and minds of the physicians back,” Slavitt told his crowd.

Basch and Kuhn agree, saying that a restructuring of the program could help do this.

“If this approach is taken now, it may not be too late to turn around clinician anger and disengagement,” they maintain. “Clinicians engaged with meaningful and helpful health IT will be better prepared for the future of health care delivery.”

In addition to the Basch and Kuhn, several other industry stakeholders have spoken to the future of the meaningful use program, including the College of Health Information Management Executives and 31 hospitals including Beth Israel Deaconess.



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