The healthcare industry is continuing to digest the proposed rule on the Medicare Access and CHIP Reauthorization Act of 2015 issued yesterday by the Department of Health and Human Services, but it’s clear that it provides a roadmap for how federal agencies expect healthcare information technology to support reform initiatives.

Observers and industry organizations say it illustrates a vision of a post-meaningful use world for healthcare IT, where implementation of clinical records systems is not an end in itself, but a means to bring about improvements in care quality.

The proposed rule would effectively eliminate the meaningful use program as a stand-alone entity for office-based physicians and other eligible clinicians, replacing it with a simplified program under which those professionals will receive incentives for reporting progress using IT to support care.

Under the plan, healthcare IT would be focused on achieving broad themes that federal agencies have been championing in recent months—patient engagement, healthcare information exchange, care coordination and patient-physician communication.

The rule addresses the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which would widely revamp approaches to physician payment to focus incentives on quality, not volume of services.

While much of the proposed rule discusses payment reform, the portions that reflect changes to information technology policy are still significant, reflecting comments earlier this year by federal officials presaging changes ahead for the meaningful use program.

“I’m encouraged that the proposed rule is moving more from having technology in place to the application of technology to improve patient outcomes,” says Chuck Christian, a former CIO and now vice president of technology and engagement for the Indiana Health Information Exchange and a long-time leader of policy initiatives for the College of Healthcare Information Management Executives.

The new rule is likely to promote a dichotomy under which some rules will apply to physicians, while others apply to hospitals and other integrated delivery organizations, Christian noted.

“The changes only apply to physician practices; the MU reporting/attestation requirements are still in place for hospitals,” Christian notes. “For those organizations that are managing both hospitals and owned or affiliated physician practices, they now have two sets of rules to follow beginning in 2017.”

However, the two sets of approaches may be only temporary, he added. “During the Health IT Stakeholder call with Andy Slavitt and Karen DeSalvo, we learned that they are working to also provide similar modifications for hospitals, but it wasn’t clear on when this work would be completed and new proposals would be made available for review and comment.”

Christian and other organizations highlighted the willingness of federal agencies to collaborate with industry groups to find ways to incorporate IT in new initiatives.

I’m also encouraged that the leadership at both CMS and ONC are willing to collaborate with those of us in the industry to draft programs that continue to move more toward a patient-centered focus,” Christian says.

CHIME’s statement on the MACRA regulations also lauds federal agencies for their willingness to continue the dialogue on how IT will fit into future healthcare reform efforts.

“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,” said the CHIME statement, attributed to CEO Russell Branzell. “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.”

“Our initial review suggests that CMS has been listening to physicians’ concerns,” said Steven J. Stack, MD, president of the American Medical Association. “In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens.”

However, Stack noted that the release of the proposed rules for review and comments by industry stakeholders only represents a small step in the reform process.

“Today’s draft rules are only a first step in the rulemaking process, and with many physicians awaiting guidance on how these rules will affect their practice, the AMA is launching comprehensive, online resources to help navigate the changes and drive successful implementation for physicians,” Stack said in a statement.

The proposed rule offers many improvements from the pure technology focus on the meaningful use era, says Jeff Smith, vice president of public policy at AMIA, an industry organization representing informaticists.

“While there is a tremendous amount of detail yet to understand, AMIA applauds CMS proposals that address the ‘all or nothing’ and threshold legacies of Meaningful Use,” says Smith. “We also support the proposals that refocus requirements on those aspects of the program that are important, such as patient data access and patient engagement, care coordination and health information exchange. These changes will enable all stakeholders—providers and policymakers—to leverage program participation as a means to learn.

“We are also encouraged by CMS’s proposals to use the clinical performance improvement activities (CPIA) to enhance the use of certified EHR technology,” Smith adds. “We firmly believe that to be successful in MIPS and APMs, a new generation of workforce skills and education will be needed, and we see CPIA options that encourage physicians, and other clinicians, to leverage informatics tools to improve practice as a step in the right direction.”

Similarly, the American Health Information Management Association said it supports the main IT thrusts of the proposed MACRA legislation.

“We support its emphasis on interoperability, information exchange and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people,’” said Lynne Thomas Gordon, AHIMA’s CEO.

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