Meaningful use losing its meaning?

June 9, 2016

Regulations surrounding electronic health records are evolving. The medical community waits hopefully for a system that focuses more on outcomes and less on the use of technology itself.

“Meaningful use” has turned out to be a major nuisance. Now, the federal government is finally promising to put its onerous electronic health records requirements out of their—and your—misery.

So is it a time for rejoicing by every dermatologist who treats Medicare and Medicaid patients? Not necessarily. The hassles spawned by meaningful use rules have stung dermatologists, and some aren’t ready to rhapsodize about better days ahead.

“The government wants to pretend meaningful use is over, so they don’t have to reveal how much of a failure it has been,” says Mark D. Kaufmann, M.D., associate clinical professor with the department of dermatology at Icahn School of Medicine at Mount Sinai. “I actually am hopeful, but only for 10-15 years from now, when electronic health records will be interoperable and more intuitive. Until then, we will have to live with the pain that often accompanies a transition period.”

At issue: Meaningful use regulations circa 2011

While dermatologists are unique, the system hasn’t always treated them that way, says George J. Hruza, M.D., MBA, a dermatologist in private practice and adjunct professor of dermatology at St. Louis University. “The meaningful use requirements were set up primarily with primary care physicians in mind, making them extra difficult for specialists like dermatologists to meet,” he says. “Dermatologists were expected to report on their patient's smoking and smoking cessation education they provide, to record body mass index, weight and blood pressure and to report on the immunization rates of their patients.”

After hearing complaints, CMS made improvements for 2016. For dermatologists, “there’s no need to report on blood pressure or smoking cessation education,” Dr. Hruza says. “Instead, the reporting is more based on demonstrating some of the capability of the EHR software such as secure electronic messaging with patients, protection of personal health information, patient specific education resources, and electronic e-prescribing.”

Next: The future is unclear

Now what?

Under the initial plan, meaningful use was supposed to evolve from Stage 1 (focus on data capturing and sharing) in 2011-2012 to Stage 2 (change clinical procedures) in 2014 and Stage 3 (improve outcomes) in 2016.

But then along came the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA, which sets new payment models to go into effect in 2019 and threw a wrench into the workings of meaningful use. Meanwhile, physicians rebelled. 

The Centers for Medicare and Medicaid Services has responded. Acting administrator Andy Slavitt set the stage for change in a speech at a conference in January: “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better,” he declared.

The new system will focus more on outcomes and less on the use of technology itself, he said. In addition, Slavitt said, providers will have more flexibility regarding their goals and the use of technology over time. However, he said, “We are deadly serious about interoperability.”

While Slavitt acknowledges that “We have to get the hearts and minds of physicians back,” dermatologists are still skeptical.

In the near term, Dr. Kaufmann expects that compliance numbers for dermatologists aged 50 years old and higher will be dismal for the latter stages of meaningful use. However, Dr. Kaufmann points out that CMS has provided a hardship exemption available for meaningful use for physicians who weren’t able to meet requirements in 2015 due to the late release of the CMS final rule.

The future is unclear

Meanwhile, Dr. Hurza says he hopes that the DataDerm registry launched by the American Academy of Dermatology will qualify as a registry for meaningful use reporting. “Once up and running and collecting data, it should help dermatologists to report on outcomes,” he says.

The future beyond 2016 is unclear. Stage 3 of meaningful use regulations is slated to be optional in 2017 and mandatory by 2019. The rules were expected to include a heavier focus on interoperability; more than 60% of proposed measures in Stage 3 require interoperability, up from 33% in Stage 2.

However, Stage 3 is undergoing a rethink, and Slavitt’s comments raise the prospect that it may be thrown out soon. Dr. Kaufmann doesn’t think that will happen. “What they’re really saying is that meaningful use will stay as is until 2019, when it will be replaced by the Merit-Based Incentive Payment System program.”

As for 2019 and beyond, Dr. Hruza says “electronic health records will not really become useful until there is true interoperability between the various EHRs with easy flow of patient data between offices, hospitals, pharmacies, labs and data registries.”

The challenge, he says, is that this kind of interoperability “has associated significant security risks to everyone plugged into such a health information exchange.”