Meaningful Use Program Officially Shelved
By News Staff
AAFP News, January 14, 2016CMS Acting Administrator Andy Slavitt recently took center stage during the J.P. Morgan 34th Annual Healthcare Conference in San Francisco for what could have been a routine speech about upcoming health care policies aimed at an interested stakeholder audience.
However, a few minutes into his remarks, available in their entirety in a CMS blog (blog.cms.gov) posted on Jan. 12, Slavitt rocked the U.S. health care world with these words:
“We are now in the process of ending meaningful use and moving to a new regime culminating with the MACRA (Medicare Access and CHIP Reauthorization Act) implementation. The meaningful use program, as it has existed, will now be effectively over and replaced with something better.”
Judging from the immediate media interest, Slavitt’s announcement caught many people off guard.
http://www.aafp.org/news/government-medicine/20160114mushelved.html
On January 11, CMS’s acting administrator, Andy Slavitt, stated at a health care “investment symposium” sponsored by J.P. Morgan that the awful “meaningful use” program inflicted on doctors by the High Tech Act of 2009 is “over.” He was quoted in Family Medicine News saying, “The meaningful use program as it has existed will now be effectively over and replaced with something better.”
Slavitt went on to say, “We have to get the hearts and minds of physicians back. I think we have lost them.”
I give Slavitt, a former employee of UnitedHealth Group, credit for having the courage to state clearly that “meaningful use” has infuriated doctors. Better late than never.
But Slavitt has put himself in a box. He has admitted that Obama’s and Congress’s decision to force doctors to use the clumsy electronic health records (EHRs) sold by the American computer industry was bad policy, but he has no idea how to fix that problem. All he can do is talk like Donald Trump – he’ll come up with “something better.”
It sounds like Slavitt wasn’t prepared for the publicity his remark generated. The next day, January 12, he and Karen DeSalvo posted a comment on both the CMS blog and The Health Care Blog seeking to temper expectations among doctors that their days of torment will soon be over. Slavitt and DeSalvo claimed that the 2015 Medicare Access and Chip Reauthorization Act (MACRA) (the bill that repealed the Sustainable Growth Rate formula), authorized CMS to improve upon the “meaningful use” law and they intended to do that. I quote:
While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next.
That sentence is a severe test of your ability to decipher gibberish. What does “the reality of where we want to go next” mean? That’s a rhetorical question. Please don’t try to answer it. To paraphrase Humpty Dumpty’s explanation to Alice, it means whatever CMS says it means.
I’m quite sure the reason Slavitt and DeSalvo selected such patently obvious weasel words is that they don’t have any idea how they’re going to “get back the hearts and minds of physicians.”
Slavitt’s problem is that he isn’t free to concoct his own solution. He has to enforce one of the craziest laws ever passed – MACRA. MACRA takes the “meaningful use” and “pay-for-checked-boxes” craze to new heights. MACRA is to “meaningful use” as Ebola is to the flu. MACRA forces doctors who treat Medicare patients to choose between two byzantine payment systems – the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs) system. Both systems are insanely complex (see my description of the MIPS system here). Either system alone would infuriate doctors and frustrate CMS administrators. The two programs together will drive everyone around the bend.
If you read the Slavitt-DeSalvo essay on The Health Care Blog, be sure to read the comments by Dr. Maralit Gur-Arie. She posts frequently on that blog and others about health information technology. At the end of one of her comments she asks, “Just out of sheer curiosity, and I most certainly don’t expect answers, is there anybody up there [at CMS] who considered even for one fleeting moment that maybe, just maybe, we should gather some hard evidence to guide our next steps, if any?”
This is the MOST fundamental question one can ask of those who peddle the EHR and pay-for-performance fads. Can you provide evidence for your claim that these fads are worth their costs in money, damage to physician morale, damage to quality of care, and damage to patient privacy?
Kip Sullivan, J.D., is a member of the board of Minnesota Physicians for a National Health Program. His articles have appeared in The New York Times, The Nation, The New England Journal of Medicine, Health Affairs, the Journal of Health Politics, Policy and Law, and the Los Angeles Times.