The Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for HIT (ONC) will publish proposed rules to update the EHR Incentive Program’s meaningful use (MU) requirements and health IT certification requirements on March 30. Pre-publication versions of the proposed rules (CMS / ONC) were made publicly available on March 20. The American College of Radiology Government Relations team reviewed both documents and released a draft summary of the highlights of interest to radiologists on March 23.
The CMS proposed rule would establish Stage 3 MU requirements. In 2017, participants could choose Stage 3 or another Stage. In 2018 and every year thereafter, Stage 3 would be the only option. The eight total Stage 3 MU objectives would be: (1) Protect Patient Health Information, (2) eRx, (3) CDS, (4) CPOE, (5) Patient Electronic Access to Health Information, (6) Coordination of Care Through Patient Engagement, (7) Health Information Exchange (HIE), and (8) Public Health and Clinical Data Registry Reporting. Of these proposed objectives, most diagnostic radiologists would likely need to do four— (1), (3), (7), and (8)—because of proposed exclusions from measures that go with the other objectives.
While CMS proposes to continue the (original) hardship exceptions that protect radiologists and others from MU penalties for up to 5 total years per individual, the start date for MU compliance would be moved up to January 1, 2018 for physicians who used up all of their hardship exceptions in 2015 through 2019. The reason: CMS proposes to eliminate the 90-day reporting period for rookie MU participants. Thus, beginning in 2017, all MU participants would have yearlong reporting periods, and all participants would avoid penalties via MU compliance 2 years before the penalty year in question (e.g., 2018 compliance to avoid 2020 penalties).
CMS proposes that the clinical quality measure (CQM) reporting requirement of MU would be updated via future Medicare payment rules (beginning with 2016 Physician Fee Schedule for 2017 MU). The goal is to further align CQM reporting across the CMS quality incentive programs, such as PQRS, which are currently updated through the annual payment rulemakings instead of via standalone rulemakings.
Proposed S3 MU for most diagnostic radiologists in 2018+ (optional in 2017):
1. Four Stage 3 MU objectives (non-excludable by most radiologists):
- Protect patient info (HIPAA)
- Enable CDS functionality
- Request Summary of Care Records/C-CDAs from referring providers and incorporate/reconcile info of interest
- Actively engage with 3 registries
2. CQM reporting requirements (TBD in 2016 payment rules)
3. CEHRT equipped at location(s) where >50% patient encounters
Note that CMS is planning a separate rulemaking to address flexibility in the current Stage 1 and Stage 2 MU requirements for 2015-2017. That proposed rule should be published around Spring/Summer if all goes to plan.
Unlike the various regulatory framework changes in the CMS proposed rule, the ONC’s proposals for the health IT certification program would not be substantially different from a radiologist end-user’s perspective. There would be the requisite updates in the form of the 2015 Edition Health IT (no longer “EHR”) certification criteria (mandatory in 2018), new and revised standards and implementation guides, changes to the privacy/security scheme, new post-certification surveillance and transparency requirements, removal of “Complete EHR” certification status, and a slightly updated Base EHR definition. Additionally, the responsibility for defining “certified EHR technology” (CEHRT) for MU purposes would shift from ONC to CMS as ONC expands its HIT certification program beyond MU exclusivity. Most of these proposals were expected based on discussions included in an earlier ONC rulemaking.
In terms of ONC’s imaging-specific 2015E certification criteria, the “image results” and “CPOE-diagnostic imaging” certification criteria would be unchanged from the previous 2014 Edition/2014 Edition Release 2 versions (the CMS proposed rule provides clarification about “diagnostic imaging” would mean in the context of CPOE [i.e., all modalities], but it would not significantly alter the previous understanding of that requirement). The “view online, download, and transmit to a 3rd party” certification requirements which support patients’ electronic access to their data via portals, PHRs, and 3rd party applications would include “Diagnostic Image Reports”—thus, HIT modules certified for the V/D/T criterion would need to be technically capable of sharing these reports with patients.
For more information, please see ACR’s draft summary (subject to change).
If ACR members have additional questions, or would like to offer feedback for potential inclusion in ACR’s future comments on either of the proposed rules, please contact Michael Peters, Director of Regulatory and Legislative Affairs, ACR Government Relations, at email@example.com / 202-223-1670.
Moments ago, the Centers for Medicare and Medicaid Services (CMS) and HHS Office of the National Coordinator for HIT (ONC) published their proposed rules to update the EHR Incentive Program (“meaningful use”) participation and software certification requirements.
- CMS proposed rule, “Electronic Health Record Incentive Program Stage 3” (pre-publication)
- ONC proposed rule, “Health Information Technology Certification Criteria, Base Electronic Health Record Definition, and ONC Health IT Certification Program Modifications” (pre-publication)
The American College of Radiology Government Relations team is currently reviewing both proposed rules.
On March 17, the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) convened for the first full committee hearing on health information technology since 2009. The hearing, “America’s Health IT Transformation: Translating the Promise of EHRs Into Better Care,” focused on interoperability and health information exchange (HIE) in the context of the extensive federal investments made through the Medicare/Medicaid EHR Incentive Program (or “Meaningful Use”).
Witnesses from the family physician, patient, EHR vendor, and academic communities universally criticized the lack of flexibility in the existing MU regulations as well as insufficient progress toward true interoperability. Committee members from both sides of the aisle were likewise critical of MU, including those who were originally supportive of the HITECH Act. The bipartisan nature of the criticism was perhaps indicative that the Hill’s patience with the Department of Health and Human Services on MU implementation is finally wearing thin.
The most compelling statements of the hearing came from Senator Sheldon Whitehouse (D-RI), previously an MU advocate, in which he questioned subsidizing cars (borrowing the frequently used EHR-as-automobile analogy) and then asking providers and physicians to build the roads on their own. He suggested that MU is currently focused on the most remote points of connectivity, physicians, despite a lack of federal governance and support for sharing data. He called for a “reboot” of the MU program with a new focus on supporting participation in HIE networks.
Senator Whitehouse also pointed out that the federal government has a role to play in preventing abuses by vendors and others who lack true interoperability in order to generate revenue through restrictions placed on connectivity among different systems and providers. This is a common issue for ambulatory radiology practices seeking to connect with ordering physicians and hospitals. Other problems were discussed as well, including the lack of EHR cost transparency for product consumers and anticompetitive practices by hospitals.
Moving forward, the Senate HELP Committee plans to discuss the issue again in the coming months and potentially engage in a legislative effort to fix and refocus the EHR Incentive Program.
On February 25, the Centers for Medicare and Medicaid Services (CMS) announced an extension to the attestation deadline for Medicare EHR Incentive Program reporting periods that occurred in calendar year (CY) 2014. Participants now have until March 20, 2015 to complete the online attestation process for their CY 2014 meaningful use (MU) compliance.
CMS recommended attesting during non-peak hours (evenings and weekends) well in advance of the deadline. For help, contact the CMS’ EHR Information Center at 1-888-734-6433, Monday-Friday, 8:30AM-7:30PM (ET).
Deadlines in the Medicaid version of the program are not necessarily impacted by this extension.
The PQRS submission deadlines for the “EHR Direct/Data Submission Vendor” and “qualified clinical data registries/QRDA III” reporting options have likewise been extended until March 20.
The negative payment adjustments for nonparticipation in the Medicare EHR Incentive Program (“Meaningful Use” or MU) will increase to -2% off covered professional services in calendar year (CY) 2016. Physicians who are eligible for the Medicare version of the program will have two ways to avoid the 2016 penalties:
Option 1: Compliance
- Prior MU participants must have been a Meaningful EHR User in 2014 to avoid the 2016 penalties. If the prior MU participant was not MU-compliant in 2014, he/she must use Option 2 below.
- Those who have never participated in MU must begin participating by July 1, 2015 and complete the attestation process by October 1, 2015 (at the latest) to avoid 2016 penalties. If the first-time participant does not meet the attestation deadline, he/she must use Option 2 below.
Option 2: Significant hardship exception
Regardless of whether or not a physician was MU compliant in the past, he/she can obtain one of several “significant hardship exceptions” to avoid 2016 penalties. CMS can grant these to physicians on an annual basis for up to 5 total years. The various available significant hardship exceptions are as follows:
- Lacking broadband/infrastructure: The physician was located in an area without sufficient Internet access to comply for any 90-day period of time from the beginning of 2014 to July 1, 2015. Moreover, the physician must have faced insurmountable barriers to obtaining the internet connectivity. A manual application is required by July 1, 2015.
- Newly practicing: The physician has been practicing for less than 2 years. This will be automatically given. No manual application is required.
- Extreme and uncontrollable circumstances: a) A previous MU participant faced extreme and uncontrollable circumstances in 2014. Or, b) a physician who has never participated in MU faced extreme and uncontrollable circumstances in 2015. A manual application is required by July 1, 2015.
- Inability to influence availability of certified EHR technology (CEHRT): The physician practiced at multiple locations, and lacked control over the availability of CEHRT at one or more locations where he/she had more than 50% of his/her patient encounters. A manual application is required by July 1, 2015.
- Lack of face-to-face/telemedicine interaction with patients AND lack of need for follow-up: The physician can demonstrate difficulty in meeting MU on the basis of lack of face-to-face or telemedicine interaction with patients and lack of need for follow up with patients. A manual application is required by July 1, 2015.
- Primary specialty listing in PECOS: The physician has a primary specialty listed in PECOS as radiology, anesthesiology, or pathology by July 1, 2015. For radiology, the primary specialty listing must be “diagnostic radiology” (30), “nuclear medicine” (36), or “interventional radiology” (94). No manual application is required.
The above information is subject to change. For more information about the significant hardship exceptions, please see CMS’ website.
On February 6, the American College of Radiology (ACR) submitted comments regarding the HHS Office of the National Coordinator for HIT’s (ONC) draft 2015-2020 update of the “Federal Health IT Strategic Plan.”
As background, Congress directed ONC in the Recovery Act of 2009 to periodically update a strategic plan on health IT goals for federal agencies. ONC’s broad policy document, which was originally created (pre-mandate) in 2008 and later updated in 2011, describes non-binding, high-level objectives for all agencies that fund related research, regulate IT solutions, or deliver health care services.
The ACR’s comments generally supported the goals, objectives, and strategies in the plan and offered insights into relevant informatics initiatives in the College and elsewhere in the radiology community. The ACR identified the following two objectives as being especially critical for federal government agency involvement and leadership:
- Objective 2A: Enable individuals, providers, and public health entities to securely send, receive, find, and use electronic health information.
- Objective 5B: Accelerate the development and commercialization of innovative technologies and solutions.
Moving forward, the ONC will use public comments and input from other sources, such as their own federal advisory committees, to refine and finalize the updated strategic plan.
The HHS Office of the National Coordinator for HIT (ONC) released its draft National Interoperability Roadmap and associated Standards Advisory today for public comment. The Roadmap builds upon ONC’s past efforts to obtain stakeholder feedback on advancing interoperability and health information exchange. The Standards Advisory is a compilation of current standards ONC identified that could facilitate implementation of the Roadmap.
Public comments are due on the Roadmap by April 3, 2015, and the Standards Advisory by May 1, 2015. Any and all members of the American College of Radiology interested in providing feedback for potential inclusion in ACR’s future comments should please email Michael Peters, ACR Director of Regulatory and Legislative Affairs, at firstname.lastname@example.org.
For additional background information, please visit healthit.gov.