Meaningful Use Is Dead, Long Live Something Better!

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Andrew-Slavitt_Meaningful Use Is Dead

Andrew Slavitt, Acting Administrator at CMS

At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt, acting administrator at the Centers for Medicare & Medicaid Services (CMS),announced on January 11th that “The meaningful use program as it has existed will now effectively be over, and replaced with something better”, and later clarified on Twitter that: 

Meaningful Use is dead. Just like that. No apologies. No nothing. As someone who’s been lamenting the havoc wreaked by the program on both doctors and patients, I should be elated nevertheless. Well, I am not.

Let’s start with appearances. The J.P. Morgan Healthcare Conference is the “largest and most informative healthcare investment symposium in the industry which brings together global industry leaders, emerging fast-growth companies, innovative technology creators, globally minded service providers, and members of the investment community”.

In other words the event is all about money for the millionaire and billionaire class. J.P. Morgan Chase itself is the largest financial institution in the country. It is the embodiment of Wall Street and its death grip on our collective neck. Was this conference really the best place to make such momentous announcement?

Besides, why would these extractors of wealth be interested in the fate of something as obscure as Meaningful Use? Shouldn’t they discuss more lucrative schemes, such as running all possible blood tests on one tiny blood droplet, or how the makers of Microsoft Office and the largest online retailer of everything are going to jointly solve for cancer? Shouldn’t they be analyzing trillion dollar addressable markets of genomic rainbows, and how mergers, acquisitions and inversions can help squeeze whatever is left in the turnips that are you and me?

Of course they should, and they did all that and much more. But changes to the Meaningful Use program are of strategic importance to all other rainbows, grails and unicorns. Why? Because Meaningful Use, other than funneling a respectable amount of billions of dollars into the health tech sector, is the enabler of data collection which fuels all other investment opportunities.

Furthermore, pretty much everything that could be sold to satisfy Meaningful Use, has been sold, so what’s next? As the Meaningful Use money making opportunities are ending, CMS is “moving to a new regime”. Interesting choice of words notwithstanding, the Meaningful Use successor consists of punishing doctors for nebulous “outcomes”, and of course all sorts of new technologies to better transfer all medical data into places where J.P. Morgan clientele can monetize them.

Let’s talk about substance. Meaningful Use has been created by an act of Congress, and enshrined for posterity in a subsequent act of Congress, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It is not clear to me how a political appointee can invalidate acts of Congress at will, although this probably makes perfect sense in the rarefied circles convened by J.P. Morgan. If nothing else, the absolute confidence that Congress will oblige, and the President of the United States will sign whatever is put in front of him/her by the Wall Street lobby, is a perfect illustration of who is running this country and how it is done. A somewhat less politically disheartening explanation is that the demise of Meaningful Use has been greatly exaggerated in this announcement.

Meaningful Use, as we discussed in the past, is not just about onerous burdens on physicians. It is also about regulating design and production of medical software to serve the needs and wants of government and large corporations. From reading Mr. Slavitt’s remarks, I suspect that the latter effort is far from being over and may actually be greatly fortified under the “new regime”. If you design clever software, and mandate its purchase and daily use, there is very little utility in paying users to show their work, which is what Meaningful Use for physicians really meant. You do however want to keep those unwittingly exploited users calm and cooperative, which may explain why CMS wants to “get the hearts and minds of physicians back”.

Related: In Retrospective, Meaningful Use was Meaningless

Enter the American Medical Association (AMA). While across the ocean, the British Medical Association (BMA) is aggressively supporting its striking members in a nationwide struggle for the soul of medicine, the AMA is launching a “Silicon Valley integrated innovation company” to monetize its members in service to the new CMS regime. In a fortuitous coincidence, the creation of this new “stand-alone, for-profit entity”, Health2047, was announced in San Francisco on the same day the J.P. Morgan conference was convened. The goal of Health2047 is to leverage physicians’ expertise to “help forge new paths and bring commercial solutions to market faster”, and of course to make boatloads of money for investors, including the AMA.

Meaningful Use is dead. Long live something better! And what is that better something? It is paying physicians for outcomes. It is the use of evidence based medicine. It is interoperability and “user-centered” design. It is Accountable Care Organizations, value, patient centeredness, coordination and such. It is also the making of markets “by leveling the technology playing field for start-ups and new entrants”, because when Epic makes money, nobody on Wall Street or in Silicon Valley gets a piece of the action. It is about engagement and analytics and population health, calculations, penalties, incentives and lots of new technology things. It is “like the second generation iPhone”.

After collectively sinking billions of dollars in Certified EHR Technology over the last five years, hospitals and doctors will now be expected to foot the bill for new software and computer products to support the lifestyles of a new generation of Silicon Valley entrepreneurs and the insatiable greed of the old generation of Silicon Valley investors. Why? Because the next app is sure to fix health care in America. It’s always the next one. There is always “something better” you can buy.

Planned obsolescence, which is fueling the obscene fortunes of Silicon Valley and destroying life everywhere else, has finally arrived to the $3 trillion health care sector. It took a bit longer than the folks at J.P. Morgan expected, I’m sure, but we’re in business now. Let the good times roll…..

Margalit Gur-Arie is the founder, BizMed. She writes regularly about the intersection of healthcare & technology on her site: On Health Care Technology. Follow her on Twitter at @margalitgurarie  

Opinions expressed by HIT Consultant Contributors are their own.

  • Easma

    It’s unfortunate that there are many media reports which were misleading in their coverage about the statements made by CMS Acting Administrator Andy Slavitt at the JPMorgan Conference indicating significant changes were in the near future for meaningful use.  For EPs, MU will become the Merit-Based Incentive Payment System (MIPS) in a few years. For EHs, there are no changes at this point. MIPS is not the end of MU. MIPS is the beginning of a new regulatory program which includes provisions related to MU attestation.
     
    Administrator Slavitt’s statement “meaningful use as we know it is coming to an end,” was in reference to pending regulatory developments for how the use of certified health information technology (CHIT) by Eligible Professionals (EPs) will be a component part of the Merit Incentive based Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
     
    Administrator Slavitt reinforced what we already know as to how use of CHIT will evolve over the next few years.
    *       For EPs, 2016 will stand to be the last year of meaningful use as a distinct incentive program under Medicare, and also the last year that an EP’s ability to be a meaningful user would impact payment adjustment for professional services under the Physician Fee Schedule in a future calendar year (2018).

    *       MIPS will combine the current separate Medicare payment adjustments for EPs related to meaningful use, the Value Based Payment Modifier and for PQRS into one composite payment adjustment.
     
    It is accurate that 2016 will be the last year for meaningful use as we know it for EPs. But HIT vendors emphasize to client providers that the use of CHIT is central to many CMS program requirements, and if anything, is only becoming increasingly significant. There are also several things that remain to be defined:
     
    *       Whether the use requirements for CHIT by EPs under MIPS will initially be the same as that applicable for meaningful use under the recent Modified Stage 2 and Stage 3 final rule

    *       Whether we will see new statutory development that will do similar things for EHs and CAHs relative to meaningful use and future payment system requirements as MIPS will do for EPs

    *       What requirements will emerge requiring use of CHIT that CMS may choose to incorporate in other program requirements and Conditions of Participation requirement that would not be too much of a stretch to see Congress or CMS mandate.  For example, it is feasible for CMS to associate use of transition of care capabilities and care planning capabilities of certified products to meet the recently proposed CMS Conditions of Participation proposed rulemaking for discharge planning.

    *       To what degree use of certified products is linked to Medicaid program requirements for other program purposes or how the future of the Medicaid EHR incentive program plays out in context of what CMS may be planning to do.

    CMS has indicated we should expect rulemaking for MIPS sometime in mid-2017, and we expect to see details emerge regarding requirements for the use of CHIT under MIPS.
     
    The word of advise is to stay watchful of CMS policy developments as to the future requirements for the use of CHIT. This does not mean the significance of CHIT is going to somehow go away. It likely means how it is referenced and required will change in a manner that results in an improved scope of applicability for its use, and appropriate scoping for what it must be used for.

  • Thank you for the detailed post. I agree with your assessment of larger and heavier technology regulations in the future, in contrast to current headlines.

  • PW

    CHIT, did you mean to put a C or an S there?

  • Easma

    Certified health information technology (CHIT)