HIT Policy Committee: Exploring 'alternate pathways' for MU

Despite the increase in EHR adoption and other gains driven by Meaningful Use (MU), implementation and meeting of reporting requirements is a costly, burdensome prospect. To address such concerns, during its April 3 meeting, the HIT Policy Committee’s MU work group discussed plans to consolidate quality measures and establish a deeming program that would reward good performance through reduced reporting requirements.

While the healthcare community is at a tipping point with MU in shifting from getting functionality into the EHR to moving data around and improving outcomes, committee vice chair Paul Tang, MD, MS, VP, CMIO of the Palo Alto Medical Foundation, said “we’re thinking of alternative ways to move the program along.”

The MU work group looked at Stages 1 and 2 experiences and asked, what are the implications for Stage 3? Tang said. "We’re building up a critical mass. The mandatory floor is creating the network effects we wanted." The gains from Stages 1 and 2 are persisting, he said. “People are holding their gains. This is all very encouraging but we’ve heard that the reporting requirements are hard. We want to reduce the burden on complying with this program.”

To reduce the burden on providers, the work group discussed consolidation of quality measures in an effort to “simplify things but advance them at the same time,” said Christine Bechtel, VP of the National Partnership for Women & Families, who led the subgroup on consolidation. The group looked at all 43 objectives originally proposed for Stage 3 and consolidated them into 25 by merging concepts and reducing duplication, she said.

The work group also has explored the possibility of deeming certain providers as a special category of meaningful users in an effort to emphasize good performance and give credit for significant improvement. Those providers could face lesser requirements in an effort “to promote innovation, reduce the burden of complying with the regulations and reward good performance,” said Bechtel. They discussed providers having this new optional pathway for those that have proved they have taken advantage of the functionality of health IT or continuing on the traditional pathway of complying with 25 objectives so that no one is left out.

The work group acknowledges there are a limited number of outcomes-related quality measures in the specialty areas. The ability to continue using the traditional pathway “doesn’t exclude anybody but continues to pressure all of us to do better. We’re trying to reward good behavior, reduce burden, and let the market-- the desire to produce good outcomes--pull people along,” said Tang.

Farzad Mostashari, MD, ScM, national coordinator of health IT, said, depending on how this effort goes, it could be applied to other areas such as accountable care. “How big a door is the work group thinking of opening here on the deeming side?”

Tang said for now, the work group did not think much outside the EHR Incentive Program.

“I would urge you to be even bolder,” Mostashari said. There are opportunities to streamline and simplify, and provide alternatives in MU moving ahead. With no Stage 3 rulemaking to focus on this year, “there is room for more reflection instead of headlong rush. I think it’s the right idea for us to take a little pause and a little reflection as we move ahead.”