The Meaningful Use (MU) program: is it bad in practice?
The Meaningful Use (MU) program may be on it’s way out. On January 11, 2016 Andy Slavitt, the acting administrator for The Centers for Medicare and Medicaid (CMS), stated: “In 2016 MU as it has existed will now be effectively over and replaced with something better.” He announced this at a healthcare conference in San Francisco, continuing: “CMS was in the process of making the much-reviled program more user friendly, with EHR technology built around individual practice needs, not the needs of the government. We have to get the hearts and minds of the physicians back, I think we’ve lost them.”
These statements don’t mean MU will end anytime soon, but it is encouraging that CMS is considering some form of change. The Meaningful Use program was intended to encourage the use of EHRs among physicians by applying bonuses and penalties. This included using technology such as e-prescribing, drug-drug allergy alerts, and promoting online communications with patients. They also implemented EHR charting standards for various illnesses or well visits. It was a good idea in theory, but bad in actual practice. For example, CMS requires all children over age 3 to have a blood pressure recorded in the EHR on routine visits. Not only is there no evidence of the benefits of screening 3 year olds for hypertension, the cost to EHR vendors to change the user interface to accommodate appropriate charting and the time for medical staff to perform the test were clearly not taken into consideration. Many charting items for meaningful use have turned out to be “clinically insignificant and time consuming”, according to statements released by the American Medical Association (AMA). According to Slavitt, regarding advice from the AMA and other clinical consultants, CMS was drafting meaningful use reforms that it would disclose over the next several months. Focusing on moving away from rewarding physicians for using EHRs to rewarding them for patient outcomes.
Discontinuing the Meaningful Use program will not be as easy as it sounds. Current legislation calls for a shift in Medicare payments from fee-for-service to pay-for-performance by 2019. A physician will then have to decide to be paid by the Alternative Payment Model (APM), which is for practices participating in Patient-Centered Medical Homes (PCMH), Accountable Care Organizations (ACOs), Medicare Savings Programs, or the Merit Based Incentive Payment System (MIPS). MIPS incorporates EHR Meaningful Use stage 2 (future stage 3), the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier.
The details of the two payment methods from CMS continue to be vague. Under the current CMS plan, the pay-for-performance method looks back in the EHR at the previous 2 years of record keeping. Many final changes for proper reporting were not released until October 2015 thus EHR vendors were not ready with functionality for the new reporting requirements leaving many physicians incapable of reporting PQRS and MU measures for that year. Congress stepped in and passed legislation that enabled physicians to file payment penalty exemptions for reporting year 2015. Physicians have until March 15, 2016 to file for exemption.
However, this did not prevent CMS from fining over 200,000 physicians in 2015 for non-adherence to Meaningful Use reporting standards. In a report just released by CMS, about 209,000 of them will lose up to 2% of their Medicare reimbursement for failing to show meaningful use by their EHR. These penalties are for the year 2014 and are thus not subject to the new legislative exemption passed for the 2015 reporting year. CMS plans to release more information about MU reformation in the spring of this year, with final rulings slated for October 2016 or later, thus once again leaving EHR vendors, RCM companies, practice managers, and physicians little hope on how to properly make the forced transition from fee-for-service to value-based reimbursement payments.
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