While CMS’s Acting Administrator Andy Slavitt said earlier this week that the meaningful use program will soon be replaced with something better, health IT leaders seem uncertain on if momentous changes are indeed in store.
Slavitt dropped the news on Monday evening, Jan. 11, at the J.P. Morgan Healthcare Conference in San Francisco, and then reiterated on his Twitter account that the focus will move away from rewarding providers for the use of technology and towards the outcomes they achieve with their patients. He officially announced that changes will be coming in a Jan. 12 blog post on the Centers for Medicare & Medicaid Services’ website. There, Slavitt wrote, “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better. Since late last year we have been working side by side with physician organizations across many communities— including with great advocacy from the AMA—and have listened to the needs and concerns of many.” After having a few days to digest the information, however, health IT leaders do not seem as surprised as one might imagine given the boldness of Slavitt’s statements.
For one, Ferdinand Velasco, M.D., chief health information officer at Arlington-based Texas Health Resources (THR), notes that it’s premature to interpret Slavitt’s comments or tweets without looking at the regulatory process and diving into the details. The legislation part of meaningful use is embedded in the American Recovery and Reinvestment Act of 2009 (ARRA), and is baked into the law, Velasco says, adding that it’s important not to overreact to Slavitt’s remarks. “That puts limits as to what an agency like CMS can do without going back and having Congress change things through legislative action. Even if CMS can make the changes, it has to happen through legislation,” he says.
The fact that CMS does not have the authority to remove meaningful use without an act of legislation is something that cannot be understated, agrees Naomi Levinthal, senior consultant, research and insights at Washington, D.C.-based The Advisory Board Company. “What is misunderstood from what Slavitt said is that meaningful use is ending. It’s not ending,” Levinthal attests. The requirement that CMS evaluates an eligible professional (EP) who is operating under the Merit-based Incentive Payment System (MIPS), within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law earlier this year, is something that is a non-negotiable under the law, she says. “Providers have to be evaluated on whether they are a meaningful EHR [electronic health record] user or not. That construct is already in place,” Levinthal says. “What it takes to evaluate whether a provider has met that is a huge unknown still.”
Levinthal further notes that there is currently nothing up for vote, nothing in committee status, and nothing that’s anywhere near the President’s desk that says meaningful use will be wiped out. “MACRA was a perfect opportunity to wipe this program from the books if that's what they wanted. That law is effective until 2024 and meaningful use is a part of that. People have an interest in keeping it around,” she says.
Beginning in 2019, physicians, depending on how much risk they are taking on, will either participate in the MIPS model or be able to opt for an alternative program involving slightly higher payments in return for participation in certain alternative payment models, or APMs. Within both payment tracks, meaningful use is engraved in some way, shape or form, Levinthal says. “Under MIPS, it’s clear where it says ‘meaningful EHR user’, and for APMs, there are two things that are necessary—one is that a provider has a certain amount of claims in risk-based models, and the other part that there is that a provider is using CEHRT [certified EHR technology]. Those words are in there. CMS doesn’t have the opportunity to say ‘we won’t do it,’ or else they won’t be following what the law says,” Levinthal says.
What’s more, according to Velasco, Slavitt “is not your typical bureaucrat,” in that he came from the private sector. “I wonder if he’s intentionally being disruptive with his comments,” Velasco ponders. “Executives from the private sector will often hint at things vaguely and then get to more explicit announcements later on. He is challenging us, and this makes us want to pay attention to not just meaningful use, but what’s coming down the line. It’s an innovative approach by Slavitt to get our attention,” he says.
Ferdinand Velasco, M.D.
At the end of the day, Velasco agrees with Levinthal in that meaningful use is not going away. “This is not big news; CMS has been foreshadowing it for some time as part of the SGR [Sustainable Growth Rate] reform and passage of MACRA,” he says. “They want the healthcare industry to move towards alternative payment models. Part of that will be how we leverage technology to deliver value for our patients. Meaningful use will be part of this ongoing reform.”