Physicians who have moaned about the government not taking their frustrations with technology seriously should feel some satisfaction after Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt acknowledged at HIMSS16 that it's time to make IT work better for doctors.
Slavitt echoed these sentiments during a small briefing with health IT reporters on the afternoon of March 1 in the Sands Expo Convention Center in Las Vegas, and then again in a joint keynote session later that evening with Karen DeSalvo, M.D., National Coordinator for Health IT, in a packed Rock of Ages Theater room. In the later session, Slavitt's speech was brutally honest as he admitted that while progress has been made in health IT, still too often technology hurts doctors rather than do as intended, which is to help them. Slavitt even joked that he and DeSalvo exchanged speeches before the HIMSS16 conference, and the National Coordinator thought that the CMS Administrator's speech was too negative. "I'm not bashful about where we need to be better and take our game up," Slavitt boldly said. "We need a user-centered approach to designing policy. The consumer is more mobile, more demanding than ever before," he said.
Slavitt went on to say that he has collected feedback from providers on the frontline, and as a result, launched a four-day session with physicians and technology companies about IT challenges. "The bulk of our work has been with physicians. There have been eight focus groups with more coming. I have been on the road having physicians taking me through their offices and telling me what can be better," he said, giving examples of what doctors were specifically telling him. One primary care physician from Atlanta, for instance, said that meaningful use puts too much of a burden on his practice and it has taken away from being able to care for patients. Another doctor noted to Slavitt that his organization's technology doesn't talk to other technology systems; in fact, it does the opposite.
"I [gather] our worst critics and bring them into our meetings," he said. "You can learn from your critics. Our job at CMS is to take big policy ideas and bring them to the doctor's office. The good news is that they aren't describing problems that we don't know how to solve," Slavitt said.
As such, three conclusions have emerged from these discussions, Slavitt said: physicians are hampered and frustrated by the lack of interoperability; regulations in their current form slow physicians down as they create a documentation burden; and they find electronic health record (EHR) technology cumbersome, as it slows them down. "Job one is to bridge the gulf between our policy work and what's actually happening in patient care," Slavitt said. He added, "We need to stop measuring clicks and focus on allowing technology to become a tool," additionally noting that doctors don't understand why they have to click eight buttons to buy an aspirin. He said that CMS favors a pull versus a push approach to incentives. "[You want to] allow outcomes, not activities, drive the agenda," Slavitt said. He continued, "What you want to do in a perfect world is allow incentives to customize around the practice goals. I have never met a doctor, nor do I want to, whose practice is driven by some incentive. It's about doing what they think is right for their patient."
Indeed, Slavitt said that the hope is that the upcoming Medicare Access and CHIP Reauthorization Act (MACRA) "will be a cultural way for how we do things long after I leave. This is legislation intended to bring value-based care to physician practices every day." In the smaller briefing with reporters earlier in the day, Slavitt said, "The way we have been spending our time, we have almost written a new playbook as we move towards MACRA. We are thinking and designing from the outside in."
In the afternoon briefing he continued, "MACRA is not a one-time shop. What we have to do is get on a path where physicians feel like those rules are starting to support them." He admitted that people don't like to be measured on anything in the first place. "I don't have illusions that doctors will enjoy being measured by MACRA," he said. "Whatever we do [with MACRA] will be open for comment, and we will make adjustments, technology will be built, and hopefully the world will be somewhat better. There will be complaints, and we will keep adding. We have to understand their needs, keep asking, and keep improving," he said, noting that CMS is still a few months away from having details on the proposed MACRA rule.
When asked about the tight window for MACRA to be put in place—2017 is the first year that the feds will measure physicians under the new legislation—Slavitt said, "We are trying to make it better, not worse. Some of these things have a lag time, and it is a journey. My hope is to create a better world and reduce more burden." When further asked by a reporter if CMS would consider delaying the start of the legislation by six months or a year, Slavitt would not comment.
Slavitt also touched on HHS' announcement earlier this week at HIMSS16 that leading vendors and health systems would collaborate in a commitment to share data, give consumer access to data, use agreed-upon interoperability standards, and not block the flow of information. The commitment has the potential to take healthcare on a new course, but there has to be substance and accountability associated with the pledge beyond what any regulation would be able to do, Slavitt said. "There are too many ways to step in the way of true interoperability, from legal clauses to commercial impediments to intellectual property, and no regulation can cover it all," he said. "The companies who live up their commitments will be recognized and applauded. I encourage to call out those who don't."