Healthcare IT executives were surprised by the timing, but not the message, of a federal announcement that 2016 would be the last year for the Meaningful Use program to support the rollout of electronic health records.
Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, made the announcement Monday, January 11, during a presentation at the J.P. Morgan Healthcare Conference in San Francisco.
The following day, several healthcare IT executives agreed that the Meaningful Use program, originally included as part of the American Recovery and Reinvestment Act of 2009, had helped fuel progress in getting EHRs into hospitals and physician offices.
But they also relayed concern about the lack of details on future federal programs to advance the use of digital systems by providers, and specifics on how the transition to the next phase would be handled.
“Now that we effectively have technology in virtually every place where care is provided, we’re now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation,” Slavitt said in his presentation. “The Meaningful Use program as it has existed will effectively be over and replaced with something better,” he said, suggesting that more details would be available within a couple months.
Chief information officers are anxious about what might be coming, says Pam McNutt, senior vice president and CIO at Methodist Health System in Dallas. “ I anxiously await more details and the chance for input in the March timeframe,” added McNutt, who’s deeply involved in policy analysis for the College of Healthcare Information Management Executives.
The Meaningful Use program provided a major boost for national implementation of electronic health records, says Paul Tang, MD, vice president and chief innovation and technology officer for the Palo Alto Medical Foundation. Tang, a member of several influential federal HIT policy advisory committees, noted that before the program started, only 10 percent of hospitals and 3 percent of physicians were using EHRs. “The program’s made a tremendous change from a policy and infrastructure point of view.”
Changes now occurring in healthcare reimbursement suggest it’s time for the program to evolve to support new priorities, Tang said. MU “pushed” the use of EHRs; now, new reimbursement initiatives will “pull” more advanced use of the systems, he suggested.
Providers may face fewer burdens without the growing challenge of the Meaningful Use program, suggests Marc Probst, vice president and CIO at Intermountain Healthcare. For Intermountain, the end of the MU program “doesn’t make a huge difference,” added Probst, who’s participated in federal committee work to guide HIT policy. “We’re on a path to implement a new EMR, and the schedule is not being directly driven by MU; rather, it is driven by what is best for our patients and providers. From a regulatory and tracking/reporting perspective, it could be a good thing—one less thing to focus on.”
With much of the industry now using electronic health records, some of the basic reasons behind the Meaningful Use program are gone, Probst believes. “I have said for quite a while that the country needs to claim victory with MU; let’s stop the program and move on. We really need to get where MU should have gone, and that is standards, for data, identifiers, data transport and APIs. This is where we can really get the value from the MU investment.”
CIOs noted that Slavitt’s comments raise a large number of questions about how the transition will be accomplished, including:
- Whether Stage 3 of the MU program will not be implemented in any fashion, or whether aspects of program will be rolled into a replacement program;
- What will happen to incentives and penalties incurred as a result of 2015 and 2016 performance under the program; and
- Whether CMS and HHS can make a decision to summarily end the meaningful use program, since its basis is in legislation passed by Congress.
“I think the change in tone is encouraging, but much of the details are missing,” said Robert Tennant, director of health information technology policy for the Medical Group Management Association. “If CMS is going to modify this year of the program, there’s still a lot of unanswered questions regarding the transition of the current program to the new program under MIPS,” the Merit-based Incentive Payment System, which is under development to guide physician reimbursement.
CMS and HHS will need to act quickly to issue proposed regulations to develop a new approach, Tennant said. “I’m less confident of the ability to release regulations in a timely manner,” he added. Even if final regulations can be developed by the end of the year, all the effort might go for naught as a new administration takes over the White House. “New administrations traditionally put a hold or cancel new regulations. The dust is clearly not going to settle on this program; we reserve judgment on whether a new program will be easier to participate in, until we see the details.”
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