At the center of efforts to delay finalization of the Stage 3 electronic health records rule are concerns about the way physicians will be paid or penalized under Medicare based on participation in the Meaningful Use program.

Section 101 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), passed by Congress earlier this year, repealed the Medicare sustainable growth rate methodology for updates to the physician fee schedule and replaced it with a new Merit-based Incentive Payment System (MIPS).  

At an October 1 hearing, Senate Health Committee Chairman Lamar Alexander (R-Tenn.) threatened to use legislative powers to delay the release of the final rule for Stage 3 of the Meaningful Use electronic health records program until Jan. 1, 2017. Among the reasons Alexander cited for delaying finalization of the rule was MIPS.

“Electronic health records are important to the shared goal between the administration and Congress to change the way the Medicare program pays doctors, so that Medicare is paying providers based on the quality rather than the quantity of care they give patients,” Alexander said. “Under the new Merit-Based Incentive Payment System, 25 percent of the score that determines a provider’s penalty or bonus payment will be based on participation in Meaningful Use and how well they comply with the regulations.”

Also See: Senator Alexander Throws Down Gauntlet on Stage 3 Rule Delay

The senator pointed out that the formula for MIPS was part of a law passed this year and that the Obama administration has begun the process to develop regulations to implement this value-based payment system. Further, the Centers for Medicare and Medicaid Services on Oct. 1 released a request for information seeking public comment on new provisions for the MIPS payment system. “It makes sense for the final stage of electronic health records to be developed at the same time as the Merit-Based Incentive Payment System,” argued Alexander. 

Last month, the American Medical Association and 41 medical societies sent letters to the Department of Health and Human Services and Office of Management and Budget urging the Obama administration to pause Stage 3. The groups want Meaningful Use re-evaluated following “pivotal changes to Medicare” such as MIPS. The proposed Stage 3 rule was developed prior to and without consideration of the changes to Medicare, even though the Meaningful Use program “will play a vital role in both the new MIPS payment system and the development of alternative payment models,” they argued.  

“We think, at a minimum, the final rule for Stage 3 should not be completed until it is done in the context of the MIPS program, which is the way physicians will be paid in the Medicare program going forward,” says American Medical Association President Steven Stack, M.D. “These programs need to all work together so that they make sense.”

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