Many in the health care field are trying to predict what will come from President Donald Trump's administration, especially his top picks for health care policy — including Tom Price, the new secretary of Health and Human Services (HHS), and Seema Verma, the new administrator of the Centers for Medicare and Medicaid Services (CMS). For those with high interest in what will happen with health IT-related federal policy, one of the burning questions has been: What will happen with meaningful use (MU)?
Beginning Jan. 1, 2018, all eligible medical professionals and hospitals that are in the EHR Incentive Programs — more commonly known as MU — will be required to meet Stage 3. Stage 3, as well as several other programs within and beyond those administered by CMS, requires adherence to the 2015 edition of the Certified Electronic Health Record Technology (CEHRT).
This combination of new requirements and deadlines, together with a new administration that has been outspoken against some of the requirements, leads to questions on the future and direction of MU.
Let's examine two of the biggest questions that we hear: 1) Do we expect MU to go away? and 2) Do we expect MU to change?
Will meaningful use be overturned?
For the first question, the answer is fairly straightforward. No, we don't expect the MU program to go away with just a change in administration. The MU program is rooted in the Health Information Technology for Economic and Clinical Health (HITECH) Act that was part of the American Recovery and Reinvestment Act (ARRA) enacted in February 2009. The HITECH Act gave CMS authority to create a program to evaluate the meaningful use of CEHRT, which led to the MU program. So, in short, MU cannot be ended without another act of Congress.
Will meaningful use change?
The answer here is a little more nuanced. The simple answer is yes. Just looking at the history of MU will tell you that it is likely to change. Since the original MU rules were released in July 2011, CMS has released four final rules that altered the MU program (the Stage 2 final rule, the Modifications to 2014 MU final rule, the Modified Stage 2/Stage 3 final rule and the Outpatient Prospective Payment System (OPPS) for 2017 final rule), and one rule that removes certain providers from the MU program (the Quality Payment Program (QPP) final rule).
These five final rules were issued under one president, two HHS secretaries and three CMS administrators. Based on the history, it appears fairly safe to say we will see changes in the MU program. This answer becomes more difficult when you attempt to determine what those changes might be.
Indicators of change: A timeline of MU discussion and sentiment
As we prepare ourselves for changes to MU, there are a few pieces of recent history to take into account.
In the summer of 2015, several U.S. senators introduced the EHR Regulatory Relief Act, which would have provided a permanent 90-day MU reporting period and relaxed the all-or-nothing approach by which MU is known. The American Medical Association (AMA) supported this bill and stated there is "growing recognition that the meaningful use program needs adjustments to achieve its goals."
In October 2015, CMS released the Modified Stage 2/Stage 3 final rule in conjunction with ONC's release of the 2015 edition Certified Health IT (CHIT) Certification Criteria final rule.
In the spring of 2016, Rep. Tom Price, now HHS Secretary Price, introduced the Flexibility in EHR Reporting Act, which would have limited the 2016 reporting period to 90 days for MU. As a U.S. representative, Price was a staunch supporter of a 90-day reporting period and a lessening of documentation requirements for eligible providers.
In November 2016, CMS finalized a 90-day reporting period for MU in 2016 and 2017, along with lower measure thresholds for several of the more difficult MU objective measures.
CMS also released the Quality Payment Program final rule under the Medicare and CHIP Reauthorization Act (MACRA) of 2015 in November 2016, revamping eligible provider and clinician use of health IT as part of the overhaul of physician payment under Medicare.
By the end of November 2016, the American Hospital Association (AHA) had sent a letter to then President-elect Trump requesting, among other things, a cancellation of Stage 3 of the MU program.
In February, Senate confirmation hearings for Price focused on the importance of health IT as well as interoperability, during which Price signaled an intent to reduce the regulatory burden of MU on providers. During Verma's Senate hearings, she also stated that MU holds promise, but is not off to a great start.
The future of meaningful use
We've established that MU will likely change under the new administration. What we don't know is when and how it will change. There does not appear to be any plans in Congress to end the MU program, and Secretary Price does not appear to want to end it, either.
What we are largely seeing is a desire to remake the MU program. Many lawmakers and health care industry leaders believe the requirements are too burdensome, but nearly as many do not believe the program has achieved the interoperability and patient access goals that it was intended to, given the money already spent on incentive payments.
While CMS does not have the authority to end the MU program or its penalties, CMS does have the authority to measure the program differently than it has to this point. The HITECH Act does not outline what is required to be measured, only that the HHS secretary — through CMS — can outline what must be demonstrated to be a meaningful user. To this extent, the HHS secretary and CMS administrator have quite a bit of leeway to change MU, though there must still be a connection to CEHRT and to clinical quality measures.
Over the next year, we will likely see many changes as the new administration attempts to make its mark. Of the MU changes we may see, the most likely is a shortening of the 2018 reporting period to 90 days.
We may see other changes to the MU program, though we are not likely to see a removal of the 2015 CEHRT requirements. Those requirements contain API and interoperability updates that many see as a required next step toward providing access to health information. Many of these requirements are echoed in the 21st Century Cures Act, which contains numerous interoperability and information blocking requirements for both health IT developers and providers.
So, while we may see some movement in the timeline for Stage 3 or the measures themselves, we should fully expect to see a continued focus on patient access and interoperability measures. The 2015 CEHRT version has also become more than MU. Its use bears requirements in QPP, Comprehensive Primary Care Plus (CPC+), Comprehensive Care for Joint Replacement (CJR), Episode Payment Models (EPMs), Accountable Care Organizations (ACOs) and the Oncology Care Model. In that vein, we continue to recommend movement to the 2015 CEHRT edition, but keep out a watchful eye for changes to the MU program.
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