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Last month, Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services (CMS), spoke at a major health care conference. You can find the text of his speech here. His remarks touched on many different subjects, which included Meaningful Use. The MU program is very controversial because many health care providers feel that portions of MU are a waste of time, difficult to achieve, as the requirements are nebulous, and don’t do anything to improve healthcare. The twitter-verse went crazy when Administrator Slavitt made the following comment: “The Meaningful Use program as it has existed, will now be effectively over”. This isn’t true, and most people know that you cannot rely on Twitter for your news.
Meaningful Use, and especially the concept of using EHRs in the documentation and provision of care, is not going to change. MU was intentionally designed to have a limited shelf-life. The legislation which established MU was passed in 2009 as part of the American Recovery and Reinvestment Act – of which the MU program itself was implemented in 2011. For many, if not most health care providers, MU incentive payments have already been received. A phase out of MU has already been contemplated and its replacement is called MIPS – which we will address later.
Like many issues in Washington, Meaningful Use was tossed back and forth this past year. Many lobbying organizations put tremendous pressure on Congress to completely end the program. Perhaps because of this lobbying effort, Administrator Slavitt issued his guidance to show that Washington was listening. However, the full text of what he said was: “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.” Just what “something better” is has not yet been fully determined.
Starting in 2017, another piece of legislation, MACRA, will take effect. Associated with MACRA is MIPS, or the Merit-Based Incentive Payment System. In CMS’s own words: The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program based on quality, resource use, clinical practice improvement and the Meaningful Use of certified EHR technology. According to Jim Tate, an expert in the field of Meaningful Use: “The failure to achieve MU of CEHRT under MIPS will cost eligible providers 25 of their maximum 100 composite MIPS scores. The potential loss of revenue dwarfs the current “payment adjustment” under the CMS EHR Incentive Program.”
Will MU change going forward? The question can be answered definitively as yes. Administrator Slavitt intends to make changes in the the program design, and likely even change the name completely. Meaningful Use has become “persona non grata” to many providers, and perhaps a rebranding is in order.
How does all of this affect HIPAA? According to an article in Healthcare Information Security, “The biggest impact of the Meaningful Use program so far has been to wake up some healthcare providers about the importance of security and privacy”. Administrator Slavitt, in addition to his comments above, signaled an increasing emphasis on interoperability – the capability for clinical systems to easily exchange data electronically. This is an area where MU fell short, but remains an area of continued focus. With increasingly greater emphasis being placed on electronic patient data and data exchange, the protection of patient data will take on an even greater priority. We can therefore expect government to focus on enforcement of HIPAA compliance to only continue to grow in the future.
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