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The Conclusion of Meaningful Use?

The industry is abuzz with the news: meaningful use is over. Indeed, Acting Centers for Medicare & Medicaid Services (CMS) Administrator Andy Slavitt made the announcement on January 12 during his presentation at a large industry conference, stating “the Meaningful Use program as it has existed, will now be effectively over and replaced with something better.” But the MU train may not be pulling into the station quite yet.

First and foremost, this announcement has nothing to do with 2015, which is the biggest opportunity for physicians today. Failure to report could mean the loss of thousands of dollars – $8,000, per physician, for most – in bonus payments, as well as the impending 3% penalty. CMS just opened the portal to report; you have until the end of February to input your 2015 data.

Second, CMS followed the January 12 proclamation with a post exactly one week later, revealing that the “it’s over” statement may have been a bit farfetched. Although I’d encourage you to read Slavitt’s January 19 blog post yourself (where he is joined by co-author National Coordinator for HIT, Karen DeSalvo), the CliffsNotes’ version reads like this:  The EHR Incentive Program is in “transition” but changes “won’t happen overnight;”  the law requires “that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments” so the agency can’t just drop it; and, finally, “existing regulations – including meaningful use Stage 3 – are still in effect.”

Third, CMS had already signaled its intention for changes to the program by dramatically relaxing the rules for 2015 last fall. Granted, the proclamation was made very late in the game, but CMS took steps to eliminate approximately half of the objectives, and retains exclusions for many of the remaining objectives, including public health reporting.

Finally, with the President’s signature on the new law – the Patient Access and Medicare Protection Act – CMS is now allowed to exempt basically anyone and everyone from the 2015 reporting year. I would dare say that the federal government would not have permitted this sweeping exemption had there not been an intention to shift the program into a different direction, as compared to its historical roots. Please note, however, that the federal government refused to allow blanket immunity. It is vital for you to submit a hardship application by March 15, 2016; review each exception carefully, noting that 2.2d includes “issues related to insufficient time to make changes to the CEHRT [your EHR system] to meet CMS regulatory requirements for reporting in 2015.” Don’t complete one unless you have to, as you’ll be giving up any bonus payment owed to you. That said, it appears to be an easy route out of the penalties.

That takes care of the here and now, so let’s talk about the future. Despite declaring meaningful use “over,” Slavitt himself refers to the “new regime,” outlining the focus on open APIs, interoperability, and patient outcomes, all of which were emphasized by CMS last fall and reiterated in the January 19 post. From the beginning, the EHR Incentive Program was scheduled to conclude in 2018, so nothing new will be long term. It is my opinion that the last two years of the program will be revamped, given CMS’ announcement, and this will surely parlay into how this topic is handled within the Merit-based Incentive Payment System (the program initiated by the Medicare Access and CHIP Reauthorization Act, passed in April 2015), slated to commence in 2019. Again, however, the actions in the fall of 2015 had already set us on that path.

For the near term, with a few exceptions, the objectives for 2016 are consistent with the relaxed criteria for 2015. Although I’m hesitant to use the term “easy” when referring to meaningful use, these revised criteria are certainly much more achievable than the original Stage Two standards (I mean, really, what was the government thinking making 5% of your patients message you electronically?!?). Recognize that the reporting period for 2016 is the full calendar year, so you should already be plugging away with the relaxed MU standards for this year.

CMS reports that the agency will issue clarifications in the “months ahead.” I, for one, will be anxiously awaiting the details. Ideally, CMS will further relax the program requirements, and continue to refine its focus on improving technology, rather than just measuring data about it. Because the EHR Incentive Program is the law, however, neither Slavitt nor CMS can change everything, including the penalties for failure to participate. They can, however, alter the meaning of meaningful use. There’s no doubt that the steam engine will get dumped in the scrap yard, hopefully replaced with a souped-up bullet train. But, we still need to be ready for the new ride.

Woodcock & Associates: Changing the Way You Work