The Merit-Based Incentive Payment System
Meaningful Use Is Not Dead: It’s Reincarnated
Last year, the MACRA bill was signed into law and in the pages of minutiae and legal language, it was outlined what would happen to meaningful use. Basically, the PQRS (Physician Quality Reporting System) and MU would be joined into one and give birth to MIPS (Merit-Based Incentive Payment System). Under the new program, doctors are required to report clinical information as well as IT data.
What the metrics we are now required to report is unknown as of yet.
CMS hinted that they heard our concerns over the ill-devised MU program. However, our voices are not what killed it: the technology and EHR vendors did. A key functionality of MU was supposed to be interoperability.
However, EHR vendors failed to create any significant degree of interoperability. The technology just has not proved capable of building effective bridges to connect systems. And the vendors are not willing to work together to make it happen. There is too much competition and they all want to sell their own products. We will never see any true interoperability.
The government spent millions on a program that never had the capacity to work. They forced healthcare providers to participate in a program that did not possess the ability to work the way it was supposed under the threat of financial penalties. And, when the time came to focus on stage 3, the realization that technology doesn’t work in the way they were trying to force us to use it was realized. MU as we know it died because it was fatally flawed.
However, the government, after spending millions of dollars on it and forcing it upon us against much public outcries will never admit this. Instead, they planned out the new and improved version of their ill-devised, terminally afflicted MU program, and put it into law under the auspices of the MACRA bill.
Doctors used to have a choice whether or not to comply with this onerous, time-consuming monstrosity of a program. Sure, we would be hit with penalties against our reimbursements. Many of us thought MU was not worth the amount of money CMS would penalize us. I personally completed the first 2 stages but I understand how many would not want to.
MIPS will entail parts of both the PQRS and MU programs. And doctors no longer have any choice in it. If we want to be paid for our services, we must comply. It is now federal law. Doctors and other providers will be paid based on their data and outcomes, not the services they provide to their patients.
Imagine this scenario: one of my patients is a diabetic. He likes to eat cookies and I have spent hours trying to encourage him to change to a more healthy diet. He listens and does what he wants. His HbA1C is 11.5.
Dr. Jones has a diabetic who is really into healthy lifestyle. His HbA1c is 6.1. Dr. Jones spends 10 minutes with him, refills his prescriptions and sends him on his way. Who will get paid more under MIPS? The doctor who spent more time and effort with the patient or the doctor with healthier patients? It seems counter-intuitive but time and effort will not be appreciated under this system. We will be penalized for our patients’ bad choices and disincentivized to make the effort to get them to change.
In fact, patients who are more complicated and have more chronic diseases are going to be greatly harmed under this system. They need more time and care but doctors cannot afford to do it for free. The more ill patients will find it hard to access the medical system.
For those who say MU is dead, it is coming back with a vengeance. Doctors and patients both stand to lose greatly in such a system. Are we going to celebrate the meaningless demise of a meaningless system and watch as it rolls out revamped and steam rolls us over? Or is it time for public outcry against big brother legally taking patients’ data out of the exam room?
