The future of meaningful use

Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, began the year with a bang with this simple tweet:

“In 2016, MU [Meaningful Use] as it existed — with MACRA — will now be effectively over and replaced with something better.”

The buzz was practically instantaneous.

“Meaningful Use is dead!” some commentators announced. Others countered, “Meaningful Use is NOT dead. It’s very much alive!”

Turns out, both camps were right. Clearing up matters was the publishing of the proposed rule for MACRA, otherwise known as the Medicare Access and CHIP Reauthorization Act, in late April.

A rose by any other name

“Under the proposed rule,” Health Data Management reported,  “Meaningful Use is essentially restructured into a new Advancing Care Information (ACI) performance category as part of MIPS for purposes of calculating payment.”

(What is MIPS, you ask? The Merit-Based Incentive Payment System, a new Medicare payment system that aims to factor value into provider reimbursement. It, along with a separate Advanced Alternative Payment Models program, was mandated by MACRA, which Congress passed in 2015.)

Health Data Management went on to quote Kate Goodrich, MD, director of the CMS Center for Clinical Standards and Quality, as clarifying that ACI and Meaningful Use “are the same.”

So long story short, Meaningful Use is being phased out, except in essence it really isn’t going anywhere. Electronic health record (EHR) technology will still play into a practice’s bottom line, only starting in 2019 it will do so via the ACI category of MIPS. Here’s how.

How EHR factors into MIPS

ACI is one of four performance categories under MIPS that will affect a provider’s Medicare reimbursement. The others are cost, quality, and clinical practice improvement activities.  ACI performance will account for one-quarter of a provider’s MIPS score.

“One thing that can be a little confusing about MIPS is that the Advancing Care Information category has a score within a score,” explains blogger John Lynne, founder of the HealthcareScene.com blog network. “Advancing Care Information makes up 25% of the [MIPS] score, but in order to calculate how much of the 25% you’ll receive, you have to figure out how many points you receive in the Advancing Care Information category.”

To earn the category’s full 25%, providers must score 100 points or higher.  Fifty points are available as a “base score” for providers who simply answer a series of “yes/no” questions about whether they have completed the requirements of the ACI, which are similar to the measures for Meaningful Use Stage 3.

“If you just report, you’re going to get half the score,” Dr. Goodrich said. “And, then, we on the back end calculate (the other 50 percent) based upon how you do on each measure.”

That’s the category’s “performance score,” which allows providers to earn up to 80 points for achievements in areas beyond participation, such as patient electronic access and health information exchange.

Finally, a “bonus point” is up for grabs for providers who meet public health and Clinical Data Registry Reporting.

Same measures, more flexibility

“According to CMS, the new requirements for EHRs will provide additional flexibility from the previous rigid standards contained in Meaningful Use requirements, but many of the same categories and measures will continue to be used in the MIPS program,” the American Gastroenterological Association explains on its website.

“The major benefit touted by CMS is that ACI abandons the existing ‘all-or-nothing’ approach of the Meaningful Use. Instead, the intention of the program is to provide a measure of partial credit to any clinician or practice that makes progress in implementing new technology.”

Per the final MACRA rule released Oct. 14, payment adjustments under MIPS will begin in 2019, but are based on provider performance in 2017.

As Lynne writes on his blog, “If you’ve been participating in Meaningful Use, then Advancing Care Information won’t be a huge obstacle. If you haven’t been participating in Meaningful Use, well, then you have some work to do.”