DeSalvo: Meaningful use program is not dead

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News of the demise of the Meaningful Use program — including Stage 3 — has been greatly exaggerated, according to Karen DeSalvo, MD, National Coordinator for Health Information Technology, who spoke Wednesday morning at a joint HIT Policy and Standards Committee meeting.

While the Obama administration is moving forward with its transition to value-based payment and the Medicare Access and CHIP Reauthorization Act (MACRA) passed by Congress last year, DeSalvo emphasized that MACRA won’t happen overnight; proposed regulations are expected this spring for public comment, she said. And physicians will continue to be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments.

“We’re moving to a place where we’re rewarding better outcomes and using health IT, rather than focusing on rewarding health IT particularly,” said DeSalvo, referring to a January 19 blog that she and CMS Acting Administrator Andy Slavitt co-authored regarding the future of the EHR Incentive Program. “We’re considering how MACRA and MIPS [the Merit-Based Incentive Payment System] vis-à-vis the Meaningful Use program will begin to shift our focus to outcomes-based rewards using health IT, compared with really incentivizing the use of health IT as a more near-term strategy that’s been successful in the last few years.”

Ding, Dong, Meaningful Use is dead! Long live Meaningful Use!’ It’s a bit like Monty Python. ‘I’m not dead yet! But, you’re almost dead. Not yet!'

Also See: CMS Details Next Steps for EHR Incentive Program

Enacted in April 2015, MACRA includes two key programs for Medicare providers: the Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APMs).

DeSalvo reiterated that the Department of Health and Human Services has set as a goal that 30 percent of Medicare payments in 2016 and 50 percent in 2018 would be based on APMs, such as accountable care organizations, bundled payments and patient-centered medical homes. The ONC chief argued that, “as we’re moving into this new chapter” of health IT, “it’s really more about knowledge that can come from that data as opposed to thinking about the adoption of platforms themselves.”

However, the transition will not necessarily mean the end of Meaningful Use—quite the opposite, according to ONC officials. Among other requirements, MACRA modifies participation and payment for MU for Medicare-eligible professionals and requires participants to use certified health IT.

As Elise Sweeney Anthony, acting director of ONC’s Office of Policy, pointed out in the meeting, 25 percent of the composite performance score that determines a physician’s penalty or bonus payment will be based on meaningful use of certified EHR technology. “We’re working hand in hand with CMS as we think about what that looks like and how best to move the use of certified health IT forward for the benefit of providers and patients.”

In addition, she said that under MIPS the HHS secretary has discretion to reduce the percentage weight for this performance category (but not below 15 percent) in any year in which the secretary estimates that the proportion of EPs who are meaningful EHR users is 75 percent or greater, resulting in an increase in the applicable percentage weights of the other performance categories.

Sweeney Anthony also made the case that MACRA focuses on Medicare EPs, not eligible hospitals, critical access hospitals or Medicaid providers. She said CMS and ONC are considering how best to align MACRA with these other stakeholders. Regardless, the Office of Policy director proclaimed that ONC’s certified health IT program will “continue to flourish” in the delivery system reform and MACRA environment.

“’Ding, Dong, Meaningful Use is dead! Long live Meaningful Use!’ It’s a bit like Monty Python. ‘I’m not dead yet! But, you’re almost dead. Not yet!’” John Halamka, MD, chief information officer of Boston’s Beth Israel Deaconess Medical Center and vice chair of the Health IT Standards Committee, told the meeting.

As an objective third party, Halamka concluded that “there’s a process for everything,” including the transition from the staged Meaningful Use program to MACRA. “We’ve heard from Andy and Karen some really interesting directions we’re all headed in as we get to more outcomes-based activities,” he said. “It will be very interesting to hear more details. It’s a process.”

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