The New, New Meaningful Use

At the recent J.P. Morgan Healthcare Conference, CMS Acting Administrator Andy Slavitt caught everyone’s attention when he said: “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.” (Full text of his comments linked from his name.) Some folks misconstrued what he said as pointing to the end of Meaningful Use, though some close observers of the healthcare IT regulatory scene understood that the field of play is limited by existing health care statutory authority.

While Slavitt noted that full exposition of his remarks would have to wait until a proposed regulation to be made public in late March, he and Karen DeSalvo published an explanatory blog post laying out the range of issues that further regulatory action will address. (The post just says to look for the regs “this year.”)

First on the list is a reminder that while the federal swing to value-based payment and MACRA both mean that quality and cost will be factored into reimbursement, Meaningful Use is not dead. There is, however, an opportunity to identify measures that jive with a new broad focus on outcomes, rather than process measures. (Easier said than done!)

Other hints dropped: health IT should be more user-centered; open APIs will be used to unlock data in EHRs to level the playing field for analytic tools and plug-ins where and when needed to support patient care; and federal interoperability standards will be implemented, recognizing the need to prioritize interoperability and “focusing on real-world uses of technology like ensuring continuity of care during referrals or finding ways for patients to engage in their own care.” (Note to self: Does this mean that we are about to embark on a re-examination of the ten-year interoperability roadmap recently finalized by ONC?)  Information blocking will not be tolerated. In addition, much of the focus in the post is on Medicare incentives for physicians. Medicaid and hospital issues must also be addressed.

Bottom line: The blog post is a more sober and realistic rendition of the blue-sky optimism showcased in San Francisco. What it means is that the federales are taking to heart the relentless criticism of the latest iterations of the Meaningful Use program (not all of it as calm and constructive as the linked letter). The challenge, of course, is to forge ahead within the parameters established by statute while guarding against regulatory capture. Organized medicine and the hospital industry share certain interests with CMS but are, of course, “the regulated community,” with other interests in play as well. As the poet asked: “How can we know the dancer from the dance?” In a refreshing turn, Slavitt and DeSalvo have extended an invitation to all interested parties to join the dance ahead of publication of a draft rule. (If you’d like some help getting your thoughts together and reaching out, let me know.)

Deadheads out there will recognize an echo of a song title in this post’s title. The line from Memphis bluesman Noah Lewis’s New, New Minglewood Blues that made the connection for me was this: “Well now the doctor call me crazy / Sometimes I am, sometimes I ain’t.” Slavitt & Co. are on the bus now thanks to the repeated urgings of organized medicine (he said as much in his J.P. Morgan remarks) and other interested parties. Let’s hope he is able to maintain focus on the priorities of patient engagement and keeping the patient at the center while remaking this complicated program within existing statutory strictures. Making this happen is critical; doing so can help ensure improvements in real-world interoperability and care coordination in ways that the federal statutes and regulations have been unable to thus far.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting