Reflections on the meaningful use program’s end and its replacement

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On Jan. 11, the first day of J.P. Morgan's 34th Annual Healthcare Conference in San Francisco, Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt said, "The Meaningful Use program as it has existed will now be effectively over and replaced with something better."

Crediting recent constructive dialog with physician organizations, notably the American Medical Association, he provided four indications as to the "something better" that will come from CMS in the next few months.

First and foremost, CMS will shift what it rewards away from using technology and toward patient outcomes. Second, physicians will be able to customize their goals, which will require healthcare IT companies to cater to physicians' individual practice needs. Third, CMS will require open application programming interfaces to make it easier for start-ups and new entrants with applications, analytic tools and connected technologies to get data out of EHRs securely. And fourth, CMS will continue its push for true interoperability by not tolerating "data blocking," presumably by certain EHR vendors.

Before considering these changes, it's important to remember that the Meaningful Use program was included in the HITECH Act, part of the American Recovery and Reinvestment Act of 2009. With the aid of hindsight—taking into account the passage of the Patient Protection and Affordable Care Act (ACA) the following year—one could view the Meaningful Use program as part of a grand master plan—a way to fund a foundational IT building block to help providers comply with the numerous healthcare delivery reforms that would subsequently be required by the ACA. In less charitable economic terms, the Meaningful Use program could be described as the federal government's subsidization of a specific category of healthcare IT—a massive, sustained transfer of wealth from taxpayers to EHR vendors.

Where did the Meaningful Use program go wrong or at least fall short? At its beginning, providers were exhorted to meet the requirements not just for the money, but to actually improve the healthcare system and the health of Americans. But with great amounts of money at stake—at least $20 billion in Medicare incentive payments to providers—it became more and more about the money. Achieving Meaningful Use became a game, and checking the boxes to earn the financial incentives became paramount.

Physician organizations exerted lots of effort contending for reduced objectives, modification or elimination of certain measures, and delays in reporting deadlines as well as Stage 3 in total. Concerns about EHR usability were also raised. Often lost in the tussle were the true end goals of improved performance and health outcomes. A cursory review of the 2015 headlines regarding Meaningful Use Stages 2 and 3 paints a picture of rancor, so one did not need a crystal ball to foresee diminishing returns from the program.

Thus, Slavitt's announcement signaling the end of the Meaningful Use program as we know it was not surprising. His indication that CMS plans to reward the end—patient outcomes—rather than one of the means to the end, is a welcome development. In simple terms, the federal government will presumably provide incentives for the "what," not so much the "how," leaving healthcare providers to figure out how to use their training, knowledge and various IT tools—not just EHRs—to improve clinical and financial outcomes.

Ironically, the new direction described by Slavitt mirrored Stage 3's original objectives—to improve performance and health outcomes—so in some sense there could at least be directional consistency between the initial intent of the Meaningful Use program and its forthcoming replacement.

To be fair, in large measure the Meaningful Use program has succeeded in getting significantly more hospitals and physicians to adopt EHRs. In 2014, three out of four (76 percent) hospitals had adopted at least a basic EHR system, up from 59 percent in 2013.1 Also in 2014, 50.5 percent of office-based physicians had adopted at least a basic EHR, up slightly over the previous year.2

If the program replacing Meaningful Use turns out to be as indicated by Slavitt, CMS will extract itself from the center of the debate over EHR usability between healthcare providers and the EHR vendors, but it will need to increasingly play the role of interoperability watchdog. Many healthcare IT and services companies—such as providers of performance management, analytics, and care coordination services—have operated for several years at a disadvantage relative to the federally subsidized EHR vendors. They will benefit from CMS's change in focus from rewarding the end rather than a particular means, and the hope is that patients will benefit the most.

Ken Perez, vice president of healthcare policy for Omnicell, Inc., writes and speaks on health reform-related topics for a number of publications, websites, and organizations.

References

1. Office of the National Coordinator for Health Information Technology, "Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2014," ONC Data Brief No. 23, April 2015.

2. Jamoom, E., Yang, N., and Hing, E., "Percentage of office-based physicians using any electronic health records or electronic medical records, physicians that have a basic system, and physicians that have a certified system, by state: United States, 2014 (table), 2015.

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