Specialists caution against building MACRA on a flawed cornerstone

Andrew Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS), recently surprised many by voicing what healthcare providers in the country had known for years: CMS’ staged Meaningful Use program had outlived its usefulness. What started out as a worthy idea to encourage use of electronic health records (EHRs) to improve care quality quickly crumbled for providers and their patients.

To meet Meaningful Use, physicians attempted to comply with arbitrary and impossible requirements associated with the use of certified EHRs. They purchased expensive technology systems and invested an incredible amount of time on training and data input, time they could have spent on patient care. To add insult to injury, the “all or nothing” nature of the program’s reporting and scoring ended up being time-consuming and financially punitive.  

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But the worst was yet to come. Without consistent, national standards for interoperability, EHR vendors developed proprietary systems that could not “talk” to one another, making the promised interchange of patient information to improve care impossible or prohibitively expensive for providers—further proof that the program needed revamping.

When a patient’s medical history cannot be shared among that patient’s health providers in a timely way, there is a genuine risk to his/her health and to our nation’s wallet. In one relatively harmless case in New Mexico, a patient with severe back pain was hospitalized. The hospital’s spine specialist determined that an MRI was necessary. The patient’s primary care physician had already obtained an MRI, but the images could not be transmitted to the hospital due to incompatible EHR software. After a literally painful delay, a second MRI had to be ordered at additional expense and the patient was diagnosed and treated. Imagine that scenario multiplied thousands of times across the country and then you can start to see the problem.

Recognizing these issues, Congress acted in late 2015 to provide providers with the opportunity to apply for a hardship exception for EHR noncompliance in 2015. But exception should not be the rule. More needs to be done if we do not want a repeat performance.

Despite its many flaws, Meaningful Use will be a cornerstone of the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), which is intended to focus less on compliance with arbitrary rules and more on paying for value and better patient care. However, unless immediate and significant changes are made to the Meaningful Use program and the interoperability of EHRs is addressed, value and better patient care facilitated by health IT will remain unattainable ideals.   

The rules CMS and the Office of the National Coordinator for Health Information Technology must implement are merely a reflection of our nation’s laws. Congress must address EHR interoperability and the Meaningful Use program before yet another promising opportunity is lost.

The House already has done its part by passing H.R. 6, the “21st Century Cures Act,” which recognizes interoperability as a key issue. The Senate just released a promising discussion draft of a related bill that calls for changes to current documentation mandates and encourages transparency and usability among EHR vendors. It’s an encouraging start.

With the implementation of MACRA, we have the opportunity to build something truly meaningful to improve patient care in our country. For the sake of our patients, let’s build a truly robust, patient-centric and nationwide interoperable health information infrastructure that would provide access to the right information at the right time.

Valadka is the chairman of the Department of Neurosurgery at Virginia Commonwealth University Medical Center and serves as spokesperson for the Alliance of Specialty Medicine, a coalition of national medical societies representing more than 100,000 specialty physicians in the United States. This non-partisan group is dedicated to the development of sound federal healthcare policy that fosters patient access to the highest quality specialty care.

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