Tuesday, 19 January 2016 21:39

Bye-Bye Meaningful Use, Hello???

Written by Kim Charland, BA, RHIT, CCS, and Stanley Nachimson

I am sure that everyone has heard in some form this past week that the Centers for Medicare & Medicaid Services (CMS) is planning on ending meaningful use as we know it for eligible providers (EPs) in 2016. But what does this really mean? And will changes soon follow for eligible hospitals (EHs) as well? This would make sense, as both EP and hospital programs and data are reviewed.

Let’s start with a quote from Stanley Nachimson, principal of Nachimson Advisors and former CMS senior technical advisor for e-health standards and services. 

“Acting Administrator Slavitt was signaling that CMS has heard the concerns of doctors regarding the meaningful use program and recognizes that changes need to be made. While the use of EHRs (electronic health records) will still be part of the MIPS measurement as required by law, the measurement of meaningful use will change,” Nachimson said. “In its RFI, CMS asked about the all-or-nothing use criteria and how it could be changed. I would expect to see something that gives docs partial credit for implementing parts of the EHR requirements, or a dramatic change in how CMS measures meaningful use.”

No one can argue that the gradual move from volume and fee-for-service to true quality with improved patient outcomes and reduced costs isn’t in motion. The PQRS program was one of the early attempts to pay for reporting of quality measures in an attempt to link them with patient outcomes.

However, the last few years have seen an onslaught of regulatory requirements that have overwhelmed physicians (EHRs, meaningful use, ICD-10, and HIPAA privacy and security, to name a few). It has been difficult for physicians to focus on these and the move to quality outcomes. In fact, providers have not really had an opportunity to learn what is necessary for them to do to adjust to this new world.

I spoke to a colleague recently who described herself as frustrated, as EPs are having a hard enough time just trying to get the quality data reported, let alone understand the impact that is coming. She suggests that we use 2016 to gain a true understanding of the quality initiatives, as 2017 will be the year to test things out. 

And 2017 will also be when it all hits the fan, as they say. If you have prepared, you might be surprised by the financial impact it could have. And while it is not all about the money, we have to be realistic and accept that we have to earn an income so we can continue to provide care to those in need. Many EPs have spent so much time trying to meet meaningful use that patient care may be suffering at this point. In addition, EHR vendors have had to spend so much time making their systems meet the meaningful use reporting requirements that changes to their systems that could actually improve quality of care continue to sit on the planning board.

As CMS works to define what the “new program” may be, it will be important to ensure that what is chosen actually leads to improving quality and healthcare outcomes while reducing costs. There is much discussion and debate in the “quality” world on whether all the initiatives are truly making an impact. When we look at some of the EH programs, there seems to be a lot of crossover (with IQR, HVBP, HAC, readmissions, etc.). CMS had to start somewhere with all of this, but now that the data is in, the true test will be to see if there can be revisions and perhaps consolidation of programs to better them in light of what the data is showing. It will be important to look at what has happened in the true penalty/bonus world of hospitals in order to ensure that EP programs are well-developed in MACRA.

Providers and their associations also should realize that they have an opportunity to impact what the new MIPS program and other federal requirements will be. The regulatory process is open for comment from the public. CMS will be publishing a proposed rule toward the end of March regarding what it thinks the MIPS program should be. We all have an opportunity to comment on those proposed rules and give CMS the information they may need to adjust their proposals. We can keep you informed about the rules and your opportunities.

In conclusion, don’t stop what you may be doing related to improving technology, whether you are an EP or an EH. The key to really impacting patient care is going to be through the transition and coordination of care. Providers must talk to each other and communicate as patients move from one care setting to another. Providers need to find better ways of communicating with patients as well to monitor their health and compliance with instructions. As we move toward more bundled payment initiatives, the only way to effectively manage most of this is through technology. So even though CMS may be saying that meaningful use is going away, it is highly probable that much of what has been in that program will remain in some capacity, as we will still need to be able to report what we are doing, coordinate among various providers and healthcare settings, and communicate with our patients. Technology is here to stay.

The following update was released yesterday, January19, 2016 by CMS: http://blog.cms.gov/2016/01/19/ehr-incentive-programs-where-we-go-next/

About the Authors

Stanley Nachimson is the principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption. The firm serves a number of clients, including the Cooperative Exchange, EHNAC, No World Borders, and the American Osteopathic Association. Stanley advises healthcare providers, vendors, and plans with their ICD-10 and other regulatory implementations. He is the director of the NCHICA-WEDI Timeline Initiative and serves on the Board of Advisors for the Lott QA Group, an innovative healthcare IT testing company. Stanley is the author of the authoritative paper on the cost of ICD-10 for physician practices, and also co-chairs the HIMSS ICD-10 Task Force and the WEDI ICD-10 Testing Workgroup.

Stanley served for over 30 years in the U.S. Department of Health and Human Services in a variety of statistical, management, and health technology positions. His last 10 years prior to his 2007 retirement were spent developing HIPAA policy, regulations, and implementation planning and monitoring, beginning CMS’s work on personal health records, and serving as the CMS liaison with several industry organizations, including WEDI and HITSP. He brings a wealth of experience and information regarding the use of standards and technology to the healthcare industry. 

Kim Charland is the editor of VBPmonitor and the senior vice president of clinical innovation with Panacea Healthcare Solutions. Kim has 30 years of experience in health information and reimbursement management for hospitals and physician offices. Kim’s primary role with Panacea is publisher of VBPmonitor, which is the company’s newest online monitor focused on value-based purchasing and quality. She is also co-host of ICD10monitor’s Internet weekly news broadcast “Talk Ten Tuesdays.” In addition, she assists with product development for Panacea’s consulting and software divisions as well as the MedLearn Publishing division. Kim is also recognized as a national speaker and has spoken for numerous organizations.

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Last modified on Wednesday, 20 January 2016 07:04