o most hospitals and physicians, the Centers for Medicare and Medicaid Services’ (CMS) Meaningful Use program has been a disaster.
In the push to improve patient care, Meaningful Use incentivized the use of electronic health records (EHRs) in coordination with MACRA. In 2015, controversy turned to frustration as the program began issuing penalties to those who weren’t keeping up with the program’s stage-based implementation.
This January, facing mounting criticism, CMS’s Acting Administrator Andy Slavitt announced the program would be ending early in the middle of its second stage, adding that a replacement program would take its place.
While the specifics of the new program are still unknown, Slavitt acknowledged the medical community’s frustrations, admitting that the current criteria were divorced from how physicians practice and deliver quality care to their patients.
The core problem of Meaningful Use
The fundamental problem of Meaningful Use is simple: it distracts physicians from providing genuine quality care to their patients.
Changing the healthcare ecosystem requires widespread patient adoption—something federal regulations can’t achieve overnight. Like other ambitious programs, Meaningful Use sought to force change on a system that is naturally slow to evolve.
Facing that realization as the program entered its second stage, the CMS attempted to soften the requirements in its final rule in October of 2015—reducing the reporting period to 90 days and changing patient/family engagement thresholds from 5% of patients to just a single person.
But despite trying to loosen the slack on hospitals and doctors, crossing the finish line of Stage 2 only presented even more controversial requirements in Stage 3, such as:
• Adopting data encryption measures and completing mandatory security assessments;
• Mandating that 60% of electronically prescribe-able medications must be prescribed electronically by eligible professionals and hospitals;
• Five clinical decision support interventions related to four or more clinical quality measures plus support for drug allergy checks;
• Mandating that 60% of labs, radiology and medication orders are done electronically;
• Requiring EPs and hospitals to make sure 10% of patients access their record electronically and that 25% send or receive a secure email;
• Mandating transition of care summaries are sent for 50% of all encounters and incorporated for 40% of patients;
(And perhaps the most controversial:)
• Requiring that 80% of patients are given access to view/download/transmit and API capabilities with 35% of patients receiving tailored educational resources electronically.
This last point exemplifies exactly why so much of the medical community sees the CMS as out of touch with reality. APIs allow third party app developers to integrate patient data into new digital tools for patients, but right now, there are only a handful of applications that actually use APIs and most patients have no idea they exist in the first place.
While it’s clear the CMS wants to shift from online patient portals to apps that pull in data from EHRs, patients still use portals because apps—for the most part—aren’t available yet.
Again, patients change their behavior when it’s easy and convenient to do so, not because federal regulators decide it’s time.
What we know about the replacement program
We don’t know exactly what to expect from the CMS’s new program to implement MACRA, but Slavitt did give us some hints of what it will look like. As he explained in his conference address, the new program will sunset three old programs, “aligning them together in a single new program.” Here’s what we know about it so far:
• “The focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients.”
• “Providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government. Technology must be user-centered and support physicians, not distract them."
• “[The program will level] the technology playing field for start-ups and new entrants. We are requiring open APIs in order to the physician desktop can be opened up and move away from the lock that early EHR decisions placed on physician organizations so that allow apps, analytic tools, and connected technologies to get data in and out of an EHR securely.”
• “[Begin] initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging a patient in their care. And technology companies that look for ways to practice ‘data blocking’ in opposition to new regulations will find that it won’t be tolerated.”
Check back for more information on this new program as it becomes available over the coming months.
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