Can the new Merit-based Incentive Payment System and meaningful use stage 3 co-exist? Or will they essentially cripple providers?

We'll find out. But at this point there's little evidence to suggest it will be simple or straightforward. 

Meaningful use stage 3, with an entire saga of its own, is part of the HITECH Act passed in 2009 to incentivize electronic health record adoption. The more recently adopted MIPS is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed last March to replace the Sustainable Growth Rate (SGR) method of reimbursing Medicare physicians, begun in 1997.

Congress had good intentions in passing both laws. One meant to advance the adoption of EHRs and, hence, improve health and contain costs. The other, a long time coming, is meant to remedy a broken reimbursement method. But when they both kick in, difficulties are likely to arise in implemenation and timing of the two measures.

Enough confusion exists that industry leaders are already wondering whether meaningful use stage 3 and MIPS can be implemented simultaneously.

"That is the billion-dollar question," said Steven Waldren, MD, director of the American Academy of Family Physicians' Center for Health IT.

One problem is both Stage 3 and MIPS need very specific health IT capabilities, and the meaning use kinks have yet to be been ironed out. Eligible providers currently await a revision of its requirements, which then must be performed on a very tight schedule.

[Related: Pending meaningful use rules are making hospitals and EHR makers very nervous.]

Compounding the chaos: The timetable for MIPS regulation release is completely unknown. A spokesman for the Centers for Medicare & Medicaid Services (CMS) said the agency is unable to discuss any details of a pending regulation. MIPS will not take effect until 2019, we know that much, which leaves a long time for the dilemma to hang over providers' heads.

"It boils down to usability and interoperability concerns," Waldren said. "Let's finish those and make sure they are working really well before we try to build something completely new."

Additionally, Waldren is concerned about forthcoming data requirements around quality measurement.

"We're s still not using the rich clinical data that could be pulled out of EHRs," he explained. "EHRs weren't originally designed for a population health or a value-based payment mentality."

What's more, some things just can't be forced.

"When Congress developed the MACRA legislation, they combined all the quality programs into a single MIPS score," said Robert Tennant, director of HIT policy at the Medical Group Management Association.

One of the challenges in general with quality reporting programs, including meaningful use, is that they are a lookback for penalties instead of a look forward, Tennant explained. In the case of meaningful use, they're looking at performance from one year to apply a negative payment adjustment two years forward.

"This is going to be particularly problematic when MIPS starts in 2019, because CMS most likely will use data from 2017," Tennant said. "Meaningful use in particular is still very much in flux."

According to consultant Jason Fortin, senior advisor with Impact Advisors, despite the hundreds of anticipated pages of regulation CMS will issue for MIPS, and the ensuing updates based on stakeholder comments, the actual roll-out will be when things get difficult.

"MIPS has the potential to be very, very complicated," Fortin said. 

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