Health IT grows in significance under final MACRA rule

The final MACRA rule declared on the day of Friday by the Department of Health and Human Services involves a latest Quality Payment Program tying physician payments to quality of care, which will need providers to depend heavily on healthcare IT, in accordance to CMS Acting Administrator Andy Slavitt.

Under the final MACRA rule, Slavitt asserts that the vendor community has a “key” and unprecedented opportunity to assist clinicians to make better the flow of electronic health information and increase the quality of patient care.

Slavitt claimed that several of the provisions in MACRA straightly relate to the use of certified health IT like EHRs, involving the Advancing Care Information performance category under the Quality Payment Program.

Particularly, the document mentions that the Quality Payment Program’s “paths for clinicians and groups—the Merit-based Incentive Payment System (MIPS) and the Advanced Alternate Payment Models (Advanced APMs)—require utilization of certified EHR technology to exchange data across providers and with sufferers to support improved care delivery, involving patient engagement and care coordination.”

Slavitt stated that the objectives in the Advancing Care Information performance category of MIPS assert measures that support clinical effectiveness, data security and patient safety, patient engagement, as well as health information exchange. Although, he pointed out that the final MACRA rule doesn’t need reporting on the clinical decision support and computerized physician order entry measures, while decreasing the number of measures clinicians must report to 5 measures that are contended on interoperability—down from eighteen measures in Stage 3 Meaningful Use and from eleven measures in the originally proposed rule for the Quality Payment Program.

In accordance to Slavitt, the concentration is on rewarding high-value, patient-centered care, which will be depicted in $1 billion in payments to providers in the year of 2017 for better quality healthcare. Although, at the similar time, he lamented the logic that technology doesn’t still support physicians in the way that they require.

“For physicians to be victorious in value-based care, it needs latest technology that is convenient to use, easier and more connected, less burdensome and intrusive, that supports the complication of medicine but also simplifies by delivering exactly what sufferers and doctors require when they need it—and no more,” Slavitt stated.

“Instead of prescribing innovation,” he added that vendors should be “targeting to open up the playing field to make solutions that help in value-based care easier.” Interoperability is crucial, summarized Slavitt, who asserted that industry must “launch the ecosystem so that physicians can choose applications that work seamlessly with electronic health records to deal their requirements.”

For its part, ONC’s 2015 Edition Health IT Certification Criteria issued last year will give the HIT foundation for the new Quality Payment Program, involving interoperability-focused standards for certified EHR systems. As part of the 2015 Edition, vendors will be needed to publish application programming interfaces (API) to make it more convenient for software programs like mobile apps to access data from other programs.

The fact sheet of ONC on the new Quality Payment Program and the role of health information technology can be found here.

 

Reviewing Meaningful Use to Accelerate Success?

A research team recommends policymakers for reviewing meaningful use or transition from Stage 1 Meaningful Use to Stage 2 that facilitate a successful transition to MIPS.

To make sure the consistent clinical quality when transitioning from Stage 2 Meaningful Use to Advancing Care Information under MIPS, policymakers should consider reviewing meaningful use and the initial transition from Stage 1 to Stage 2 Meaningful use.

In a latest study published in the Journal of the American Medical Informatics Association, researchers did merely that — assessing and reviewing the consistency of clinical quality as healthcare agencies progressed through the first 2 phases of meaningful use.

The research team evaluated a longitudinal research at hospitals affiliated with Brigham and Women’s Hospital between the month of September and November 2012 and October and December 2014. These were the timeframes during which the network attested to Stage 1 and Stage 2 Meaningful Use, respectively.

During these time periods, the researchers looked at the 7 clinical quality measures that sustained consistent between the 2 stages of the program: influenza immunization, hypertension control, and counseling, tobacco use assessment, diabetes control, senior weight screening follow-up, Chlamydia screening, and adult weight screening and follow-up.

From one program stage to the next, the researchers observed betterment in hypertension control (35 to 40%), influenza immunization (63 to 68%), tobacco use assessment and counseling (86 to 96%), and diabetes control (93 to 96%).

Senior weight screening worsened from 54% in Stage 1 Meaningful Use to 49% in Stage 2 Meaningful Use. Adult weight and Chlamydia screening sustained to be consistent.

“While our research doesn’t make a causal link between the transition to MU2 and quality, it recommends that few of the elements, like electronic reporting of clinical quality measures at stricter thresholds, secure messaging, and information exchange, might have a positive impact on quality,” the researchers concluded.

While the Advancing Care Information performance category does involve several differences from meaningful use, it yet consists some of the same elements. This might be depicted in reviewing meaningful use and transition from Stage 1 to Stage 2 Meaningful Use.

“Several elements of MU2 are preserved in the proposed rule, like mandated reporting of institution-selected quality measures at stricter thresholds, secure messaging, and information exchange,” the researchers elaborated. “Hence, the affect of reviewing meaningful use and transitioning from MU1 to MU2 has significant implications for the latest policy, specifically for agencies that will be transitioning directly from MU1 to the latest program.”

Given these outcomes, the researchers recommend the following steps for the development and progress of MACRA implementation.

First, CMS should make sure that the MACRA measures are rooted in evidence that shows they will make better the outcomes. For instance, the CMS proposal to remove clinical decision support might not be effective because there is little evidence to recommend that clinical decision support limits care quality. In accordance to the researchers, most evidence proves that clinical decision support really improves quality.

However, scant evidence supports the efficiency of secure direct messaging between patient and provider. The researchers recommend CMS look at measures to make sure that they are not inquiring eligible clinicians to report measures that aren’t proven to empower care quality. Rather, CMS should conduct research to evaluate how effective this measure is.

Second, the researchers recommend CMS continue setting a high bar for providers. The heightened expectations providers were subject to in Stage 2 Meaningful Use compared to Stage 1 might have been a driving factor behind the increased care quality. Should providers be held to a lower or more stagnant standard, they may not continuously improve quality.

Third, CMS should review how providers utilize certified EHR technology for clinical quality measures reporting.

Fourth, CMS should make certain that providers can track their Advancing Care Information progress through their own EHRs. In accordance to the researchers, several providers were capable to do this during either stage of meaningful use and found it useful for their successful program attestation. Such abilities could likewise be beneficial under MACRA.