Though Centers for Medicare and Medicaid Services officials on Tuesday tried to clear up confusion over changes and the ultimate replacement of meaningful use, the future is very much in question according one expert who is slated to talk about the subject at the HIMSS16 conference.

[Also: Meaningful use still in effect, Slavitt and DeSalvo say]

Elliot Sloane, president of the Center for Healthcare Information Research and Policy, has a theory: Instead of precision medicine, the evolving meaningful use program will usher in “precision reimbursement.”

Sloane said that he expects CMS to transition from Meaningful Use to Medicare Access & CHIP Reauthorization Act of 2015, or MACRA. That means continuing to use certified EHRs and electronic quality reporting but will turn its attention to quality as opposed to adoption of technical sharing.

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“There still has to be standardized EHRs, reliable healthcare information exchange, consistent quality measurement tools, “ Sloane said. CMS “identified this in the MACRA plan.”

Sloane will be presenting the Feb. 29 session “Standards: Moving Beyond Meaningful Use” at HIMSS16 along with Terrence O’Malley, MD, a physician at Partners HealthCare.

The presentation comes at an opportune time: CMS acting administrator Andy Slavitt revealed in January that meaningful use “as it has existed will now be effectively over and replaced with something better.”

[Also: Meaningful use will likely end in 2016]

The MACRA document, released by CMS in December 2015, has a timeline built out to 2019, targeting 30 percent of Medicare payments tied to quality or value by 2016 and 50 percent by 2019.

“These are measurable goals to move the Medicare program and our healthcare system at large toward paying providers based on quality, rather than quantity, of care,” CMS stated.

That’s where Sloane’s theory of precision reimbursement comes into play.

“If the average payment is $1, then the only way it works is if hospitals and physicians who provide better than average service might get $1.10,” Sloane said. “But that means those who deliver less than optimal quality will only get $0.90.”

Sloane anticipates this new era to be a market-driven, Adam Smith-like approach that rewards better service.

One worry Sloane has is organizations paring down the services they aren’t as good at, thereby keeping their reimbursement rates up but also creating a void for community health services.

“We have to figure out how this all ties together. There will be things I haven’t considered. There are likely to be penalties that aren’t visible,” Sloane said. “There will be more specific penalties for measureable errors.”

The shift to value-based reimbursement is consistent to what the government has said it would do all along. The only thing that is new, Sloane added, is that meaningful use didn’t have a way to transition from technology-based rewards to outcomes.

What’s more, CMS and the Office of the National Coordinator for Health IT fueling the digitization of America’s healthcare system via meaningful use simultaneously paved the way for this new payment model.

“We’ve been measuring the data requirements and validating that data,” Sloane explained, “and now we switch to more intentional use of those measurements.”

The HIMSS16 session “Standards: Moving Beyond Meaningful Use,” is scheduled for Feb. 29, 2016 from 9:30 to 10:30 a.m. in the Sands Expo Convention Center Bellini 2004.

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