Rumors of meaningful use’s demise have been greatly exaggerated

Change is on the horizon for the much-maligned meaningful use program after recent public comments, yet AOA tempers those remarks indicate a coming overhaul in line with AOA-backed provisions.

The Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt generated a stir with comments he made at a health care conference on Jan. 11, stating, "The meaningful use program, as it has existed, will now be effectively over and replaced with something better."

Many have construed Slavitt's comments as affirmation that the meaningful use program will end in 2016, especially in light of the fact that CMS has asked for input from stakeholders about the program. Yet, Slavitt's comments more alluded to the program's evolution in the months ahead.

"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," Slavitt remarked.

Speaking of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that effectively repealed Medicare's sustainable growth rate (SGR) formula last year, Slavitt was pointing toward changes brought about by MACRA's Merit-based Incentive Payment System (MIPS) that consolidates elements of the meaningful use program, Value-Based Modifier and the Physician Quality Reporting System. That move to MIPS is slated to begin in 2019, but meaningful use isn't going anywhere just yet. And, as MACRA made its way through Congress, the AOA successfully fought to ensure that the new MIPS program fully recognizes doctors of optometry as physicians.

The 2009 American Recovery and Reinvestment Act requires the meaningful use program and it would take Congressional action to eliminate the program altogether, says the AOA Advocacy Group. Accordingly, meaningful use will change when it is incorporated into MIPS, as MACRA intends the system to determine whether an eligible professional is a "meaningful EHR user." While doctors might notice more flexibility, they will still be expected to show positive patient care results from using EHRs.

Furthermore, just this past December, at the request of AOA and other physician organizations, Congress formally granted CMS the authority to exempt many more physicians from the program. While AOA and its members still anxiously await the details from CMS regarding how changes to the exemption process will affect physicians, EHR use will continue.

AOA advocates for improved meaningful use requirements

Bolstered by member feedback, AOA continues to fight for common sense and reasonable changes that would allow doctors of optometry to use EHRs in practical ways that would benefit their patients.

This past year, AOA penned two letters to Slavitt that reflected such concerns and cited how various regulatory requirements of the EHR Incentive Program have distracted from the true goal of improving patient care.

"Given the serious problems encountered by physicians related to certification and Stage 2 implementation in 2014, program changes are critically needed in 2015 and going forward. The AOA has long warned CMS that the meaningful use standards were ill-advised, placing far too many demands on doctors and software developers," AOA's June 15, 2015, letter stated.

AOA's comments to CMS resounded the need to reduce the burden of meaningful use requirements on doctors, be it through longer reporting periods, increased flexibility, expanded exemptions and common-sense modifications to specific measures.

"CMS absolutely should go back to the drawing board," AOA President Steven A. Loomis, O.D., says. "Doctors should be able to use EHRs to improve patient care in their practice, but not be forced to use a bunch of features that don't work well together."

Aside from Slavitt's comments regarding meaningful use's progression, he also noted several broad and overarching themes that will guide implementation in the foreseeable future, including:

• Shifting emphasis toward patient outcomes, as opposed to rewarding providers for using technology.
• Provider-derived goals for technology, as opposed to government objectives, so technology is more user-centric.
• Leveling the technology playing field for start-up companies to allow new tools and technologies to access EHR data securely.
• Expanded interoperability to close referral loops and actively engage patients.

Read more information about the EHR Incentive Program from CMS.