The American Medical Association (AMA) recently opened a physician survey to assist the HHS Office of the National Coordinator for HIT (ONC) with gathering information pertaining to Summary of Care documents exchanged as part of the Medicare/Medicaid EHR Incentive Program (Meaningful Use).
Interested American College of Radiology (ACR) members are encouraged to complete the survey to inform ONC of the data sets that are important to be provided by referring physicians, and the EHR functionality that is most desirable for incorporating and reconciling any data elements of interest from received SoCs.
Representative Tom Price (R-GA-6) recently introduced H.R. 3940, the Meaningful Use (MU) Hardship Relief Act of 2015, to authorize a blanket significant hardship exception from EHR Incentive Program penalties for CY 2015 reporting periods. The bill would address obvious concerns that CMS published the final rule to modify MU in 2015 around mid-October, weeks after the last possible start date for a 90-day CY 2015 reporting period.
As written, the legislation would prevent CMS from penalizing providers for failing to meet MU in CY 2015. Presumably, this blanket hardship exception would thus negate all MU penalties for everyone in CY 2017, as that would be the applicable payment adjustment year. The bill’s language does not explicitly address the issue of would-be-rookie participants who could have avoided payment adjustments in CY 2016 as well by beginning the program in CY 2015.
The blanket exception is not “free,” as it would still count toward an individual’s cap of five total years of awarded hardship exceptions.
Diagnostic radiologists, interventional radiologists, and nuclear medicine physicians already automatically avoid MU penalties via a different hardship exception option, so this bill would primarily benefit ACR’s radiation oncologist members as well as non-radiologists.
In 2013, the American College of Radiology (ACR) Council passed a resolution directing the College to make interoperability and information-sharing an advocacy priority. That same year, ACR provided input into an Office of the National Coordinator for Health IT (ONC) request for information about health information exchange and interoperability, and successfully worked with the Centers for Medicare and Medicaid Services (CMS) and the HHS Office of Inspector General (IOG) to strengthen regulatory requirements around the previously lax “interoperability” prerequisites in the EHR exception and safe harbor from self-referral and anti-kickback requirements.
This week, ACR continued its efforts to proliferate interoperability and exchange by officially supporting S. 2141, the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015, sponsored by U.S. Senators Bill Cassidy, MD (R-LA) and Sheldon Whitehouse (D-RI). This bipartisan legislation would expand HHS OIG’s authority to investigate and penalize “information blocking” beyond EHR donations under the EHR exception/safe harbor to include any information blocking related to certified health IT. If a hospital/provider, vendor, or system were reported for information blocking, HHS OIG would be empowered to investigate and assess a civil monetary penalty of up to $10,000 per act.
The legislation defines “information blocking” as follows:
The term ‘information blocking’ means, with respect to the development, configuration, implementation, and use of qualified electronic health records and other health information technology, business, technical, and organizational practices that—
“(A) except as required by law, prevent or materially discourage the access, exchange, or use of electronic health information; and
“(B) the person knows or should know (as defined in section 1128A(i)(7) of the Social Security Act [SSA]) are likely to interfere with the access, exchange, or use of electronic health information.
“Should know” in the current section 1128(i)(7) of the SSA means:
The term “should know” means that a person, with respect to information—
(A) acts in deliberate ignorance of the truth or falsity of the information; or
(B) acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required
Beyond empowering HHS OIG to investigate and penalize information blocking, the legislation would also improve physician and consumer protections by implementing a development council-administered, three star ratings scale for certified health IT products in the areas of usability, interoperability, and security. The HHS and the development council would work with specialty physicians, among other stakeholders, to develop reporting criteria to guide the ratings.
The TRUST IT Act arose out of a series of several Senate Health, Education, Labor and Pensions Committee hearings on interoperability issues and barriers throughout 2015. Senators Cassidy and Whitehouse both serve on the committee. ACR is now urging Congress to include TRUST IT Act in the upcoming Senate companion to H.R. 6, the 21st Century Cures Act.
If members have questions about the TRUST IT Act or ACR’s support for this bill, please contact Michael Peters, ACR Director of Regulatory and Legislative Affairs, at email@example.com.
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, elimination and re-weighting, 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 firstname.lastname@example.org 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 email@example.com.
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 firstname.lastname@example.org.