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The Congressional Case for Rebooting Meaningful Use Program

Despite the emergence of MIPS as an alternative to meaningful use, GOP senators still seek changes to the latter.

By Kyle Murphy, PhD

- The answer to that question is a resounding yes from a contingent of Republican senators still looking to improve the EHR Incentive Programs by revising meaningful use requirements.

A reboot of meaningful use requirements

Sens. John Thune (R-SD), Lamar Alexander (R-TN), Mike Enzi (R-WY), Pat Roberts (R-KS), Richard Burr (R-NC), and Bill Cassidy (R-LA) — the authors of a plan to  reboot the meaningful use program published back in 2013 — recently wrote  the Department of Health & Human Services (HHS) seeking feedback on new draft legislation comprising several policy changes to EHR Incentive Programs. The deadline for feedback is set for May 13, 2016.

“[W]e have identified a few key policy changes outlined in the enclosed draft legislation, and we respectfully request feedback as part of our continued constructive dialogue on these issues,” the senators stated in a joint public statement. “These policies seek to provide CMS with the tools and guidance necessary to advance the use of EHRs as part of utilizing health IT to the benefit of patients in a manner that protects the significant taxpayer investment in our nation’s health care system.”

The draft legislation has three goals. The first is reducing the  2016 meaningful use reporting period from 365 to 90 days. The second aims to remove the all-or-nothing (i.e., pass/fail) methodology used by the Centers for Medicare & Medicaid Services to determine a successful meaningful use attestation. The third and final provision targets expanding flexibility for meaningful use hardship exceptions in program years 2017 and 2018.

Read: Proposed MACRA Rule to End Meaningful Use for Physicians

The draft legislation overlaps with similar legislative efforts already underway. Just last month, Representative Renee Ellmers (R-NC) and others introduced a bill — the Flexibility in EHR Reporting Act of 2016 — whose goal is to replace the full-year reporting requirement with a 90-day reporting period for both eligible professionals and hospitals in 2016 to avoid Medicare payment adjustments in 2018.

“The continued procrastination by CMS to provide relief from the tough and inflexible deadlines within the Meaningful Use Program has prompted myself and Senator Portman to rally our colleagues and take action," Rep. Ellmers said at the time. "Today, I have introduced H.R. 5001 to deliver flexibility to hospitals and doctors facing stiff penalties from unmanageable requirements."

The Ellmers-sponsored bill drew support from the likes of the American College of Cardiology and College of Healthcare Information Management Executives.

While these two pieces of legislation — one introduced and the other drafted — appear to seek similar ends; however, both come at a time when HHS and CMS are engaged in efforts to move away from meaningful use through implementing provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

In statements accompanying the release of a proposed rule for MACRA implementation, CMS Acting Administrator called attention to the end of meaningful use and the beginning of the Merit-based Incentive Payment System (MIPS).

Read: MIPS Requirements for Physicians Under Proposed MACRA Rule

“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,” he said last week in a media call.

“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."

Last week's developments should raise questions about the value of modifying a program scheduled to be sunset at the beginning of next year. As things stand, meaningful use requirements still provide a foundation for the Advancing Care Information component of MIPS, one of four performance categories contributing to a composite performance score used for determining positive, neutral, or negative Medicare payment adjustments in 2019 and beyond.

With the proposed rule for MACRA implementation months away from finalization, time remains for industry groups and members of the public to sway HHS and CMS opinion about meaningful use–related MIPS requirements. That being said, the all-or-nothing provision of meaningful use is slated for elimination and Congress already empowered HHS to use its discretion more widely when granting meaningful use hardship exceptions.

As a result, these most recent Congressional efforts could very well be moot.



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