Is CMS looking to replace meaningful use for hospitals?
Speaking at the American Hospital Association’s annual meeting this week, Centers for Medicare and Medicaid Acting Administrator Andy Slavitt highlighted the fact that healthcare has been in flux these past few years, with so much "change of every type – new consumers entering the system, changing payment models, advancing technology, issues of real challenge to rural hospitals, consolidation of all types – that it’s hard to keep track of it all."
One of those changing payment models, of course, is the recently proposed MACRA rule, whose Merit-based Incentive Payment System would reimburse physicians based on their prowess at delivering better quality, lowering costs, improving clinical practice and, crucially, "advancing care information."
For that component, docs must attest to customizable measures that show how they use technology – with a focus on data exchange and interoperability – in their day-to-day practice. CMS would begin measuring performance in 2017, with payments doled out based on the measures starting in 2019.
That new Advancing Care Information program would effectively replace the current meaningful use program for Medicare physician practices – but not for hospitals. Nonetheless, recent comments from CMS suggest hospitals could also soon expect some changes related to meaningful use.
The day the MACRA rule was published, Slavitt noted (in a blog post co-authored with National Coordinator Karen DeSalvo, MD) that "we are already meeting with hospitals to discuss potential opportunities to align the programs to best serve clinicians and patients, and will be engaging with Medicaid stakeholders as well."
Earlier this week, CMS Chief Medical Officer Patrick Conway, MD, offered similar comments. "We always want programs to align," he said at an Alliance for Health Reform event, according to Politico. He added, however, that the agency's hands were tied – specifically with regard to meaningful use's all-or-nothing requirements.
Altering those requirements, said Conway, "would likely require a statutory change."
But the American Hospital Association itself recently laid out a detailed list of reasons why, by its calculations, that's not true. In a March 22 letter to Conway, the AHA – which believes hospitals that meet 70 percent of MU requirements should be deemed in compliance – contended that CMS "is not legally required to maintain its all-or-nothing approach to meaningful use."
Instead, CMS has "ample legal authority" to adopt a more forgiving approach, said Ashley Thompson, AHA's senior vice president of public policy analysis and development.
At any rate, a legislative fix could conceivably be on the way, if a group of GOP Senators has their way. In April, U.S. Senators John Thune, R-South Dakota, Lamar Alexander, R-Tennessee, Mike Enzi, R-Wyoming, Pat Roberts, R-Kansas, Richard Burr, R-North Carolina and Bill Cassidy, R-Louisiana, wrote to Slavitt, seeking feedback on draft legislation that would relax the all-or-nothing approach, shorten reporting periods and make it easier to apply for a hardship exemptions.
Where that bill ultimately goes remains to be seen. In the meantime, in his remarks to the AHA Slavitt seemed perhaps to be hinting that hospitals should pay close attention to the policy changes being developed in Washington.
"Our proposal to replace meaningful use in the physician’s office with a new program, Advancing Care Information, is an example of where we have responded to considerable feedback to move the focus from 'clicking' to care provision and collaboration," he said.
"Over the next 60 days, the proposal will be available for public comment," Slavitt told the hospital executives. "We need meaningful engagement on this proposal and the team and I will be conducting dozens of listening sessions and educational sessions to collect feedback.
"I offer one editorial comment on new payment models," Slavitt added. "We should all take a step back and recognize that all of them are at early stages."