How Medicare's new payment overhaul tries to change how docs use tech

Medicare's new system for paying physicians will kill off the so-called “meaningful use” regime the government has used for the past five years to judge whether providers deserved to be rewarded for using electronic health records.

But Medicare will still hold doctors accountable for incorporating information technology into their practices. And clinicians may still struggle to clear the bar, even though the new law and the proposed rule the CMS issued last week have made significant efforts to make the new framework less rigid and more valuable.

Under the Medicare Access and CHIP Reauthorization Act (MACRA), the CMS will roll its new IT metrics, to be dubbed Advancing Care Information, into a unified incentive-payment system applicable to most physicians.

The IT part, accounting for 25% of physicians' overall score, emphasizes interoperability, information exchange and security.

It also makes an effort to reorient how Medicare gauges the success of IT toward how useful it is to clinicians and patients, including through requiring the use of application program interfaces, commonly known as APIs. APIs make it possible for data to flow between different systems.

The new framework would omit requirements such as clinical decision support and computerized provider- order entry in physician EHRs.

And by allowing physicians to choose from a number of categories, the program seeks to correct the all-or-nothing approach that was a common gripe lobbed at the former meaningful-use rules.

The CMS has touted that the program allows physicians to choose several paths to achieve a maximum score in the IT category, but that flexibility only comes into play for their “performance” score. Physicians must satisfy all of the requirements for their base score (half the total), or they'll receive a zero.

“We appreciate the attempt at flexibility, but we really want to see a system that maybe is a little bit less prescriptive,” said Robert Tennant, health IT policy director for the Medical Group Management Association.

Physicians would have to demonstrate that their EHR system isn't “data-blocking,” a term the government uses to refer to a broad range of activities that hinder the sharing of information among various IT products, often for competitive reasons.

Another notable provision would require physicians and hospitals to allow HHS' Office of the National Coordinator for Health Information Technology to evaluate the performance of their EHR systems, giving the agency authority as a post-market reviewer of health IT products to make sure they work as promised in the real world.

Many physicians would welcome that, said Dr. Steve Waldren, director of the American Academy of Family Physicians' Alliance for eHealth Innovation. Some AAFP members have discovered that the systems they bought don't have certain quality measurement or interoperability features that were promised by the manufacturer.

Waldren stressed, however, that providers need to be held harmless if their EHR doesn't pass a field inspection because of manufacturer issues, and the ONC needs to maintain grace periods that allow providers to switch products if theirs are decertified.

The proposed rule also asserts the importance of technology in healthcare beyond the realm of patient records—namely in telehealth. The CMS proposes to “include telehealth services in the definition of patient-facing encounters,” a practice some states and insurers have resisted.

“If the way that the MACRA law treats technology continues and branches off, it could be a game-changer for healthcare,” said Robert Horne, executive director of Health IT Now, a coalition of payers, provider organizations and patient-advocacy groups.