Meaningful Use 'Bombshell' Leaves Nary a Mark

Andy Slavitt throttles back his forecast for the end of meaningful use as we know it, disappointing many, and proving that government reform is coming… but at its own excruciating pace.

What are we to make of CMS Acting Administrator Andy Slavitt's pronouncement last week that meaningful use is "effectively over" and that it "will be replaced with something better"?

As of this morning, my take on things is that Slavitt said disappointingly little that was truly new, and various journalists, myself included, jumped to conclusions when we characterized his remarks as a bombshell.

The evidence for this appeared just this morning, as Slavitt himself, in this blog post with Karen DeSalvo, head of the Office of the National Coordinator, basically throttled back his prediction of the end of meaningful use as we know it in 2016. The highlight:

"The approach to meaningful use under MACRA [the Medicare Access and CHIP Reauthorization Act of 2015] won't happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what's next and to continue to give us input. We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations—including meaningful use Stage 3—are still in effect."

Last week, perhaps expecting this walk-back, a spokesman for the College of Information Management Executives (CHIME) had this to say:

"CHIME members need to be focused on meeting the regulations that are currently on the books. While CHIME is encouraged to hear that CMS may be retooling the program, the current regs are still the current regs."

Indeed, Meaningful Use stage 2 regulations remain in effect, and are likely to remain so for some time to come. Final rules adopted in late 2015 make minor adjustments to the program, but it fundamentally remains in place.

Meaningful Use Program 'Effectively Over,' Says CMS Head

Some Relief
One bright ray of hope did appear at the end of 2015. On a voice vote, Congress passed legislation offering a blanket hardship exemption to providers from 2015's meaningful use penalties for not attesting successfully for meaningful use requirements.

While this one vote does not in itself end all meaningful use penalties, it provides a path to sustained program penalty relief, which allows providers to look forward, beyond the EHR incentive/penalty program aspects of meaningful use.

In that sense, meaningful use as we knew it has already ceased to exist, to providers' great relief.

Meanwhile, meaningful use stage 3 software certification regulations, also adopted at the end of 2015, continue to act as a starting gun for EHR software developers. They must immediately begin to implement a raft of modifications to their software, with the prospect that some customers could ask for this software by next year, in order to capitalize on 2017 being an optional stage 3 implementation year, while all other providers are expected to implement stage 3 certified software in 2018.

Other CMS requirements that affect implementation of EHR software, namely the Value-Based Modifier and PQRS reporting, are moving forward. In general, these requirements are moving, as meaningful use did, from carrots (incentive payments) to sticks (penalties for non-reporting).

I admit to getting swept up by some of last week's temporary euphoria. After all, this was no mere speech.

Private-sector Sensibilities
Slavitt, who was appointed in February 2015 as CMS acting administrator, comes from the private sector, most recently as group executive vice president of United Health Group's Optum unit. He brings more agile private sector sensibilities to a by-the-book regulatory agency, as evidenced by CMS immediately posting the full text of his JP Morgan comments to the CMS blog, and several summary Twitter posts by Slavitt.

This was a full-court press to address criticism of meaningful use in a way his predecessors had not, in a manner that private industry is comfortable doing. And he did it not at HIMSS, not in front of a crowd of physicians or healthcare administrators, but in one of healthcare's most demanding audiences: the bankers who underwrite the industry's debt and issue new stock offerings.

There was no talk of the existing regulations continuing. This was an effort to spin CMS's response to the genuine hatred of the meaningful use program before an influential audience.

It is also worth reflecting that Slavitt did not come alone. Accompanying him was James Madara MD, American Medical Association executive vice president and CEO, at Tuesday's opening JP Morgan conference keynote, "A Discussion with CMS & AMA on the Evolving Healthcare Market."

AMA, CMS Leaders Signal New Era of Cooperation

The AMA has been the most vocal critic of the meaningful use program for the past two years. In Slavitt's words, said while sharing the stage with Madara:

We need to simplify. We have the opportunity to sunset three old programs and align them together in a single new program. That program needs to be streamlined and simple to use so physicians can focus where they need to—on their patients. We are designing from the outside-in. We started by working with front-line physicians, tech companies, and practice managers over a four day session and through an RFI to garner direct feedback on the right measures for each specialty and how to implement the program most simply. Jim and the AMA team were of significant help."

Measurement Continues
In their blog post, Slavitt and DeSalvo note MACRA, passed by Congress, considers quality, cost, and clinical practice improvement activities in calculating how Medicare physician payments are determined.

The post notes that MACRA continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments. We must wait to see just how MACRA's measurement of meaningful use differs from the existing program. The answer to that won't emerge until later this year, when we see the note of proposed rule-making for MACRA.

That just goes to show that not only is hope not a strategy, but neither is reading more into a single speech than is there. Government reform grinds on at much of its customary pace.