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Flexibility guides EHR future


CMS' meaningful use program for electronic health records (EHRs) has morphed into the Advancing Care Information (ACI) initiative, which loosens restrictions for earning EHR bonuses.

Encouraging signs within healthcare reform include changes to meaningful use regulations and the promise that electronic health records (EHRs) will one day deliver, says an expert who spoke at the 75th American Academy of Dermatology Annual Meeting, Orland, Fla.

Dr. Kaufmann"In 10 years," says Mark D. Kaufmann, M.D., "none of us will be seeing a doctor who doesn't use an EHR system. By that time, the EHR will have evolved into something that will enhance our medical care. It will assist the physician. So while he or she is seeing a patient, it will suggest different ways to treat their condition- as well as the success rate of each method. It will suggest what labs to order on a given patient. EHRs are going to help us, rather than be a thorn in our side. The transition period is always the most difficult – and that is where we still find ourselves." He is an associate clinical professor, Department of Dermatology, Icahn School of Medicine at Mount Sinai.

Meanwhile, "The meaningful use program became so untenable that the government had to abandon the term," softening requirements along the way. As of January 1, the incentive system has been rechristened "Advancing Care Information (ACI)" under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Along with programs formerly known as the Physician Quality Reporting System (PQRS) and value-based modifiers (VBM), ACI is a pillar of the new Merit-based Incentive Payment System (MIPS). "MIPS is also a penalty system because the incentives are paid from the penalties" that debut in 2019.

"Keep in mind, the 2019 beginning of the program is based on what you do in 2017. Right now, we're working on our 2019 MIPS incentive or penalty even though we're not in the program yet." However, he added, the cost pillar (formerly VBM) is not in play until 2018.

With the change to ACI,  Dr. Kaufmann says the Centers for Medicare and Medicaid Services (CMS) has shown flexibility. Rather than having to comply with all measurements to reap any rewards, "You must do all 5 ACI base measures to start, but then you have a menu where you can choose from 9 other measures, and you don't have to do all 9" to qualify for incentives. Meeting the five basic requirements confers 50 points, he says, and choosing five more of the remaining nine qualifies for 100% of the incentives.

"There are also bonus points that allow you to earn points in another way without having to do the measures," he notes. For example, practices can earn bonus points by using a specialty registry such as the AAD's DataDerm.

Disclosures: Dr. Kaufmann owns stock in Modernizing Medicine.

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