Meaningful Use Program 'Effectively Over,' Says CMS Head

MU will be "replaced with something better," says Andy Slavitt. Reaction from healthcare CIOs is largely one of relief.

For the first time, the leader of the Centers for Medicare & Medicaid Services has said publicly that the agency "has the opportunity" to sunset the meaningful use program in 2016.

Andy Slavitt, acting administrator of CMS, made his remarks Tuesday at the J.P. Morgan Healthcare Conference in San Francisco. Slavitt's full remarks were then posted on the CMS blog, and summarized in a series of tweets.

"As any physician will tell you, physician burden and frustration levels are real," Slavitt said. "Programs designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that people who build these programs just don't get it.

"The Meaningful Use program as it has existed, will now be effectively over and replaced with something better."

Slavitt credited feedback and collaboration with front-line physicians and the American Medical Association in moving CMS "from rewarding providers for the use of technology and toward the outcome they achieve with their patients."

Meaningful Use 'Bombshell' Leaves Nary a Mark

One way to aid this, he said, is by leveling the technology playing field for start-ups and new entrants. "We are requiring open APIs in order [that] the physician desktop can be opened up and move away from the lock that early EHR decisions placed on physician organizations. [That will] allow apps, analytic tools, and connected technologies to get data in and out of an EHR securely."

In addition, Slavitt said, "providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government. Technology must be user-centered and support physicians, not distract them."

Slavitt highlighted recently passed bipartisan legislation as being "squarely on our punch list." The Medicare Access and CHIP Reauthorization Act (MACRA) "brings pay-for-value into the mainstream through something called the merit-based incentive program, which compels us to measure physicians on four categories: quality, cost, the use of technology, and practice improvement."

CIO Reaction
Reaction from healthcare CIOs to Slavitt's announcement is largely one of relief.

"I have been an advocate for claiming victory for meaningful use and stopping the program," says Marc Probst, CIO of Intermountain Healthcare. "It doesn't seem to be adding value."

Probst expressed skepticism that CMS can simply halt the meaningful use program. "It's going to be a little more difficult to unravel than just staying we're stopping and moving over to MACRA or whatever."

Another CIO cites a recent precedent for CMS to simply stop enforcing the provisions of such regulations.

"The Sustainable Growth Rate fix has a whole bunch of pages on the fact that you must have radiology decision support systems before you order a complex radiology test," says John Halamka, CIO of Beth Israel Deaconess Medical Center. But "there aren't any products or services in the marketplace to do this yet, so how could it be required? So a few months ago, CMS issued the following statement: 'We will not enforce any of the provisions in the Sustainable Growth Rate fix that require radiology decision support systems.'"

"That isn't to say the meaningful use certification rule [and the] meaningful use attestation rule stay on the books. But if no one enforces them, and no penalties are levied, they could stay on the books for eternity."

Halamka already had no plans to move toward implementing stage 3 of meaningful use within the next six quarters. A bill signed by President Obama late last year provided a path to blanket amnesty for providers from meaningful use stage 2 penalties, and signaled to Halamka "that either legislative or regulatory relief is coming" from the meaningful use program as a whole."

Both Probst and Halamka say Slavitt's remarks further free their health systems to turn to pressing healthcare IT priorities. In Probst's case, it is completing three-fourths of Intermountain's conversion to the Cerner EHR system. Meaningful use is "not our main strategy anymore," he says.

In Halamka's case, priority is given to implementing "numerous innovations" to reduce healthcare cost.

"We're putting bathroom scales and blood pressure cuffs in people's homes connected to iPhones," Halamka says. "We're doing all those things because I have $1.5 billion in risk contracts through the Affordable Care Act and private-payer alternative payment models."

"Certainly Andy suggested that MACRA will provide us with an alternative, to get us back the concept of [a] carrot, if you achieve a remarkable innovation, as opposed to stick if you don't achieve a checklist."

Halamka predicts that CMS's move will free up EHR vendors as well to innovate instead of coding to satisfy regulatory requirements. "It's going to take 150 man-years to achieve full [meaningful use stage 3] certification of everything in the EHR," he says.

"We could either create bold new population health and care management functionality, or spent 150 man-years certifying for meaningful use. I guarantee you, not one customer if the penalty is eliminated will suggest that certification for meaningful use is relevant. So the EHR vendors will go back to what their customers want, as opposed to what the government is mandating."

In a statement released Tuesday, The College of Healthcare Information Management Executives (CHIME) said it is "encouraged that Acting Administrator Slavitt and CMS are open to improving the Meaningful Use program.