Moving Forward with Meaningful Use Stage 3 and MACRA

A little over a month ago, CMS Acting Administrator Andy Slavitt delivered some unexpected news.   

Now that we effectively have technology into virtually every place care is provided, we are now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation. 

The Meaningful Use program as it has existed, will now be effectively over and replaced with something better. Since late last year we have been working side by side with physician organizations across many communities — including with great advocacy from the AMA — and have listened to the needs and concerns of many. We will be putting out the details on this next stage over the next few months, but I will give you a themes guiding our implementation.

Andy Slavitt, JP Morgan Annual Health Care Conference, January 11, 2016 (emphasis my own).

The comments left many wondering if they heard him correctly.  After all, the final Stage 2 modification and Stage 3 rule (the “MU Stage 3 Rule”) was just published in October this past year despite criticism and calls from health care providers and other stakeholders to delay Stage 3. Furthermore, the statutory basis of the program would hinder a compelte death toll for Meaningful Use. Others took to their Twitter feeds and blog posts proclaiming MU effectively “dead” as a result of Mr. Slavitt’s comments.

There was more to come from CMS.  Mr. Slavitt, along with Karen DeSalvo, Acting Assistant Secretary for HHS, released a follow up “sorry, not sorry” blog post clarifying next steps for Meaningful Use and stating the following:    

  1. The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system. But we will continue to listen and learn and make improvements based on what happens on the front line.
  2. The MACRA legislation only addresses Medicare physician and clinician payment adjustments. The EHR incentive programs for Medicaid and Medicare hospitals have a different set of statutory requirements. We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program.
  3. The approach to meaningful use under MACRA 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.

To give some background, the Medicare Access and CHIP Reauthorization Act (“MACRA”) was signed into law in early 2015.  Several provisions relate to improvement of health care delivery, including a Merit-based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”).  CMS released a request for information regarding implementation of many of these provisions shortly before news of the MU Stage 3 Rule broke, and detailed MACRA regulations are expected later this year.  A key component of MACRA is meaningful use of CEHRT (i.e., demonstration of the requirements of Meaningful Use). Up to 25% of an EP’s score under the MIPS is tied to successful demonstration of Meaningful Use. 

MACRA did not (and CMS and HHS cannot through rulemaking) repeal the current statutory framework of Meaningful Use.  Furthermore, MACRA only applies to clinicians, leaving hospitals and CAHs out in the cold for now.  Any real change to Meaningful Use would require substantial changes at the statutory and/or regulatory level. 

The Meaningful Use Program has seen its share of changes over the years, as CMS responded to pressure and concerns from various stakeholders (albeit dragging its feet the entire way). This would appear to be just another evolution for Meaningful Use through MACRA, and not a complete end to or replacement of Meaningful Use. Whatever Meaningful Use will look like in the coming months, it is apparent that the focus will turn more to quality outcomes for patients, as opposed to mere use of health technology. Given that the current Stage 3 regulations seek to align reporting between eligible providers and hospitals/CAHs, we can expect to see changes to Meaningful Use not only for clinicians as a result of the MACRA regulations, but also for hospitals. 

We could potentially see the MACRA regulations at the end of March, as has been hinted, or over the summer.  Providers will have to wait until then with bated breath to see what direction CMS and HHS will take moving forward with Meaningful Use.