Medicare chief discusses new Merit-Based Incentive Payment System

Amy Farouk , Past News Editor

Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt on Monday said that the agency is changing its culture to focus more on listening to physician needs and giving them the freedom they need to keep patients at the center of the practice of medicine.

Regaining physicians’ trust

“The day-to-day work of CMS at this point in time is to start up new consumer- and provider-facing capabilities, and then scale them, nurture and mature them,” Slavitt said during a panel at the 34th annual J.P. Morgan Healthcare Conference in San Francisco. “It demands that we change our culture and execute with clarity, with discipline and with collaboration. Things we haven’t always been known for.”

“We have to get the hearts and minds of the physicians back because these are the people that our beneficiaries and consumers count on every day,” he said. “And I think we lost them.”

Referring to execution of the electronic health record (EHR) meaningful use program, Slavitt noted that the agency’s previous regulatory approach created difficulties. “When in doubt, I think, do less and figure it out. … I remind people all the time that good ideas piled on top of other good ideas become bad ideas pretty quickly because they sink under their own weight.”

Instead, Slavitt said he views the agency’s role in setting policy and acting as a regulator as a two-way street. “Here our most important job is to listen and learn,” he said. “Policy is often a blunt instrument, and in the real world, it takes continual adjusting.”

The recent ICD-10 transition is evidence of how this collaborative approach can work well. Listening to physician needs, CMS adopted AMA recommendations to make implementation of the new code set less disruptive for their practices.

Slavitt now is turning his attention to a critical issue that has plagued the nation’s physicians for the past several years.

The end of meaningful use and the start of something new

“The meaningful use program as it has existed will now be effectively over and replaced with something better,” Slavitt said.

In its place will be the new Merit-Based Incentive Payment System (MIPS), called for in the Medicare Access and CHIP Reauthorization Act of 2015, which is intended to sunset the three existing reporting programs and streamline them into a single program.

“The stakes are high for this program,” Slavitt said. “As any physician will tell you, physician burden and frustration levels are real. Programs designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don’t get it.”

“At its core, we need to simplify,” he said. “That program needs to be streamlined and simple to use so physicians can focus where they need to—on their patients.”

Importantly, Slavitt noted that they are taking an “outside-in” approach to designing this program. “Since late last year, we have been working side by side with physician organizations across many communities—including with great advocacy from the AMA—and have listened to the needs and concerns of many,” he said.

In November, the AMA and 100 state and specialty medical associations submitted 10 principles to guide the foundation of the MIPS, and provided detailed comments as part of its ongoing efforts on this issue. The AMA also continues to drive home the message that the problems inherent in the meaningful use program must not be adopted into MIPS. To that end, the AMA last month submitted a detailed framework for what needs to change.

“Administrator Slavitt acknowledged the frustration of physicians attempting to comply with the meaningful use regulations and pledged to work collaboratively with physicians to replace the program with a more effective alternative,” said AMA CEO and Executive Vice President James L. Madara, MD. “His leadership is a model for how Washington should work. He listened to working physicians who said the meaningful use program made them choose between following byzantine technological requirements and spending more time with their patients. This is a win for patients, physicians and common sense.”

Slavitt said several themes will be guiding implementation of the new system:

  • Emphasis will be placed on outcomes. “The focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients,” Slavitt said.
  • Health IT will be about physician needs. “Providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government,” he said. “Technology must be user-centered and support physicians, not distract them.”
  • Vendors will need to unlock data. Slavitt said requirements will be put in place to “allow apps, analytic tools and connected technologies to get data in and out of an EHR securely.”
  • Vendors will need to make health IT interoperable. “We are deadly serious about interoperability,” he said. “We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging patients in their care.”

“The AMA will continue to work with CMS and the Administration on moving to a new framework for EHRs,” Dr. Madara said. “Physicians are at the front lines of these programs, and their insights should guide how the regulations are written and implemented.”