Comments by CMS Administrator Andy Slavitt earlier this week have created some confusion among providers and the Health IT community about the future of Meaningful Use.

On Monday, January 11th, Mr. Slavitt stated the following in a speech, which was also subsequently posted on the CMS Blog:

“…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.”

Headlines following the event heralded the end of Meaningful Use. But if you read closely what Mr. Slavitt stated, not the headlines, he stated the Meaningful Use Program [emphasis added] is going away and will be replaced with another CMS program.

So, what does this mean? The key to understanding Mr. Slavitt’s remarks is in understanding the new legislation called MACRA.

What does the MACRA legislation say about Meaningful Use?

The Medicare Access and CHIP Reauthorization Act (MACRA) was passed in April 2015, and is more widely known as the legislation that repealed the Sustainable Growth Rate cuts.

The MACRA legislation mandates broad changes in the way that physicians will be paid by Medicare. Beginning in January 2019, Medicare eligible providers will have to choose between two new value-based payment approaches. The first will be the new Merit-Based Incentive Payment System (MIPS), in essence a pay-for-performance approach. The second payment approach will be through Alternative Payment Models (or APMs), such as the Medicare Shared Savings ACO program.

The reason that the Medicare Meaningful Use Incentive Program is going away is twofold:

• First, the final incentive payments under the Medicare EHR Incentive Program were finished in 2016, as established by the ARRA legislation.
• Second, the new MACRA legislation authorizes CMS to roll three of its programs into one new program. So, Meaningful Use, the Physician Quality Reporting System (PQRS) and the Value Based Modifier programs as stand-alone programs will all be rolled into the new MIPS program.

One point to be clear on: MACRA doesn’t get rid of the Meaningful Use requirement for physicians. Instead, Meaningful Use of a certified electronic health record becomes one of the four performance categories under MIPS. Physicians will have their reimbursement from Medicare adjusted up or down depending on level of performance in those four categories, which include:

• Quality (30%)
• Resource use (30%)
• Clinical practice improvement activities (15%)
• Meaningful Use of certified EHR technology (25%)

The MACRA legislation also makes it clear that Meaningful Use will be a condition for full payment under Medicare for years to come. The law states:

(D) CONTINUED APPLICATION FOR PURPOSES OF MIPS.— With respect to 2019 and each subsequent payment year, the Secretary shall… determine whether an eligible professional … for such year is a meaningful EHR user.

MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.—Twenty-five percent of such score shall be based on performance with respect to [this] category.

So, bottom line, the Medicare Meaningful Use Incentive Program will end in 2016, just as planned. But, CMS will replace it with Meaningful Use requirements under the new MIPS program. CMS is also expected to release rules later this year that will give more specifics on exactly how the new MIPS program will work.

What about the Medicaid EHR Incentive Program?

Another confusing part in all this is that there are actually TWO EHR Incentive Programs, one for Medicare and one for Medicaid. So, Mr. Slavitt’s remarks about Meaningful Use have created confusion among providers participating in the Medicaid EHR Incentive Program.

Providers planning on participating in the Medicaid EHR Incentive Program should understand that by federal law the program must continue through 2021. 2016 is still the last year to join the Medicaid EHR Incentive program.

What remains unclear is how the changes under MACRA will impact Medicaid providers. Because Medicaid is a jointly operated program between CMS and all 50 states, the answer will likely vary by state. What we do know is that CMS continues to push states to include use of certified EHR technology and health information exchange in their requirements for Medicaid funding.

The good news in all this is that CMS has indicated it plans to simplify and consolidate requirements going forward. The Modified Stage 2 Meaningful Use requirements reduced the burden on providers significantly. Let’s hope CMS continues to get the message that providers are overwhelmed by all the different programmatic requirements and eases the burden on providers.

It is confusing, so we’re here to help.

As always, if you as a provider have questions about Meaningful Use, the Kentucky REC team is here to help. Coming in March, the REC will host webinars on MACRA and other value based payment programs to prepare providers for what’s ahead. Also, stay tuned to the REC, as our team will be analyzing the rules for MACRA once CMS releases them later this year, just as we have always done for Meaningful Use.

If you are interested in learning more about the MACRA legislation, the REC team is happy to speak to your organization or supply your team with more information. Just give us a call or email us your questions.