WASHINGTON—The long-awaited sustainable growth-rate fix that passed the House on Thursday is wired to boost the use of health information technology, even beyond electronic health records.
The new Medicare framework for paying physicians would include a merit-based incentive payment system (MIPS) that would award bonuses and impose penalties based on whether physicians score above or below a certain threshold on quality measures, including meeting the requirements for the meaningful use of health IT.
The incentive program essentially rolls together and is intended to harmonize three existing quality-incentive programs: the EHR incentive program, the Physician Quality Reporting System and the value-based payment modifier established under the Affordable Care Act.
That will simplify the quality reporting burdens for providers, said Robert Tennant, senior policy adviser for the Medical Group Management Association.
The new incentives would range from a 4% maximum penalty or bonus in 2019 to a 9% maximum penalty or bonus in 2022 and beyond. The new system would supplant the existing penalties and bonuses under the government's EHR incentive program. Providers now face a 3% penalty starting in 2017, which rises to 5% in 2019 and beyond.
Physicians who receive a significant portion of their revenue from alternative payment models, including from private payers, would be exempt from MIPS and would get more generous payment increases from Medicare.
The approach, said Dr. Farzad Mostashari, “is intended to create ongoing incentives for quality improvement, and there are both direct incentives for health IT and health IT as an enabler.”
Mostashari is a former head of HHS' Office of the National Coordinator for Health IT and now is CEO of startup Aledade, which advises independent practices on forming ACOs. He said the new system could play an important role in nudging the industry toward alternative payment models.
Under the MIPS, providers would continue attesting to meeting the CMS' requirements for the meaningful use of health IT, which would account for 25% of the score. Quality and resource utilization would each account for 30%, and “clinical practice improvement activities” would contribute the remaining 15%.
Those proportions may vary as time goes on. If at least 75% of providers are clearing the meaningful-use bar, its weight could be lowered to as little as 15%. (Currently, about 50% of eligible physicians are facing Medicare penalties because they haven't met the IT requirements.)
The new incentive structure may blunt the impact of failing to meet the requirements of the meaningful-use regime. Now, missing the mark means a guaranteed and fixed penalty. Under the new structure, it would be only one component of a score that yields a sliding scale of bonuses and penalties.
But how much the change helps providers depends on how HHS designs the formula, Tennant said, noting that the EHR incentive program grew in scope significantly over time. In comparison to meaningful use, the new program “might be more punitive. (We) have to be careful in the design of the payment structure.”
Technologies other than EHRs would be encouraged by the portion of the MIPS score tied to clinical-practice improvement activities. The bill specifically names telehealth and remote monitoring as potential score-boosters.
The legislation also would reward “timely exchange of clinical information to patients and other providers” and “after-hours access to clinician advice,” a category that could potentially be fulfilled through video visits or secure messaging with doctors.
Kristen Ratcliff, a partner at lobbying firm Sirona Strategies, which manages the telehealth trade group Alliance for Connected Care, called the bill “a significant opportunity for all types of vendors—health IT vendors, telehealth providers, predictive analytic companies and more."
Jeff Smith, vice president of public policy for the College of Healthcare Information Management Executives, said he's a “bit more conservative in his assessment.”
“I would say that the legislation creates the possibility of driving the adoption of health IT tools beyond what (meaningful use) requires,” he continued. Ultimately, he said, it depends on how HHS defines the formula.
The EHR incentive program, enacted as the HITECH provision of the 2009 stimulus law, has paid out more than $29.1 billion to hospitals, physicians and other professionals for adopting and using health IT.
Saurabh Singh, an analyst for Morgan Stanley, agreed with Smith's more conservative take. “I am sure it is an incremental positive for the industry, but I just don't see it as the same magnitude of opportunity that HITECH enabled.”
