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Meaningful use still in effect, Slavitt and DeSalvo say, MACRA changes will take time

While news of the program's demise excited the industry, changes to it will not arrive at least until the spring, officials say.
By Mike Miliard
01:36 PM
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One week after Andy Slavitt said meaningful use would be replaced soon, the acting Centers for Medicare and Medicaid Services administrator and national coordinator Karen DeSalvo made it clear that the changes would take time and that providers must still follow the current program.

Slavitt and DeSalvo in a blog post Tuesday afternoon explained the new regulatory framework would move away from measuring clicks to focusing on care.

[Also: Meaningful use will likely end in 2016, CMS chief Andy Slavitt says]

Two big changes have helped cause this shift from measuring technology adoption levels to looking for quality outcomes, they wrote.

First was HHS' ambitious goal, announced about a year ago, that 30 percent of Medicare payments be linked to value-based care in 2016, and 50 percent by 2018.

The second was the passage of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, which holds quality, cost and clinical practice improvements as key factors in determining how Medicare physician payments are doled out.

"While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments," Slavitt and DeSalvo wrote, "it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next."

CMS has been "working side by side with physician and consumer communities and have listened to their needs and concerns," according to CMS and ONC.

[Also: CIOs celebrate end to meaningful use]

Further details for the proposed rules, along with a public comment period, will be forthcoming "this spring." In the meantime, Slavitt and DeSalvo promised a new set of priorities that reward providers for the outcomes they're able to achieve for their patients with the help of technology.

This means they'll be "allowing providers the flexibility to customize health IT to their individual practice needs," they wrote. "Technology must be user-centered and support physicians."

They also pledge to help level the playing field to spur innovation, "including for start-ups and new entrants," by focusing on the open APIs so common in consumer technology. "This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care," according to Slavitt and DeSalvo.

And interoperability will continue to be a priority for both agencies, which will continue to drive national interoperability standards that are based in "real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care."

Slavitt and DeSalvo can be expected to offer more details on these coming changes at HIMSS16 in Las Vegas, Feb 29-March 4. In the meantime, they said physicians and hospitals alike should keep some important things in mind as staged meaningful use is phased out and this new MACRA-based program comes into focus.

First, existing law "requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system."

Second, MACRA "only addresses Medicare physician and clinician payment adjustments." Hospitals have a different set of statutory requirements. "We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program."

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Third, the changes to meaningful use under MACRA "won’t happen overnight," they write. "Our goal in communicating our principles now is to give everyone time to plan for what's next and to continue to give us input. We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect."

Fourth, they point to recent legislation that streamlines CMS' process for granting meaningful use hardship exceptions. "This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon."

In closing, Slavitt and DeSalvo said that "moving from principles to reality" can be challenging.  But ultimately, they write, "we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients. We look forward to working collaboratively with stakeholders on advancing this change in the months ahead."

Twitter: @MikeMiliardHITN