The Medicare Access and CHIP Reauthorization Act (MACRA) proposes a new approach, with new branding labels, to paying clinicians for the value and the quality of care that they provide by replacing a patchwork of existing quality-related programs, including the Electronic Health Records (EHRs) Incentive Programs, also known as “Meaningful Use.”  Under MACRA’s Merit-Based Incentive Payment System (MIPS), Advancing Care Information is one of four performance measures. In our first blog on the proposed rule, CMS Releases Proposed Rule for MACRA Implementation and Merit Based Incentive Payment Systems (MIPS), we discussed MIPS more fully.  Our final MACRA blog will discuss the Alternative Payment Models (APMs).

Advancing Care Information is a MIPS performance category focused on use of electronic health records (“EHR”).  Clinicians will get to choose to report customizable measures that reflect how they use EHR technology in their day-to-day practice, with a particular emphasis on interoperability and information exchange. Clinicians would need to use technologies, standards, policies, and practices to assure that their EHR technology is interoperatble, compliant with Office of the National Coordinator for Health IT (ONC) standards (including allowing patients timely access to EHR information to view, download, and transmit) and that it allows for the exchange of structured health information with other health care providers (including unaffiliated providers) using different EHR vendors.

Unlike the existing Meaningful Use program, the Advancing Care Information program would not require all-or-nothing EHR measurement or quarterly reporting.  Note that while the Advancing Care Information program replaces the meaningful use program for physicians for Medicare, that program remains unchanged for hospitals and as well as for eligible professionals (“EPs”) under Medicaid.

In a CMS blog post announcing the rule, Andy Slavitt, the Acting Administrator, Centers for Medicare & Medicaid Services, and Dr. Karen DeSalvo, National Coordinator, ONC, said that compared to the existing Medicare Meaningful Use program for physicians, the new Advancing Care Information approach would increase flexibility, reduce burden, and improve patient outcomes by:

• Allowing physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice

• Simplify the process for achievement and provide multiple paths for success

• Align with the Office of the National Coordinator for Health Information Technology’s 2015 Edition Health IT Certification Criteria

• Emphasize interoperability, information exchange, and security measures and require patients to access to their health information through use of application programming interfaces (APIs)

• Simplify reporting by no longer requiring all-or-nothing EHR measurement or quality reporting

• Reduce the number of measures to an all-time low of 11 measures, down from 18 measures, and no longer require reporting on the Clinical Decision Support and the Computerized Provider Order Entry measures

• Exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group

In MACRA, Congress elevated its concerns about barriers to interoperability to a new level. MACRA requires EPs to demonstrate that he or she has not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of certified EHR technology. The Proposed Rule creates a new program for ONC surveillance and direct review of certified EHR technology with required cooperation by EPs, including responding in a timely manner and in good faith to requests for information (telephone inquiries, written surveys) about the performance of EHR technology.  Also, the program includes provisions for the prevention of information blocking. To be a meaningful EHR user under the program, a provider must demonstrate that he or she has not taken action to limit or restrict the compatibility or interoperability of certified EHR technology.

In moving away from the meaningful use program for EPs, Congress understood the many difficulties with that program.  Despite these changes, MACRA’s Advancing Care Information program is still intended to measure a physician’s meaningful use of certified EHR technology and its requirements remain very similar to those included in the Meaningful Use rule released by CMS last year .  CMS has, however, made an effort to reduce and streamline reporting obligations and allow physicians greater flexibility.

If finalized, the Advancing Care Information program would replace the current Meaningful Use program and reporting would begin January 1, 2017.