Hot Topic: Meaningful Use
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1 Hot Topic: Meaningful Use Rebecca Hancock Manager, Quality & HIT Policy American Academy of Ophthalmology How did this start? 2004 President George W. Bush State of Union Address: By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care. Creation of the Office of the National Coordinator for Health IT with a $42 million budget 2009 HITECH Act passed as part of the American Recovery and Reinvestment Act of 2009, creating Meaningful Use Called for the development of a nationwide HIT infrastructure that allows for the electronic use and exchange of information to improve quality, reduce medical errors, reduce health care costs 2 EHR Incentive Programs: Meaningful Use Created by the HITECH Act, the program was established in 2011 Intended to stimulate adoption of EHRs by providing financial incentives to EPs who demonstrate meaningful use of an EHR, and penalties to those that do not comply Ultimate goals: data capturing and sharing, advanced clinical processes and improved outcomes 3 1
2 Meaningful Use Check Up How are we doing? Adoption of EHRs As of May 2016, CMS paid over $34B in MU bonuses, including $9 billion to Medicare EPs (308,000), and $4.6 billion to Medicaid EPs (173,000) In 2008, about 17% of office-based physicians had a basic EHR, growing to 51% by 2014 Adoption not as high for some providers: CDC data show office-based specialists lag behind primary care in EHR adoption While general medicine hospitals had 84% EHR adoption in 2015, adoption was 15% at psychiatric hospitals and 55% at children s hospitals, and estimates show about 45% of nursing homes have EHR There is no certified EHR for ASC setting 5 What about improved quality? Lack of evidence MGMA survey finds that more than 83% of physicians do not believe quality reporting programs like MU are improving the quality of care Alert Fatigue AMA and RAND study found that EHR systems, and particularly those with reminders, alerts and secure messaging, decrease physician job satisfaction OIG flags EHR documentation integrity issues However, EHRs are paving the way for clinical data registries and other quality improvement and population management tools 6 2
3 What about information sharing? CDC reports that in 2014, only 1/3 of office-based physicians with a CEHRT electronically shared patient health information with external providers Only about 13% shared with behavioral health, long-term care and home health providers ONC report identifies major roadblocks to interoperability Data blocking is rampant OAG report says Meaningful Use program is a hindrance to interoperability 7 Challenges and Other Issues Lack of resources 2015 MGMA report shows providers spending more on technology today than ever before - up nearly 34 percent from four years ago Program not viewed as meaningful or successful Rigid, all-or-nothing structure Difficult to meet measures that are often beyond a provider s control and aren t relevant Technology issues and lack of interoperability 8 Meaningful Use Penalties About 2 in 5 physicians are receiving Meaningful Use penalties 257,000 Medicare EPs received 1% penalty in ,000 Medicare EPs receiving 2% penalty in penalties for Medicare EPs are estimated to total to $600 million In 2017, penalties increase to 3% In 2018, penalties increase to 4% 9 3
4 7/13/16 Changes to Meaningful Use Addressing Provider Concerns Timeline of Meaningful Use Changes 2013 CMS Stage 2 rule gives extra time and permits providers to report by October 1, 2014 to avoid 2015 penalties 2014 Flexibility rule, 90 day reporting 2015 Modifications rule, 90 day reporting, hardship exception 2016 Newly proposed 90 day reporting for 2016 and hardship for new participants transitioning to MIPs MIPS 11 Meaningful Use and MACRA January 2016 headlines: Not really: 12 4
5 Advancing Care Information / MU Proposals 25% of MIPS score New name for Meaningful Use Increase Flexibility Removing minimum patient reporting thresholds (for example use e- prescribing for 50% of patients) Instead, ECs to report each measure for at least one patient Same measures & objectives (Modified Stage 2) in 2017 All are required to report Stage 3 in 2018 and to upgrade EHR technology 13 5
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