CMS: Meaningful Use for Physicians Would End in 2017

Under proposed rules, the Meaningful Use incentive payment and penalty program would be replaced by the new, "less burdensome" Advancing Care Information program for physicians being paid by Medicare.

The Centers for Medicare & Medicaid Services wants to replace the meaningful use program for physicians with a program that is " far simpler, less burdensome, and more flexible," CMS Acting Administrator Andy Slavitt said Wednesday.

Slavitt and Karen DeSalvo, HHS acting assistant secretary for health and director of HHS' Office of the National Coordinator spoke to media by teleconference Wednesday afternoon as CMS released its proposed rules based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed by Congress last fall.

Under the proposed rules, the meaningful use incentive payment and penalty program created by the 2009 HITECH act, would be replaced by the new Advancing Care Information program for physicians being paid by Medicare.

The meaningful use regulations approved last fall for hospitals and recipients of Medicaid remain unaffected by the MACRA proposed rule, which now enters a 60-day public comment period, CMS officials said.

"The proposal will allow physicians and other clinicians to select the measures that reflect how technology best suits their day-to-day practice, and only report on those with multiple paths to success," replacing meaningful use's all-or-nothing attestation process for physicians, Slavitt said.

Related: New Medicare Rules Would Increase Bonus Opportunities, Ease Reporting

Common Standards

The MACRA proposed rule also moves U.S. healthcare toward common standards, changing the culture around data sharing and creating appropriate business cases, says Karen DeSalvo MD, HHS acting assistant secretary for health and director of HHS' Office of the National Coordinator.

Currently, Medicare measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs. Some clinicians are part of Alternative Payment Models such as the Accountable Care Organizations, the Comprehensive Primary Care Initiative, and the Medicare Shared Savings Program—and most participate in programs such as the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.

In enacting MACRA, Congress streamlined these various programs into a single framework to help clinicians transition from payments based on volume to payments based on value. Wednesday's proposed rule would implement these changes through the unified framework called the Quality Payment Program, which includes two paths, MIPS [Merit-based Incentive Payment System] and APM [Advanced Alternative Payment Model].

"Whether the provider, doctor, or clinician is in the MIPS portion of this program, or an in Advanced Alternative Payment Model, there will be an expectation that they're using certified technology to improve the care of patient," DeSalvo said. "We also recognize that care is very local, and we need to be flexible. It's time we can pull away some of the prior expectations in the program, like computerized order entry."

Reaction

In a statement, the American Medical Association praised the MACRA notice of proposed rulemaking:

"It is hard to overstate the significance of these proposed regulations for patients and physicians," said AMA President Steven J. Stack MD. "When Congress overwhelmingly passed MACRA last year, lawmakers signaled that they wanted to transform Medicare by promoting flexibility and innovation in the delivery of care, changes that could lead to improved quality and better outcomes for patients.

"Our initial review suggests that CMS has been listening to physicians' concerns. In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens. "The existing Medicare pay-for-performance programs are burdensome, meaningless, and punitive.  The new incentive system needs to be relevant to the real-world practice of medicine and establish meaningful links between payments and the quality of patient care, while reducing red tape."

The head of the College of Healthcare Information Management Executives (CHIME) also issued a statement of support:

"CHIME has long supported the goals of the federal Meaningful Use program to advance health IT solutions that increase efficiency and improve patient care," said CHIME president and CEO Russell Branzell. "While the proposed regulations are largely focused on physicians, there are elements concerning data blocking that apply to hospitals and will be of significant interest to our members. We are encouraged that CMS Acting Administrator Andy Slavitt said the agency will continue to meet with hospital officials to create alignment across health IT programs. We look forward to working with the administration to address critical issues impacting CHIME members, including adopting a 90-day reporting period and removing the pass-fail construct for attestation."

In a blog post, one prominent hospital CIO did question whether the existing certification rules for HIT software need further modification.

"The use of the ONC 2015 Certification Rule [as part of the MACRA NPRM] is not a good idea," wrote John Halamka MD, CIO of Beth Israel Deaconess Medical Center. "The burden of certification will consume developer resources that could be used for innovation."