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Proposed MACRA Rule to End Meaningful Use for Physicians

HHS will bring meaningful use to an end for Medicare physicians as of Jan. 1, 2017.

- In issuing a notice of proposed rulemaking for MACRA implementation, the Department of Health & Human Services (HHS) has signaled the end of meaningful use for Medicare physicians. The program is still under review for hospitals.

Meaningful use comes to an end

“We’re proposing today to replace meaningful use in the physician office with a new effort that moves the emphasis away from the use of information technology to one that support patient care supported by better and more connected technology,” the Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt said during a media call Wednesday evening.

“Based on significant feedback, the program Advancing Care Information is designed to far simpler, less burdensome, and more flexible. If this proposal’s finalized, this would replace the current meaningful use program for physician offices and be effective January 1, 2017 along with the other components of the MACRA implementation.

Meaningful use will give way to the Advancing Care Information program this coming January for Medicare physician offices, but not for hospitals. Likewise on the way out as separate programs are the Physician Quality Reporting System and Value Modifier Program. All are becoming part of the Merit-Based Incentive Payment System (MIPS).

Slavitt emphasized the impact the EHR Incentive Programs have had on health IT infrastructure.

“The context behind this change is important,” he continued. “Over the last seven years, meaningful use has played an important role in helping us develop the information technology infrastructure that we have and can no build from. There have been important advances like e-prescribing. Thousands and thousands of physicians and hospitals have implemented in their clinics and hospitals.”

Unfortunately for the programs, they have not advanced alongside the healthcare industry:

But as many doctors and patients will tell you and have told us, we remain a long way from fully realizing the potential of these important tools, whether measured in patient care or physician satisfaction. At the same time we have been invested in technology, the healthcare system as a whole has been changing. As a nation, we have made significant advances in transitioning the healthcare system to one that pays for quality, encourages coordinated care and smarter spending, and focuses on healthier outcomes for people.

Value-based programs such as Medicare Shared Savings will fall under Alternative Payment Models (APMs). MIPS and APMs now represent the two paths of the “unified framework” known as the Quality Payment Program.

Provisions are in place for providers to satisfy the requirements of MIPS using certified EHR technology that predated the 2015 Edition Health IT Certification, confirmed representatives from the Office of the National Coordinator for Health IT, including Karen DeSalvo, MD, MPH, MSc.

Providers failing to demonstrate meaningful use this year and prior are still on the hook for meaningful use penalties (i.e., Medicare payment adjustments) through the end of 2018, two years following the meaningful use reporting year of 2016.

MIPS participation will begin in 2017 and payment adjustments will be assessed in 2019, maintaining the two-year lag used for meaningful use penalties.

In a joint post on the official CMS blog, Slavitt and DeSalvo provided several details about the goals of Advancing Care Information.  The program will:

  • Allow physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice
  • Simplify the process for achievement and provide multiple paths for success
  • Align with the Office of the National Coordinator for Health Information Technology’s 2015 Edition Health IT Certification Criteria
  • Emphasize interoperability, information exchange, and security measures and require patients to access to their health information through of APIs
  • Simplify reporting by no longer requiring all-or-nothing EHR measurement or quality reporting
  • Reduce the number of measures to an all-time low of 11 measures, down from 18 measures, and no longer require reporting on the Clinical Decision Support and the Computerized Provider Order Entry measures
  • Exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group

Following the publishing of the notice of proposed rulemaking, the public will have 60 days to submit comments.

Further details about the MACRA proposed rule are available on the CMS website.

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