Meaningful Use
Though Centers for Medicare and Medicaid Services officials on Tuesday tried to clear up confusion over changes and the ultimate replacement of meaningful use, the future is very much in question according one expert who is slated to talk about the subject at the HIMSS16 conference.
One week after Andy Slavitt said meaningful use would be replaced soon, the acting Centers for Medicare and Medicaid Services administrator and national coordinator Karen DeSalvo made it clear that the changes would take time and that providers must still follow the current program.
Slavitt and DeSalvo in a blog post Tuesday afternoon explained the new regulatory framework would move away from measuring clicks to focusing on care.
[Also: Meaningful use will likely end in 2016, CMS chief Andy Slavitt says]
Two big changes have helped cause this shift from measuring technology adoption levels to looking for quality outcomes, they wrote.
First was HHS' ambitious goal, announced about a year ago, that 30 percent of Medicare payments be linked to value-based care in 2016, and 50 percent by 2018.
The second was the passage of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, which holds quality, cost and clinical practice improvements as key factors in determining how Medicare physician payments are doled out.
"While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments," Slavitt and DeSalvo wrote, "it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next."
CMS has been "working side by side with physician and consumer communities and have listened to their needs and concerns," according to CMS and ONC.
[Also: CIOs celebrate end to meaningful use]
Further details for the proposed rules, along with a public comment period, will be forthcoming "this spring." In the meantime, Slavitt and DeSalvo promised a new set of priorities that reward providers for the outcomes they're able to achieve for their patients with the help of technology.
This means they'll be "allowing providers the flexibility to customize health IT to their individual practice needs," they wrote. "Technology must be user-centered and support physicians."
They also pledge to help level the playing field to spur innovation, "including for start-ups and new entrants," by focusing on the open APIs so common in consumer technology. "This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care," according to Slavitt and DeSalvo.
And interoperability will continue to be a priority for both agencies, which will continue to drive national interoperability standards that are based in "real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care."
Slavitt and DeSalvo can be expected to offer more details on these coming changes at HIMSS16 in Las Vegas, Feb 29-March 4. In the meantime, they said physicians and hospitals alike should keep some important things in mind as staged meaningful use is phased out and this new MACRA-based program comes into focus.
First, existing law "requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system."
Second, MACRA "only addresses Medicare physician and clinician payment adjustments." Hospitals have a different set of statutory requirements. "We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program."
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Third, the changes to meaningful use under MACRA "won’t happen overnight," they write. "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."
Fourth, they point to recent legislation that streamlines CMS' process for granting meaningful use hardship exceptions. "This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. 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."
In closing, Slavitt and DeSalvo said that "moving from principles to reality" can be challenging. But ultimately, they write, "we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients. We look forward to working collaboratively with stakeholders on advancing this change in the months ahead."
Twitter: @MikeMiliardHITN
Thirty-one top health systems, hospitals and clinics are urging the Department of Health and Human Services to think again about pressing forward on Stage 3 meaningful use.
Among them are Beth Israel Deaconess Medical Center and Partners HealthCare in Boston; Geisinger Health Systems in Pennsylvania; Henry Ford Health System in Michigan and Intermountain Healthcare in Salt Lake City.
In a January 14 letter to HHS Secretary Sylvia Burwell, the organizations say they are concerned that Stage 3 might even thwart much needed improvements to electronic health record systems.
[Also: Meaningful use will likely end in 2016]
“We recognize that the MU program has successfully driven the adoption of EHRs, with over 80 percent of hospitals and physicians now using these systems,” they write, adding that now is the time to make sure all practices “have high-functioning technology to achieve interoperability across all care settings.”
Their pleas come on the heels of CMS chief Andy Slavitt’s claim that meaningful use would come to an end in 2016, a statement he made January 12 at the J.P. Morgan Healthcare Conference in San Francisco. He gave few details beyond that, except to say the program would be replaced by something better.
John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston, posted the letter on his blog. Halamka had already called for a halt to the program back in November.
[Also: Did meaningful use spawn or stall EHR innovation?]
“In particular, the MU program has diverted clinician, staff, and other resources away from activities with greater patient benefit and has forced technology to develop in a way that limits innovation,” the healthcare organizations said in their letter to Burwell.
Also, the group points to the meaningful use program as the driving factor behind the poor design of EHR technology.
“We believe Stage 2 EHR design requirements have been a fundamental drag on interoperability and that Stage 3 will worsen these problems,” they said. “The Stage 3 final rule, like its predecessor rules, is too focused on pass-fail requirements and lacks emphasis on outcomes. By maintaining this flawed structure, we do not believe Stage 3 will support movement towards more innovative care models or encourage continued participation.”
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Robert M. Wachter, MD, a professor and the interim chairman of the department of medicine at the University of California, in a Jan. 16 opinion piece in the New York Times pointed to several measures that he said have failed doctors and teachers.
“Of course, we need to hold professionals accountable,” he wrote. “But the focus on numbers has gone too far. We’re hitting the targets, but missing the point.”
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Despite officials this week signaling the end of the meaningful use program, more than 200,000 eligible providers will see a 2 percent cut in their Medicaid payments in 2016 for failing to meet standards in 2014, recent Centers for Medicare and Medicaid Services data show.
Healthcare chief information officers breathed a sigh of relief on Tuesday when Andy Slavitt said the end of the meaningful use program was near. But many are waiting on the details before celebrating too much.
Acting CMS administrator says several programs will change as healthcare industry wades deeper into value-based reimbursement.
New regulations aimed at value-based payment models demand a more streamlined regulatory approach, acting administrator tells audience at J.P. Morgan Healthcare Conference.
John Sharp sits down with Healthcare IT News to discuss patient engagement as it relates to meaningful use and mobile apps, and shows off his Regina Holliday Walking Gallery jacket painting entitled "Community."
LEARNING CENTER: 2015 HIMSS Connected Health Conference Session Recordings
Brian Yeaman, MD, founder and president of Norman, Oklahoma-based Yeaman and Associates and Yeaman Signature Health Clinic has been named the recipient of the 2015 HIMSS Physician IT Leadership Award for his work in meaningful use and health information exchange.
Yeaman previously served as chief medical information officer at Norman Regional Health System for 10 years, where he guided both inpatient and outpatient EHR implementations and Stage 1 and 2 meaningful use attestation.
Watch the full video.
Yeaman is also a leader in health information exchange. As chief administrative officer for Coordinated Care Oklahoma, his service area includes about 4 million patients with data received from facilities in five states. HIMSS called it “a model for sustainable HIE conducted under private funding and governance.”
"I'm thankful for the opportunity to practice medicine as well as serve on the front lines of defining a new healthcare,” Yeaman said in a statement. “I feel that we are still early in our journey of realizing the potential we have to improve care delivery with interoperability and health IT across the board.”
Yeaman will be honored at the HIMSS16 Awards Gala on, Thursday, March 3 at the 2016 HIMSS Conference & Exhibition. Learn more about HIMSS16 and the Physicians' IT Symposium.
Twitter: @MikeMiliardHITN
Avera McKennan Hospital and University Health Center, the largest private employer in South Dakota, has reached Stage 7 on the HIMSS Analytics Electronic Medical Record Adoption Model.
By achieving Stage 7, the highest level on the EMRAM scale measuring healthcare organization implementation and use of EHRs, Avera McKennan joins an elite crowd. During the second quarter of 2015, only 3.7 percent of the more than 5,400 U.S. hospitals in the HIMSS Analytics Database reached Stage 7.
“Our staff have been working diligently to implement a fully integrated electronic medical record across the Avera system,” Dave Kapaska, regional president and CEO of Avera McKennan, said in a statement.
Avera McKennan is an integrated health system composed of more than 330 locations in 100 communities in a five-state region and employs 6,000 staff and physicians.
Calling the health system “an incredibly innovative organization that is truly enabling their broad mission with information technology,” HIMSS Analytics executive vice president John Hoyt pointed to Avera McKennan’s e-health outreach practices, HIE connections spanning 40 states, and cutting-edge use of pharmacogenomics as some of the factors making it a leader in the field.
HIMSS Analytics developed the EMR Adoption Model in 2005 as a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics Database. The validation process to confirm a hospital has reached Stage 7 includes a site visit by an executive from HIMSS Analytics and former or current chief information officers to ensure an unbiased evaluation of the Stage 7 environments.
Avera McKennan will be recognized at the 2016 HIMSS Conference and Exhibition, which runs from Feb. 29 to March 4 at the Venetian – Palazzo – Sands Expo Center in Las Vegas.
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