Meaningful Use & MACRA
The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act established the Centers for Medicare and Medicaid’s (CMS) Meaningful Use program to leverage technology in healthcare, and specifically to promote electronic health record (EHR) and clinical decision support adoption.
From 2011 to2012, Stage 1 of Meaningful Use incentivized healthcare organizations seeking reimbursement from CMS to adopt an Office of the National Coordinator (ONC) certified EHR and comply with other data capture and sharing measures. In 2014, Stage 2 retained the Stage 1 objectives but in many cases increased reporting thresholds. Stage 3 will begin as an optional requirement in 2017 and required in 2018. Instead of the core and menu options, Stage 3 requires compliance with one or multiple measures within eight overall objectives. In the clinical decision support category, there are two measures, and both must be met.
In 2016 CMS announced that it would replace Meaningful Use with the Medicare Access & CHIP Reauthorization Act (MACRA). MACRA combines the existing Meaningful Use, Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) programs into the Merit-Based Incentive Payment System (MIPS), starting with the 2017 performance year. Payment adjustments will start in 2019 and depend on the earned MIPS composite performance score (CPS), with up to 100 points coming from the areas of Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Resource Use. Clinical decision support rolls up into the Advancing Care Information category, which is worth up to 25% of the CPS.
MACRA would focus on quality outcomes over technology adoption to align the successes of Meaningful Use with the Department of Health and Human Services’ (HHS) larger goals around Value-Based Care. Specifically, the proposed rule released in April 2016 removes the pass-fail nature of reporting on EHR and quality measures, as well as reduces the number of EHR measures from 18 to 11.
CMS’ new emphasis on results over specific processes it will create more flexibility for providers to select their own technology. Although the EHR will remain central, there will be greater onus on healthcare organizations to determine the complementary technologies that best help them provide better care.