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Replacing Meaningful Use, Advancing Care Information

Screen Shot 2016-04-27 at 1.46.53 PMSeven years ago, Congress passed a law to spur the country to digitize the health care experience for Americans and connect doctors’ practices and hospitals, thereby modernizing patient care through the Electronic Health Records (EHRs) Incentive Programs, also known as “Meaningful Use.” Before this shift began, many providers did not have the capital to invest in health information technology and patient information was siloed in paper records. Since then, we have made incredible progress, with nearly all hospitals and three-quarters of doctors using EHRs. Through the use of health information technology, we are seeing some of the benefits from early applications like safe and accurate prescriptions sent electronically to pharmacies and lab results available from home. But, as many doctors and patients will tell you (and have told us), we remain a long way from fully realizing the potential of these important tools to improve care and health.

That is why, as we mentioned earlier this year, we have conducted a review of the Meaningful Use Program for Medicare physicians as part of our implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), with the aim of reconsidering the program so we could move closer to achieving the full potential health IT offers.

Over the last several months, we have made an unprecedented commitment to listening to and learning from physicians and patients about their experience with health information technology – both the positive and negative. We spoke with over 6,000 stakeholders across the country, including clinicians and patients, in a variety of local communities. Today, based on that feedback, we are proposing to incorporate the program into the Merit-based Payment System (MIPS) in a way that makes it more patient-centricpractice-driven and focused on connectivity. This new program within MIPS is named Advancing Care Information.

What We’ve Learned

In our extensive sessions and workshops with stakeholders, a near-universal vision of health information technology surfaced: Physicians, patients, and other clinicians collaborating on patient care by sharing and building on relevant information.

Three central priorities to address moving forward:

  1. Improved interoperability and the ability of physicians and patients to easily move and receive information from other physician’s systems;
  2. Increased flexibility in the Meaningful Use program; and
  3. User-friendly technology designed around how a physician works and interacts with patients.

This feedback created a blueprint for how we go forward to replace the Meaningful Use program for Medicare physicians with a more flexible, outcome-oriented and less burdensome proposal.

How We’re Moving Forward

Our goal with Advancing Care Information is to support the vision of a simpler, more connected, less burdensome technology. Compared to the existing Medicare Meaningful Use program for physicians, the new approach increases flexibility, reduces burden, and improves patient outcomes because it would:

  • Allow physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice
  • Simplify the process for achievement and provide multiple paths for success
  • Align with the Office of the National Coordinator for Health Information Technology’s 2015 Edition Health IT Certification Criteria
  • Emphasize interoperability, information exchange, and security measures and require patients to access to their health information through of APIs
  • Simplify reporting by no longer requiring all-or-nothing EHR measurement or quality reporting
  • Reduce reporting to a single public health immunization registry
  • Reduce the number of measures to an all-time low of 11 measures, down from 18 measures, and no longer require reporting on the Clinical Decision Support and the Computerized Provider Order Entry measures
  • Exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group

A full list of the operational differences included in this new proposal is available here, along with more details on how it would work.

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.

Under the new law, Advancing Care Information would affect only Medicare payments to physician offices, not Medicare hospitals or Medicaid programs. We are already meeting with hospitals to discuss potential opportunities to align the programs to best serve clinicians and patients, and will be engaging with Medicaid stakeholders as well.

This proposal, if finalized, would replace the current Meaningful Use program and reporting would begin January 1, 2017, along with the other components of the Quality Payment Program. Over the next 60 days, the proposal will be available for public comment. It is summarized here (link) and the full text is available here (link). We will continually revise and improve the program as we gather feedback from patients and physicians providing and receiving care under the Advancing Care Information category – and the Quality Payment Program as a whole. We look forward to hearing from you and working together to continue making progress in the coming months and years.

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flog1954Rob Lambertsusapromocode1Pesto SauceRasu Shrestha MD MBA Recent comment authors
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flog1954
Member
flog1954

We should start with a national enrollment database that the insurance companies update and use to post emr .. Would help start towards fixing the inconsistent data we see.. Maybe navinet would build and operate

Rob Lamberts
Member

As one who was once an EHR enthusiast and proponent of the HITECH when it first came out, I see the greatest error in this was the obsession with “trees” while ignoring the “forest.” By that I mean that the thing that drove medical records away from utility and toward interfering with care was the fact that the data were more important than the records themselves. I understand that there was fear that a doc might call a word processing program their EMR and so get paid for minimal EHR effort. But this missed the fact that if the physician… Read more »

usapromocode1
Member

Admin, if not okay please remove!

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Pesto Sauce
Member
Pesto Sauce

Advancing Care Information…engaging the patient with EHR…reporting measures…all in between the tearful depressed diabetic with leg ulcers and the rheumatoid arthritic patient with mycoplasma pneumonia…and gee hmm, really difficult to do when my patients can’t get their records to me from other offices “because HIPPA” and we’re all reduced to waiting around the fax. How much brain power and intelligence equity was wasted on Meaningful Use for it now to be flushed down the toilet? But I digress. The real issue is that they’re running out of other people’s money and the pie is getting smaller every year. Health care… Read more »

Steven Findlay
Member
Steven Findlay

Very good dialogue. I certainly hear the frustration and blow back and see that Anish has a new THCB post, The Angry Physician. And I share some of his observations below. I’ve also started reading Dr. Abraham Nussbaum’s book, “The Finest Traditions of My Calling,” which purportedly presents a robust and somewhat unique view from the trenches of medicine. Again, I understand the angst and spoke to it in my recent Health Affairs post. As with so many issues, I think the truth lies in the middle here. Doctors have legitimate gripes about measurement, meaningful use, government missteps, insurance company… Read more »

jamesepurcell
Member

I’m with Steven Findlay below. Andy has a rather tough job, and his willingness to blog here is appreciated. I hope he reads these comments. As with anything disruptive and technology based, initial attempts are pretty Gawd awful. But there is NO question that we must improve our patient-centered technology. Medicine has technology where it assists the care givers in performing care functions but not for communicating, coordinating, or saving waste/error. This is non-negotiable. We just have to do better. I agree with someone below who said offer $1B to whoever can come up with a universally adoptable app that… Read more »

Steven Findlay
Member
Steven Findlay

A lot of angst, frustration, and cynicism in the comments below. As one of the consumer/patient reps on the original HIT Standards Committee, and a close follower of HIT developments for years, I share the frustration. MU was partially bungled, but it’s not communism! Did we waste $30B? Maybe some of it. Was it all “MEANINGFUL?” In the end, I think, yes. It was all just harder than envisioned because it was (a) a new technology, (b) compelling doc en mass to change their behavior, and (c) being integrated into the developed world’s most screwed up health system. I think… Read more »

Hayward Zwerling
Member

Steven
I would be interested to see the publications you mentioned which support the proposition that “patient engagement” results in an improvement in the quality of healthcare. Please email me directly.
Thank you
Hayward Zwerling
HZMD@me.com

Paul @ Pivot ConsultingLLC
Member

Steven Findlay or Hayward Zwerling….please post the citations here too.
I wish Steven Findlay would back up his assertions about research with citations. He has posted re MACRA “The overall intent of the law is sound and its thrust is consistent with an overwhelming body of research and experience”. I just would like to see some of the “overwhelming body”. I think it would contribute to the debate rather than just to make broad statements.

anishkoka
Member

Steve, The angst is driven by something real. I sense you would like to dismiss this is grumbling a of doctors who don’t want to change. The reality is that there is tremendous anger and frustration among any physicians that actually had to implement meaningful use. I was a devotee as well until I realized two years in how ridiculous this was. I always new it as a first draft, and was Willing to go along with the hopes that the leaders I elected were in this to help us to this better. Whether this was the intent or not,… Read more »

Margalit Gur-Arie
Member

MU was not “partially bungled”. It achieved precisely the goals it set out to accomplish: dismantling the “cottage industry” and enriching the sponsors of said legislation. As to the explanations for why it was “harder than envisioned”, and I agree that it was, a) there was nothing new about the technology, b) why on earth would a dozen people in a little room by the Potomac, many representing special interests, be remotely empowered to engage in “compelling doc en mass to change their behavior”???, c) one can rarely fix a “screwed up system” by adding heaps of complexity to what’s… Read more »

Adrian Gropper, MD
Member
Adrian Gropper, MD

Margalit is dead-on. The failure of federal “Certification” of health information technology as a strategy was called out by me the day it was announced as the path to HITECH. To any entrepreneur and anyone who understands open source software communities, it was obvious that open source health IT and innovators would be shut out of a process that is fundamentally incompatible with community-led software development. Six years later, we’re still fighting the same battle and it has a name: Data Blocking. Although the API Task Force is clearly saying that patient-directed access should not disadvantage open source apps, neither… Read more »

LeoHolmMD
Member
LeoHolmMD

Agree with Margalit. My behavior has been changed though: I am consumed, on a daily basis, with mitigating the distraction of poorly functioning technology. I now spend and least twice the amount of time reviewing data, and twice the amount of time entering data. This defeats actual patient care. Other than that, physician behavior has not changed much. Mostly you are seeing work arounds. The fundamentals of how our screwed up health system works have not changed. I would like to move forward, but in order to do that, real change has to happen. The EHR is actually reinforcing many… Read more »

Adrian Gropper, MD
Member
Adrian Gropper, MD

Advancing Care Information is another vague term as much as the “pledge” to not block data is un-enforceable. As long as HIPAA and the regulations prevent the patient from exercising: – an absolute right to transparency of how data is shared (no more HIPAA TPO exclusions), and – a right to direct our own data to any third party without delay under a digitally signed release of information, data blocking will continue because it provides significant benefits to the incumbent institutions and EHR vendors that HITECH created. The main vehicle for this benefit is the ability of these institutions and… Read more »

Margalit Gur-Arie
Member

Oh, just forget all the pesky details guys. Here is what “you need to know” about MACRA: https://www.youtube.com/watch?v=7df7cHghaS4&feature=youtu.be
(rainbows and unicorns available separately)

Perry
Member
Perry

Blah Blah Blah. BMI-check. Smoker-check. Recent fall?-check. Afraid in home?-check.
Yeah this will fix it.

Hayward Zwerling
Member

I believe the decision to continue the mandate that physicians must use Certfied EHR is unfortunate as this will hinder innovative HIT solution by guaranteeing the longevity and power of the large Certified EHR vendors.

Every rational person believes we need to reduce the cost of healthcare and improve the quality of healthcare. I think a more enlightened solution would have been for CMS to focus its rule-making authority precisely on that target rather then prescribing what solutions CMS believes should be implemented to achieve that target.

Hayward Zwerling
Member

Let me be a bit more precise. There is little/no data to support the conclusion that allowing patients access to their healthcare data, promoting patient engagement or facilitating the development of health information exchanges will definitively reduce the cost of healthcare or improve the quality of healthcare. While these are all admirable goals, achieving them will not guarantee better/less expensive health care. And it is not inconceivable that these processes may ultimately turn out to be a distraction from achieving the desired goal. Only time will tell. We all want the same thing, better quality and less expensive healthcare. Until… Read more »

LeoHolmMD
Member
LeoHolmMD

You understand, that thanks to CMS, communication amongst providers is at the lowest point I have seen in a 23 year span of history. Notes, discharge summaries, home health communication, care plans: all about 99% useless garbage thanks to central planning. Carrier pigeon is more functional than the EMR in sending and receiving meaningful information amongst providers. The medical record is practically an unusable wasteland. Much of this is caused by deep dedication to our broken billing and coding system that MACRA was supposed to address. Turns out “value” simply gets overlaid on volume, which will produce the worst of… Read more »

William Palmer MD
Member
William Palmer MD

Annals of Praise and Accountability, Vol 2:

Yes, and people who pushed this should be tracked down and have their pensions reduced to the FPL upon retiring.

Perry
Member
Perry

Hmm, the AAFP seems encouraged by these developments, their constituency however, does not.

By the way, this is what practitioners are saying about these new programs:
http://www.medscape.com/viewarticle/862566

Paul @ Pivot ConsultingLLC
Member

I see an opportunity for a politician and perhaps a party to run (with a populist tone) on repealing the mandates, penalties, subsidies for EHR…..highlighting the wasted sunk cost in clunky systems that expose patient data to disclosure/hacking….and interfere with physician’s interaction with patients and reduce productivity. Then let hospital systems decide what to do with their EHR systems based on whether they really add value….and IT companies would focus on getting them to really work…..then someday a company might come up with the iphone of EHR’s….ie an EHR that is so wonderful that patients demand them and hospital systems… Read more »