Guest Editorial

The Uncertain Future of Meaningful Use

January 28, 2016 09:52 am Steven Waldren, M.D.

Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation, cautions that although CMS has announced an end to meaningful use, the program's requirements remain in place.

CMS Acting Administrator Andy Slavitt gave a speech(blog.cms.gov) Jan. 11 at the J.P. Morgan Health Care Conference in which he said, "The meaningful use (MU) program, as it has existed, will now be effectively over and replaced with something better."

Slavitt also said CMS had been "working side by side with physician organizations" and had "listened to the needs and concerns of many." He said CMS will be releasing details about the next stage of MU -- or whatever its replacement is called -- in the coming months, but in the short term, he offered themes that will guide the agency. For one, he said, the focus will move away from physicians' use of electronic health records and toward the outcomes they achieve with patients.

This provoked a fury of articles about the pending demise of the MU program, and it seemed reasonable to be optimistic about Slavitt's comments for a number of reasons.

  • The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rolled MU into the merit-based incentive payment system (MIPS), which is one of the paths forward for physician payment within MACRA.
  • In its final rule regarding MU, CMS stated it planned to make changes to the program that would be published in the pending MACRA regulations due out in spring 2016.
  • Many physician organizations, including the AAFP, have been articulating the challenges of MU and the need for substantive changes in the program.

But eight days after Slavitt's speech, he and HHS Acting Assistant Secretary for Health Karen DeSalvo, M.D., M.P.H., posted comments on The CMS Blog(blog.cms.gov) to clarify points from the J.P. Morgan speech. Notable was the fact that physicians still will be required to attest to the criteria of MU using certified electronic health record technology.

Obviously, this could be interpreted as inconsistent with Slavitt's initial statement.

So, the question is what -- if anything -- is ending and when?

The answer, just like the MU program itself, is not simple. It would seem that MU could be ending in name only. After MIPS is implemented in 2019, MU as a stand-alone program will end but the requirements on providers, as well as the potential for penalties, will be rolled into the MIPS program.

But in addition to MIPS, another path for physician payment under MACRA is the alternative payment model (APM). Because MU will be rolled into MIPS, providers on the APM path may not be required to fulfill the requirements of MU. They will, however, have to fulfill the requirements of APM (such as participating in an accountable care organization or a patient-centered medical home), which may require criteria similar to those required for MU.

It is unclear what might change with the release of the MACRA regulations later this spring. CMS will have new authority under MACRA to make changes to MU. The catch is that MACRA does not allow CMS to exercise its new authority until 2017.

The AAFP continues to advocate that MU be paused until the regulatory path forward for physicians is clear and there is complete alignment across CMS programs that impact physicians.

In an interview after the J.P. Morgan speech, Slavitt said, "We have to get the hearts and minds of physicians back. I think we've lost them."

For CMS to win back our hearts and minds, the MU program needs fundamental changes, not simply a new name.

Steven Waldren, M.D., is director of the AAFP's Alliance for eHealth Innovation.


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