During the Obama administration, there were a number of health care regulation acts that
changed have health care is delivered in the United States. While the Patient Protection and
Affordable Care Act was President Obama’s cornerstone of his presidency, Congress also passed
the Health Information Technology for Economic and Clinical Health (HITECH) Act. The goal was
to encourage faster implementation of electronic health records. This led to Medicare Electronic
Health Records (EHR) Incentive program, which is referred as meaningful use. Then
approximately five years later, Medicare Access and CHIP Reauthorization Act (MARCA) was
passed and meaningful was incorporated with other Medicare quality improvement programs
to establish the Merit-based Incentive Payment System (MIPS). These programs have changed
how health care is implemented in United States by making healthcare go digital.
EHR systems are not new but the government wanted to persuade health care
organizations into adoption. The meaningful use program was not started to cover the cost of
implementation but to give incentives to switch to EHR (Meyer, 2018. pg. 318). The program
was set to have three stages of increasing criteria to meet for incentives. The criteria include but
limited to performance benchmarks associated to quality, safety, efficiency, care coordination,
and patient/family engagement (Brice & et al., 2018). After several years, the meaningful use
program become mandatory and organization could face penalties if they do not meet the
standards of the programs. Considering the adoption and use of EHR, the meaningful use
program could be considered a success (Brice & et al., 2018). MIPS was implemented to include
meaningful use. In 2015, MARCA was passed into law and changed how healthcare coverage
was paid. Payments for healthcare were based on fee for service and were adjusted for standard
adherence of four categories including meaningful use (Doherty, 2015).
EHR has been widely accepted across the United States. The government wanted EHR to
implemented because they thought it could help close quality gaps and improve clinical
outcomes (Brice & et al., 2018). There are many markers for improved clinical outcomes, two
common ones are 30-day remission rates and returned ED visits. An analysis of 160 hospitals
showed that there was no statistical improvement of 30-day remission rates and a slight
deterioration on returned ED visits (Brice & et al., 2018). Authors of the study noted the
deterioration was not likely from the EHR implementation.
MIPS is the new healthcare reimbursement system in the United States. MIPS attempts to
regulate healthcare cost and improve the quality in the United States (Puentes & et al., 2018).
MIPS was intended to build off of meaningful use and improve quality and reduce health
disparity (“Meaningful Use”, 2019). MIPS does identify gaps of health care and disparities, but it
can exacerbate the inequalities (Eggleton & et al., 2018). Healthcare disparities can be
geological and financial barriers to healthcare access. MIPS does not specifically address these
barriers and gives to incentive to address these inequalities (Eggleton & et al., 2018).
With HITECH Act and MARCA, healthcare in the United States took a big step in the
digital age. Meaningful use and MIPS attempted to incorporate quality improvements, financial
incentives, and health information technology. While there have been some success there is
still a need for improvement to improve healthcare.
Brice, Y. N., Joynt, K. E., Tompkins, C. P., & Ritter, G. A. (2018). Meaningful use and hospital
performance on post acute utilization indicators.‐ Health services research, 53(2), 803-
823. Doi: 10.1111/1475-6773.12677
Doherty, R. B. (2015). Goodbye, sustainable growth rate-hello, merit-based incentive payment
system. Annals of Internal Medicine, 163(2), 138. Doi:10.7326/M15-0992
Eggleton, K., Liaw, W., & Bazemore, A. (2017). Impact of gaps in merit-based incentive payment
system measures on marginalized populations. The Annals of Family Medicine, 15(3), 255-257.
Meaningful Use. Healthit.gov. (2019). Retrieved 7 August 2020, from
https://www.healthit.gov/topic/meaningful-use-and-macra/meaningful-use.
Meyer, C. (2018). Implementing and upgrading an information system. In R. Nelson & N.
Staggers (eds.), Health informatics: an interprofessional approach (2nd ed., p. 318). Elsevier.
Puentes, J., Stojkic, I., Coffin, J., & Williams, L. (2018). The merit-based incentive payment
system: What practicing clinicians need to know. The Journal of medical practice
management, 34(3), 142-145.
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