The Centers for Medicare and Medicaid Services (CMS) recently released its final rule to implement Stage 3 Meaningful Use (MU) participation requirements as well as changes to the existing MU requirements in 2015, 2016, and 2017.
Here are five things radiologists should know about the final rule…
1. Radiologists will continue to avoid payment adjustments as before
The final rule did not modify or eliminate the original significant hardship exception options. Diagnostic radiologists, nuclear medicine physicians, and interventional radiologists will continue to automatically obtain hardship exceptions based on PECOS specialty code on an annual basis for up to 5 total years. This will likely remain true until the future Merit-based Incentive Payment System (MIPS) assumes control over the financial implications of the Medicare incentive programs in 2019.
2. Stage 3 MU will be far less burdensome for participating radiologists than any previous stage
Radiologists without office visits will likely meet the exclusions of all but 3 or 4 of the Stage 3 objectives/measures. The remaining objectives/measures involve:
- protecting patient data,
- enabling five distinct clinical decision support (CDS) interventions/rules,
- incorporating and reconciling certain summary of care record (C-CDA) data into CEHRT, and,
- actively engaging with three registries.
Some radiologists may be able to be excluded from the third one above, depending on certain factors.
Beyond completing the MU objectives/measures, participants will need to report clinical quality measures (CQMs) and have certified EHR technology (CEHRT) “equipped” (accessed remotely, brought it on mobile device, or installed) at a location or combination of locations in which they have >50% patient encounters. The CQMs and CQM reporting options will be determined in future payment rules.
Stage 3 will be optional with a ninety-day reporting period in 2017 and mandatory with yearlong reporting periods in 2018 and beyond.
3. Modified Stage 2 in 2015, 2016, and 2017 is an improvement over the previous Stage 1 and Stage 2 requirements, but not as flexible as Stage 3 for radiologists
For ninety-day reporting periods in 2015, and full-year reporting periods in 2016 and (optionally) 2017, MU participants will be in “modified Stage 2.” Modified Stage 2 is essentially a slimmed down and consolidated version of Stage 2 MU objectives/measures. These modifications do not alter the currently acceptable CQMs or CQM reporting options.
All MU participants in modified Stage 2, including those who were scheduled to be in Stage 1, need to complete a smaller set of Stage 2 MU objectives. Participants slated for Stage 1 (i.e., first or second-year participants) can use certain Stage 1 thresholds in 2015. Those participants also have new “alternate exclusions” available to them. Based on 2014 participation statistics, and because of the hardship exception removing any incentive to start participating for the first time in 2015, I believe fewer than 200 diagnostic radiologists would have been in Stage 1 in 2015.
Diagnostic radiologists who were scheduled to be in Stage 2 in 2015 and 2016—i.e., most radiologist MU participants—would likely need to complete the measures of up to 5 total MU objectives related to:
- protecting patient data,
- enabling five distinct clinical decision support (CDS) interventions/rules,
- medication reconciliation,
- providing patients with the ability to view/download/transmit data, and at least 1 patient has done so (in 2015 and 2016), and
- actively engaging with two registries.
It is possible for some radiologists to meet the various measure exclusions needed to avoid the fifth objective above. Depending on interpretation, it may be possible for some radiologists to exclude from the fourth as well.
4. The “imaging results access” objective was eliminated from MU
There are pros and cons to the elimination of the referring physician-focused Stage 2 objective/measure to make imaging results accessible via CEHRT. While images and accompanying data continue to be critical to the patient’s record, many radiology practices were concerned that the MU regulatory requirement was sometimes misused by certain EHR vendors and hospitals/systems to misinform and discourage ordering physicians from referring their patients to unaffiliated imaging providers.
In the end, this and other previous Stage 2 MU objectives were eliminated by CMS from the modified Stage 2 MU requirements as part of the agency’s effort to simplify and consolidate MU in 2015, 2016, and 2017. Image-sharing and connectivity with referring physicians will continue to be important for patient care, customer service, and the future of radiology—it simply will no longer be part of the MU regulatory requirements for referring physicians.
5. Pay close attention to next year’s MIPS rulemaking
Ultimately, whether radiologists participate in Stage 3 MU will depend entirely on the outcome of the MIPS rulemaking in 2016. MIPS will serve as a likely less-preferred alternative to Alternative Payment Models (APMs) in 2019 and beyond. The MIPS concept effectively repackages and revamps the financial implications of the three current CMS quality incentive programs into an umbrella carrot-and-stick program based on a composite score comprised of various performance categories. MU participation would make up 25% of the composite score.
The MIPS/APMs-establishing legislation also directed CMS to explore potential alternatives to portions of the MIPS composite score for “non-patient-facing professionals.” It is possible that CMS could provide alternative pathways, or even a 1:1 substitute, for MU’s portion of the MIPS composite score for non-patient-facing radiologists.
Time will tell if such alternatives to MU will be provided, and if the alternatives will be more attractive than Stage 3 MU. The answers to these questions, more than anything in this week’s final rule, will drive or deter Stage 3 MU participation by radiologists in the future MIPS era.
Questions about MU? Please contact Michael Peters, ACR Director of Regulatory and Legislative Affairs, at email@example.com or 202-223-1670.
Earlier today, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) publicly released final rules to update the participation and technology certification requirements related to the EHR Incentive Program (“Meaningful Use” or MU). Both final rules will formally publish in the Federal Register on October 16.
CMS consolidated the Stage 3 MU and MU reforms for 2015-2017 rulemakings into an extensive single final rule. CMS also included a public request for MU-related comments regarding the future Merit-based Incentive Payment System (MIPS).
ONC’s 2015 Edition Health IT Certification Criteria final rule is as expected and provides the updated product certification requirements corresponding with the Stage 3 MU requirements.
On an unrelated note, ONC also released the final iteration of its long-anticipated Interoperability Roadmap moments prior to the MU rules. The agency focused most of today’s HIT Policy and Standards Committee joint meeting on its content. It is unlikely that ONC timed the release of the roadmap for the same day as the MU-related final rules on purpose.
As always, American College of Radiology (ACR) government relations staff are reviewing and analyzing the two final rules and roadmap policy document, and will release summaries in the near future. ACR members with questions or feedback should please contact Michael Peters, ACR Director of Regulatory and Legislative Affairs, at firstname.lastname@example.org.
At this writing, the Centers for Medicare and Medicaid Services (CMS) final rule on EHR Incentive Program modifications for 2015 through 2017 remains under White House Office of Management and Budget (OMB) regulatory review. In reality, time ran out before October 1 because of the need for an extra cushion to allow for adequate analysis, planning, and implementation of the new flexibility in advance of the reporting period start date.
What does this final rule’s delay mean for Meaningful Use (MU) in 2015?
CMS submitted the final modifications rule to OMB on September 3. OMB regulatory reviews of lengthy rulemakings do not often happen within 30 days, so CMS staff would/should have known upon submission that this outcome would have been likely. Given this, it is possible that the final rule could have included additional flexibility with the reporting period timing that was not included in the proposed rule.
Hope aside, if physicians were left without future options for MU in 2015 because the final rule was published after the last opportunity to begin a 90-day reporting period, this would be an extremely negative outcome with widespread financial implications across the provider world. CMS signaled very strongly and publicly in late January 2015 that a 90-day reporting period was coming in 2015. MU participants probably stopped pursuing their yearlong reporting periods at that time in anticipation of having better MU compliance pathways in the future. Thus, if additional timing flexibility is not provided in this imminent final rule, I expect to see MU participation dip dramatically in 2015, perhaps even to its lowest levels.
In response to this delay, the AMA is calling for CMS to provide an automatic hardship exception for all noncompliant physicians in CY 2015. The vast majority of ACR’s members are already covered by the automatically awarded hardship exception based on primary PECOS specialty code. We should know more about this situation when the final rule hits the Federal Register public inspection desk… soon?
Earlier today, the Centers for Medicare and Medicaid Services (CMS) released its long-anticipated Request for Information (RFI) on implementation of the Merit-based Incentive Payment System (MIPS) and promotion of Alternative Payment Models (APMs). The RFI will be formally published in the Federal Register on October 1 for a thirty-day public comment period. The bulk of the actual rulemaking activity is expected to commence next year, with 2019 being the start of the APM/MIPS payment implications.
As background, APM participation was promoted by legislation that permanently repealed the Sustainable Growth Rate (SGR) physician payment formula (Medicare Access and CHIP Reauthorization Act of 2015). Physicians with inadequate proportions of compensation from APMs would alternatively participate in MIPS—an umbrella quality incentive program that will restructure and revamp the existing Medicare quality incentive programs (PQRS, EHR/Meaningful Use, and VBM) into a composite score-driven incentive/penalty structure.
The government relations, economics, and quality and safety components of the ACR staff and leadership are reviewing the RFI as a team and compiling formal comments for submission to CMS. To provide input to ACR on the EHR/Meaningful Use/health IT components of the RFI, please email Michael Peters, ACR Director of Regulatory and Legislative Affairs, at email@example.com.
The HHS Office of the National Coordinator for Health IT (ONC) released its final “Federal Health IT Strategic Plan” for 2015 through 2020 on September 21. The American College of Radiology (ACR) submitted comments on the draft version in early 2015.
The latest strategic plan is the third iteration since 2008 of broad policy milestones for all health IT-related agencies in the U.S. federal government. The plan does not address private sector goals and activities, but instead focuses exclusively on outcomes government actors should strive for over given periods of time.
ACR Government Relations staff will review the document over the coming days for differences between the final and draft versions. Members with questions or feedback should please contact Michael Peters, ACR’s Director of Regulatory and Legislative Affairs, at firstname.lastname@example.org.
The HHS Office of the National Coordinator for Health IT (ONC) recently announced a new webpage for physicians and others to file unresolved health IT product complaints. The service is meant to be a last resort for those who already contacted their vendor and, if applicable, the ONC-Authorized Certification Body (ACB) that certified the product in question. The following are potential concerns that would be legitimate reasons for contacting the agency:
- Health information blocking
- Unable to share or receive health information
- Product usability
- ONC-ACB certified capabilities not performing as expected
- Product safety
Please see the ONC’s blog entry for details about this helpful new service.
On a different but related note, the American Medical Association (AMA) provides a relatively new website, BreakTheRedTape.org, for sharing stories and information about challenges with the Medicare/Medicaid EHR Incentive Program. The site also includes educational resources about the program and grassroots advocacy features.
The American College of Radiology continues to provide radiologist-specific resources on its Meaningful Use Resources page.
Last week, the HHS Office of the National Coordinator for HIT (ONC) and Centers for Medicare and Medicaid Services (CMS) submitted final rules to update the EHR Incentive Program participation and technology certification requirements for White House Office of Management and Budget (OMB) regulatory review. OMB regulatory review is one of the final closed steps prior to public release, and the process typically takes 30 to 90 days.
There are two CMS final rules (2015-2017 and Stage 3) and one ONC final rule (2015 Edition HIT certification criteria) under review. We should expect at least the main final rule on meaningful use (MU) modifications for 2015-2017 to be published before October to enable 90-day reporting periods to commence on October 1. The Stage 3 final rule also includes “modifications for 2015-2017” in the title, which could mean pieces of the MU fix are divided between some sort of expedited “modifications” final rule and a lengthier “Stage 3” final rule to be published later. However, it is equally possible that all three CMS and ONC final rules will be published simultaneously given that all three were submitted for OMB review on the same September 3 date.