The new MU: What's next for providers and EHRs

Many stakeholders in the healthcare IT industry applaud CMS Acting Administrator Andy Slavitt's announcement earlier this week about the end of the meaningful use program. While Mr. Slavitt said the meaningful use program "as it has existed" will be no more, providers and hospitals will still be held accountable for use of technology in patient care.

The end of meaningful use as we know it means there are no more incentives from Medicare. (Note: There are still a few incentives left on the Medicaid side.) So, an eligible provider who fails to attest to meaningful use will still face a penalty, but that's it.

Although, the recently passed blanket hardship exemption permitting any meaningful use participant to apply for an exemption from meaningful use penalties in 2017 may bring the reimbursement penalties that year close to zero.

Changes to the meaningful use program hinge on the Medicare Access and CHIP Reauthorization Act of 2015, which has two components: the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Dan Golder, DDS, principal at Impact Advisors, says MIPS is essentially a harmonization of existing CMS quality programs, including meaningful use, the Physician Quality Reporting System and Value-Based Payment Modifiers.

MIPS is now comprised of four sections: EHR use, quality, resource use and clinical improvement. Each of these sections are given different weights to create a composite MIPS score. Clinical improvement is 15 percent, quality and resource use each are 30 percent and EHR use is 25 percent.

"That EHR use piece is really meaningful use," says Dan Golder, DDS, principal at Impact Advisors. As just a quarter of the total MIPS score, EHR use becomes less of a threat to providers' reimbursement. Dr. Golder also notes the $500 million annual bonus pool CMS has set aside "for providers in MIPS who achieved exceptional performance," in the words of CMS.

"If you do really good on the MIPS score, you get a little bit of carrot. If you do really bad on the MIPS score, you might get a stick," Dr. Golder says.

What's more, the weight given to each of the sections of the MIPS score can change. Dr. Golder says if a high number of providers perform well on the EHR component, CMS can change the weight of the score, possibly lowering it to increase the weight of another element and focus improvement elsewhere.

Meaningful use has been divisive, drawing ire from many providers. (Here are 25 quotes illustrating the frustration among physicians.) But Dr. Golder says meaningful use certainly had its positives. And, he is optimistic about the proposed changes and the future of EHRs' role in improving the healthcare system.

"I do think there has been more EHRs implemented and adopted with meaningful use than there would have been without," Dr. Golder says. "Meaningful use was probably a good thing. It's through a certain phase now. We're reaching the end of the incentives and we're now evolving to the next step."

"It would be great if the MIPS composite score really does help us improve care, lower cost and increase adoption and interoperability and all the things we really want as part of our healthcare system," he says.

More articles on health IT:

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Is interoperability getting better or worse? 6 key thoughts

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