Guest post by Emily Tyson, director of emerging markets, Curaspan.
On the cusp of many important changes currently impacting major healthcare policies, Andy Slavitt, acting administrator at the Centers for Medicare & Medicaid Services (CMS), made a striking statement to the audience at the J.P. Morgan Health Care Conference earlier this year: “The meaningful use program as it has existed will now be effectively over and replaced with something better.” This remark created a stir within the healthcare community, which has long lamented the burdensome documentation and lackluster results most often associated with the Meaningful Use (MU) program, and left many providers and healthcare organizations wondering what that really meant for the future of reimbursement, along with healthcare technology and EHR regulation.
What do we know today?
Slavitt’s comments reference a transition – not a replacement – to a new payment program. The government is making a concerted effort to lessen the burden associated with its programs and push the industry toward value-based care. Last year Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA). The Act made three notable, high impact changes to Medicare reimbursement:
- It ended the Sustainable Growth Rate (SGR) formula for physician reimbursement;
- It created a new framework to compensate healthcare providers for better, higher quality care (rather than higher volumes of services); and
- It streamlined the process by combining existing quality reporting programs into one new system.
With the recent release of the proposed MACRA ruling, the Act and associated rules may take effect on January 1, 2017 and will offer healthcare providers two options for participating in quality programs: (1) Fee-for-service (FFS) combined with greater incentives through a new Merit-Based Incentive Payment System (MIPS), or (2) Alternative Payment Models (APMs). The current payment adjustments associated with the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBPM), and MU will be phased out and replaced with a consolidated approach. MIPS will provide payment adjustments based on four weighted performance categories: Quality (30 percent), Resource Use (30 percent), Meaningful Use of Certified EHR Technology (25 percent), and Clinical Practice Improvement Activities (15 percent). APMs include reimbursement models, such as ACOs, patient centered medical homes, and bundled payments.
What does this really mean for the future of MU?
MU is still in effect under the current law and requirements for 2016 are not changing, though the longer term future remains somewhat unclear. It’s important to note the current changes outlined above apply only to Medicare reimbursement for physicians. Hospitals and health systems should begin evaluating existing financial relationships with physicians and assess their ability to respond to the impending changes. At the same time, hospitals should continue to prepare for the requirements of Meaningful Use 3. While CMS hopes for similarly streamlined and updated legislation for hospitals, it has not yet been proposed. Regardless, we expect any new legislation likely will carry forward many of the existing requirements as CMS continues its drive toward value-based reimbursement, interoperability, and coordinated care.