The American College of Radiology (ACR) is conducting a very brief, one-minute, 3-question survey for radiologists regarding the Medicare/Medicaid EHR Incentive Program. The objective of the survey is to get a better understanding of radiologists’ decisions to participate or not participate in the program.
If you are a practicing diagnostic radiologist, interventional radiologist, nuclear medicine physician, or radiation oncologist, please take a moment of your time to complete the survey. Your responses will help inform future ACR advocacy and/or educational efforts.
ONC Federal Advisory Committees Hold Joint Meeting on Interoperability; Two Senior ONC Staff Leaving the Agency
On October 15, the HHS Office of the National Coordinator for HIT (ONC) held a joint meeting of the HIT Policy Committee and HIT Standards Committee to discuss the draft interoperability roadmap, health information exchange (HIE: the verb, not necessarily the noun) governance, and the JASON Task Force recommendations. The outcome of the meeting was an approved set of broad recommendations to ONC indicating a desire to leverage open Application Programming Interfaces (APIs) as the foundational approach for nationwide HIE.
ONC also announced that two senior ONC staff, Dr. Doug Fridsma and Judy Murphy, would be attending their last federal advisory committee meeting as employees of the agency. Dr. Fridsma has been with the agency for four years and most recently served as Chief Science Officer. Judy Murphy most recently served as Deputy National Coordinator for Programs and Policy.
CMS Addresses Attestation System Issue by Extending Significant Hardship Exception Application Deadline for Some
Earlier today, the Centers for Medicare and Medicaid Services (CMS) announced that the significant hardship exception application deadline has been extended until November 30, 2014 for physicians who are eligible to use the September 4, 2014 flexibility AND who were unable to attest by the October 1, 2014 deadline for first-year participants.
What does this mean? This was CMS’ answer to the problem recently identified by the Medical Group Management Association (MGMA) pertaining to the timing of a planned update to CMS’ web-based attestation system. CMS plans to implement a system patch in October that would enable the agency to receive online attestations from participants using the September 4, 2014 flexibility. Unfortunately, the deadline for first-year program participants to complete their attestations for a 2014 reporting period already came and went on October 1. Therefore, if a first-year program participant intended to use the September 4 flexibility, they would have missed the deadline because of CMS’ unpatched system.
The number of first-year participants expected to require the latest extension is small. In radiology, most diagnostic radiologists, interventional radiologists, and nuclear medicine physicians did not need to apply for a significant hardship exception because they were automatically given one.
The Medical Group Management Association (MGMA) recently discovered an issue with the timing of a planned update to the Centers for Medicare and Medicaid Services’ (CMS) attestation system for the Medicare/Medicaid EHR Incentive Program. Apparently, the agency’s system will not be able to accept attestations tied to recently enabled flexibility until the middle of October 2014 or later.
Earlier this month, CMS and the Office of the National Coordinator for HIT (ONC) published a final rule to allow EHR Incentive Program participants to meaningfully use (MU) EHR technology with outdated (2011 Edition) certification status, coupled with the 2013 iteration of the Stage 1 MU requirements, in CY 2014. While limited in utility because of its late arrival in the calendar year, the rule allows participants who would otherwise miss out on this year’s MU incentive payments to still participate in the program in CY 2014. If audited in the future, participants who leveraged this flexibility would need to defend their inability to implement 2014 Edition certified EHR technology in time for their respective CY 2014 reporting periods.
Meanwhile, rookie EHR Incentive Program participants must have already begun their CY 2014 reporting periods by July, and must attest/report to CMS by October 1, to both get an incentive payment this year and avoid next year’s payment adjustments via compliance. Only those MU rookies who had the foresight to also obtain a significant hardship exception for 2015 will not encounter a timing problem.
Unless CMS expedites the update to the attestation system, or they extend the October 1 attestation deadline for MU rookies, any physicians who meet ALL of the following characteristics will be adversely affected:
- Those eligible for the Medicare version of the EHR Incentive Program, who:
- Are rookies in the EHR Incentive Program in 2014, AND,
- Leverage the flexibility allowed by the September 4 rule, AND,
- Failed to previously obtain a significant hardship exception to avoid negative payment adjustments in 2015.
Importantly, this problem impacts a relatively small subset of MU participants. Also note that most (non-radiation oncologist) American College of Radiology members will not be affected because they were automatically granted a significant hardship exception for 2015 by CMS based on their primary specialty code in PECOS.
It has been a busy couple of weeks in the Medicare/Medicaid EHR Incentive Program. While everyone’s focus was on the Centers for Medicare and Medicaid Services’ (CMS) final rule to allow a certain subset of participants to meaningfully use (MU) EHR technology with outdated certification status, as well as on the Office of the National Coordinator for HIT’s (ONC) “Release 2” of the 2014 Edition EHR certification criteria, CMS distributed some clarifications regarding the Stage 1 and Stage 2 MU objective for “view/download/transmit (V/D/T),” also known as the “patient portal” or “PHR” objective. Most of this information was included in the September 2012 “Stage 2” final rule and the “Patient Electronic Access Tipsheet,” but it is worth repeating…
First, patients who choose not to access their health information (“opt out”) can be counted in the numerator of the Stage 1 and 2 “provide patients with ability” measure of the V/D/T objective if they are given all information needed to change their minds and access (or “opt in”) without having to reconnect with the provider. CMS’ example of doing this is when a patient is given a user ID and password combined with instructions about how to access the portal/PHR/patient website and how to create an account. Patients who choose not to access/opt out are required to be included in the denominator regardless.
Second, for the Stage 2-only second measure of “patients viewed, downloaded, or transmitted to a 3rd party” of that objective, patients who access their health information via an online personal health record (PHR) during the reporting period can be counted in the numerator for all eligible providers who contributed information to that PHR. The patient does not have to V/D/T the specific information contributed by an individual provider for it to count.
Third—and this is more obvious—everyone in a group practice is able to share credit for the Stage 2-only second measure of “patients actually viewed, downloaded, or transmitted to a 3rd party” if they each saw the patient during the same reporting period and are using the same certified EHR technology.
From a radiology perspective, I am constantly asked if imaging results need to be included in patient portal/PHR for the V/D/T objective. The answer is simply no—doing so would be beyond the minimum MU compliance requirements. The data elements that must be offered for V/D/T when updated are the “Common MU Data Set” in addition to the provider’s name and office contact information. Therefore, if all radiologists did was provide patients with access to key images and/or reports via the portal and did not include the Common MU Data Set, etc., this would actually not be in MU compliance. However, providing radiology information to the patient in addition to the basic data types required for MU may be desirable or even necessary for non-MU reasons, and it could give the patient a motivation to V/D/T their own health information on the radiologist’s portal for credit towards the second measure of the Stage 2 MU V/D/T objective.
The Office of the National Coordinator for HIT (ONC) published its final rule to promulgate the “2014 Edition Release 2” EHR certification criteria for health IT products used in the Medicare/Medicaid EHR Incentive Program. Importantly, this final rule corresponds with the “2015 Edition” proposed rule released for comment last February. ONC elected to change the version titles of the EHR certification criteria to correspond with the calendar year in which they are finalized, not the year in which they become mandatory for EHR Incentive Program participants. Incremental updates to existing certification criteria will henceforth be called “releases.”
If you think this version title change is confusing now, just wait until the “2015 Edition” EHR certification criteria proposed rule is published for comment later this year (hint: it will not be the same content as last February’s proposed rule). The upcoming rulemaking was previously slated to be called the “2017 Edition,” and will be released simultaneously with the CMS EHR Incentive Program/Meaningful Use (MU) “Stage 3” proposed rule.
Importantly, the “2014 Edition Release 2” is mechanically different than what was proposed for the “2015 Edition.” Instead of being an incomplete and voluntary set of alternative criteria to the 2014 Edition—as the 2015 Edition was proposed to be—all newly added certification criteria in Release 2 will be deemed optional, and any revisions to previous criteria made in Release 2 are considered to be clarifications/additive to what was already required.
While the necessity of this rulemaking has been (rightfully) called into question by many, it does contain several improvements over what was proposed in the 2015 Edition proposed rule. For instance, Release 2 finalizes ONC’s proposal to separate the three unrelated order types (diagnostic imaging, lab-tests, and medications) into three separate certification criteria, which allows specialized CPOE software to achieve certification for only one order type instead of needing to package the functionality to order all three disparate order types. Also, ONC chose to not finalize the “Non-MU certification” and “certification packages” concepts that were in the proposed rule—these concepts, as proposed, promised mass confusion for little practical benefit. ONC also finalized its proposal to eliminate “Complete EHR” certification status (starting with the next edition), which should help clear up any confusion in the specialty IT industry about whether ONC’s HIT certification program is for their products too.
The ACR Government Relations Department is reviewing the ONC’s final rule and will publish a regulatory summary in the near future. Also, note that Dr. David Hunt from ONC staff will be on hand to discuss the government’s efforts related to nationwide EHR technology adoption at the ACR’s fourth annual Imaging Informatics Summit on October 29-30, 2014 (event/registration information: acrinformatics.org).
On September 4, the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for HIT (ONC) will publish the final rule to allow 2011 Edition certified EHR technology, coupled with the 2013 version of Stage 1 Meaningful Use (MU) requirements, to comply with the EHR Incentive Program in calendar year (CY) 2014. The rule also includes compliance options for those with combinations of 2011 Edition and 2014 Edition certified HIT products. Prior to these changes, all participants needed to meaningfully use 2014 Edition certified products in CY 2014.
While the latest revision is far too late to be a practical option for most MU participants, it is intended to help previous MUsers who were unable to fully upgrade to 2014 Edition certified products in time for the fourth (and final) special quarterly reporting period in CY 2014 that begins in less than one month. These individuals would have otherwise had to forgo their incentive payments for 2014 and use up a precious significant hardship exception year to avoid the CY 2016 penalties.
Regardless of this last minute flexibility, all MU participants are required to use 2014 Edition certified products beginning in CY 2015, so it is not recommended that physicians (who have a choice) delay implementing the newer 2014 Edition certified products. In fact, those who leverage this new flexibility will need to prove their inability to fully upgrade to 2014 Edition certified EHR technology to auditors.
The pre-publication formatted version of the final rule is currently accessible via the Office of the Federal Register’s public inspection desk. The ACR Government Relations team is reviewing the text and may re-release our CY 2013 educational materials for those seeking to leverage this flexibility.