Meaningful Use

As policy wonks and advocates battle over just how much meaningful use will likely change in 2016, the Physician Quality Reporting System might have snuck up on healthcare IT staffs tasked with implementing new technology platforms. "The focus for most of the health IT folks has obviously been meaningful use regulations, and there hasn’t been a lot of focus on the PQRS," said Deborah Gash, CIO of Kansas City, Missouri-based St. Luke's Health System. In fact, Gash said she actually had what she called an "aha!" moment when colleagues at St. Luke's began asking her about how best to address PQRS stipulations in concert with other reporting requirements. [Also: 21 awesome photos from past HIMSS conferences] Gash and Anantachai Panjamapirom, senior consultant at The Advisory Board Company, will present on St. Luke's experience in "PQRS and Alignment Opportunity — Concept to Operationalization," during HIMSS16 beginning in late February. "Bringing awareness to what this program is, how we were able to work through all the operational issues, and create a program to allow us to follow through and successfully meet the requirements was something we thought would be worthwhile to share," Gash said. Panjamapirom said numerous Advisory Board clients, such as St. Luke's, have already taken steps to align not only MU and PQRS, but also try to devise strategies to bring other programs, such as Hospital Inpatient Quality Reporting and the Value-Based Payment Modifier, into efficient alignment. Twitter: @HealthITNews "Most of what you have to do is workflow and culture changes," Gash said, "such as documenting the right elements and being consistent about it, plus developing workflows and decision support tools in your EHR to ensure you're getting the quality data captured. That's really where the lion's share of the work is for organizations." Gash also said larger organizations are not necessarily better prepared to operationalize alignment. "I think the complexity of the organization can increase your risk," she said. "I find smaller practices that are paying attention do quite well.  It's that lack of awareness and understanding of what you have to do in the requirements that puts you at risk." "PQRS and Alignment Opportunity - Concept to Operationalization" will be presented March 1 from 2:30 - 3:30 p.m. at Sands Expo Convention Center, Palazzo D. Twitter: @HealthITNews This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

Have you heard of the #HIMSS16 MixTape? Well, Colin Hung is the man who put that together. He also founded and moderates the Healthcare Leadership (#hlcdr) and serves as a healthcare marketing executive at Stericycle Communications Solutions in Toronto. And at HIMSS16 he’ll be among the Social Media Ambassadors credentialed to cover the conference via multiple channels. See all of our HIMSS16 previews Hung answered our questions leading up to HIMSS16. Q: What’s your top health IT prediction for 2016? A: There will still be more talk about interoperability in 2016 than action. On a more optimistic side, I think that the conversation will shift from compliance to innovation in 2016.  Q: What are you most looking forward to learning about at HIMSS16. A: I'm really excited about the latest developments in Artificial Intelligence for healthcare. I think IBM Watson and other related technologies have the potential to revolutionize the way healthcare is delivered. I'm definitely hoping to learn more about the practical applications for that Big Data + AI combination. I'm also looking forward to seeing what's next for the EHR vendors. Now that the meaningful use program is in its twilight, I'm really curious to see if one of the players decides it's time to "break-the-mold" and take their system in a completely new direction. I certainly hope someone will seize this opportunity once the meaningful use shackles come off.  Q: What inspired you to apply for the SMA program? A: Since the program started, I've made it a point to follow the SMAs during HIMSS and I have always found their tweets, posts and comments to be extremely valuable. At a conference the size of HIMSS there is a lot of noise. I find that the SMAs help cut through the babble and they somehow find a way to highlight undercurrents that might have otherwise gone unnoticed. It's exciting to be part of the SMA team doing that at #HIMSS16. Q: What in your mind are the untold benefits of social media in healthcare today? A: I think one of the most untapped uses of social media in healthcare is crowdsourcing feedback. Twitter, Facebook and LinkedIn are amazing platforms to test ideas. There isn't another place where you can go and tap into a community of people who are passionate about improving healthcare for feedback. I'm constantly pinging friends I've met online for their opinion on ideas that I have, to clarify my understanding of a particular topic or to ask for reference materials. If I were involved in product development I'd tap into social media to solicit feedback on UX/UI designs and vet approaches to developing products. That to me is the one of the greatest uses of social media that very few are realizing.  Q: What's something that even your devout followers likely don't know about you? A: Oh this is a tough one. I think most people know about my love of all things SciFi and how I first met John Lynn (@techguy) while tweeting/texting using a phone in each hand at HIMSS12. But what people probably don't know is that I love sushi. Can't get enough of it.  Twitter: @SullyHIT This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

IT veteran Laura Young will share best practices for health information exchange among long-term post-acute care and mental and behavioral health providers  at HIMSS16.

While rural providers have adopted health IT at the same time or at greater rates as their urban counterparts, meaningful use varies dramatically among them, according to a recent HealthAffairs study.

Though Centers for Medicare and Medicaid Services officials on Tuesday tried to clear up confusion over changes and the ultimate replacement of meaningful use, the future is very much in question according one expert who is slated to talk about the subject at the HIMSS16 conference.

One week after Andy Slavitt said meaningful use would be replaced soon, the acting Centers for Medicare and Medicaid Services administrator and national coordinator Karen DeSalvo made it clear that the changes would take time and that providers must still follow the current program. Slavitt and DeSalvo in a blog post Tuesday afternoon explained the new regulatory framework would move away from measuring clicks to focusing on care. [Also: Meaningful use will likely end in 2016, CMS chief Andy Slavitt says] Two big changes have helped cause this shift from measuring technology adoption levels to looking for quality outcomes, they wrote. First was HHS' ambitious goal, announced about a year ago, that 30 percent of Medicare payments be linked to value-based care in 2016, and 50 percent by 2018. The second was the passage of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, which holds quality, cost and clinical practice improvements as key factors in determining how Medicare physician payments are doled out. "While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments," Slavitt and DeSalvo wrote, "it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next." CMS has been "working side by side with physician and consumer communities and have listened to their needs and concerns," according to CMS and ONC. [Also: CIOs celebrate end to meaningful use] Further details for the proposed rules, along with a public comment period, will be forthcoming "this spring." In the meantime, Slavitt and DeSalvo promised a new set of priorities that reward providers for the outcomes they're able to achieve for their patients with the help of technology. This means they'll be "allowing providers the flexibility to customize health IT to their individual practice needs," they wrote. "Technology must be user-centered and support physicians." They also pledge to help level the playing field to spur innovation, "including for start-ups and new entrants," by focusing on the open APIs so common in consumer technology. "This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care," according to Slavitt and DeSalvo. And interoperability will continue to be a priority for both agencies, which will continue to drive national interoperability standards that are based in "real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care." Slavitt and DeSalvo can be expected to offer more details on these coming changes at HIMSS16 in Las Vegas, Feb 29-March 4. In the meantime, they said physicians and hospitals alike should keep some important things in mind as staged meaningful use is phased out and this new MACRA-based program comes into focus. First, existing law "requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system." Second, MACRA "only addresses Medicare physician and clinician payment adjustments." Hospitals have a different set of statutory requirements. "We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program." [Like Healthcare IT News on Facebook] Third, the changes to meaningful use under MACRA "won’t happen overnight," they write. "Our goal in communicating our principles now is to give everyone time to plan for what's next and to continue to give us input. We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect." Fourth, they point to recent legislation that streamlines CMS' process for granting meaningful use hardship exceptions. "This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon." In closing, Slavitt and DeSalvo said that "moving from principles to reality" can be challenging.  But ultimately, they write, "we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients. We look forward to working collaboratively with stakeholders on advancing this change in the months ahead." Twitter: @MikeMiliardHITN

Thirty-one top health systems, hospitals and clinics are urging the Department of Health and Human Services to think again about pressing forward on Stage 3 meaningful use. Among them are Beth Israel Deaconess Medical Center and Partners HealthCare in Boston; Geisinger Health Systems in Pennsylvania; Henry Ford Health System in Michigan and Intermountain Healthcare in Salt Lake City. In a January 14 letter to HHS Secretary Sylvia Burwell, the organizations say they are concerned that Stage 3 might even thwart much needed improvements to electronic health record systems. [Also: Meaningful use will likely end in 2016] “We recognize that the MU program has successfully driven the adoption of EHRs, with over 80 percent of hospitals and physicians now using these systems,” they write, adding that now is the time to make sure all practices “have high-functioning technology to achieve interoperability across all care settings.” Their pleas come on the heels of CMS chief Andy Slavitt’s claim that meaningful use would come to an end in 2016, a statement he made January 12 at the J.P. Morgan Healthcare Conference in San Francisco. He gave few details beyond that, except to say the program would be replaced by something better. John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston, posted the letter on his blog. Halamka had already called for a halt to the program back in November. [Also: Did meaningful use spawn or stall EHR innovation?] “In particular, the MU program has diverted clinician, staff, and other resources away from activities with greater patient benefit and has forced technology to develop in a way that limits innovation,” the healthcare organizations said in their letter to Burwell. Also, the group points to the meaningful use program as the driving factor behind the poor design of EHR technology. “We believe Stage 2 EHR design requirements have been a fundamental drag on interoperability and that Stage 3 will worsen these problems,” they said. “The Stage 3 final rule, like its predecessor rules, is too focused on pass-fail requirements and lacks emphasis on outcomes. By maintaining this flawed structure, we do not believe Stage 3 will support movement towards more innovative care models or encourage continued participation.” [Like Healthcare IT News on Facebook] Robert M. Wachter, MD, a professor and the interim chairman of the department of medicine at the University of California, in a Jan. 16 opinion piece in the New York Times pointed to several measures that he said have failed doctors and teachers. “Of course, we need to hold professionals accountable,” he wrote. “But the focus on numbers has gone too far. We’re hitting the targets, but missing the point.” Twitter: @HealthITNews

Despite officials this week signaling the end of the meaningful use program, more than 200,000 eligible providers will see a 2 percent cut in their Medicaid payments in 2016 for failing to meet standards in 2014, recent Centers for Medicare and Medicaid Services data show.

Healthcare chief information officers breathed a sigh of relief on Tuesday when Andy Slavitt said the end of the meaningful use program was near. But many are waiting on the details before celebrating too much.

Acting CMS administrator says several programs will change as healthcare industry wades deeper into value-based reimbursement.