Meaningful Use Workgroup Prepares to Present Stage 3 MU Recommendations to Full HIT Policy Committee for Approval
The HIT Policy Committee (HITPC) Meaningful Use (MU) Workgroup held its final public discussion on March 4 in preparation for next week’s full HITPC meeting when the workgroup’s Stage 3 MU recommendations will be presented and likely approved. Following HITPC approval, the recommendations will go to the HHS Office of the National Coordinator for HIT (ONC) and Centers for Medicare and Medicaid Services (CMS) to inform the future Stage 3 MU and 2017 Edition EHR Certification Criteria rulemakings.
Importantly, CMS and ONC staff are free to use or not use the HITPC recommendations however they wish as they work on proposed rules over the next several months. CMS and ONC hope to publish the Notices of Proposed Rulemaking on Stage 3 MU and the 2017 Edition around Fall 2014 for public comment, with final rules promulgated around mid-2015.
In terms of imaging-related subtopics, the MU Workgroup will likely recommend discontinuing the “imaging results access” objective in Stage 3 MU. The workgroup’s expressed goal for this change was to reduce participants’ reporting burden (i.e., the total number of MU objectives recommended for Stage 3 Meaningful EHR Users). Also, the MU Workgroup is not explicitly recommending the inclusion of imaging data in the “patient view, download, transmit” (or “patient portal”) objective despite the recent work of the HIT Standards Committee’s Clinical Operations Workgroup. Finally, the MU Workgroup continues to recommend that one of the main priority areas for CDS rules/interventions be radiology and lab-test appropriateness.
ONC’s Proposed Rule on the Optional 2015 Edition EHR Certification Criteria Released for Public Comment
Earlier this evening, the Office of the National Coordinator for HIT (ONC) made available its Notice of Proposed Rulemaking (NPRM, or proposed rule) to establish the optional 2015 Edition EHR certification criteria for HIT products used in the Medicare/Medicaid EHR Incentive Program. The NPRM is currently on the Federal Register‘s public inspection desk and is scheduled to be formally published on February 26 for a sixty-day public comment period.
It is somewhat of an unorthodox NPRM in that portions of it deal with proposals for the 2015 Edition regulations, while the rest is comprised of RFI-style questions for use in informing the 2017 Edition rulemaking. ONC noted in the preamble that they will not be addressing public comments submitted on 2017 Edition in the future 2015 Edition final rule. However, one of the challenges of incorporating 2017 Edition-specific questions in this NPRM is that those items are then technically viable for finalization in the 2015 Edition final rule per the Administrative Procedure Act.
The ACR Government Relations team is currently reviewing the NPRM and will work with ACR’s IT and Informatics Committee leaders on developing comments in the near future. Some of the proposals of interest for the 2015 Edition include:
- Doing away with the “Complete EHR” certification status to emphasize modular certification.
- Maintaining the exact same “imaging results accessibility” certification criterion as the 2014 Edition iteration.
- Separating the three order types (meds, labs, and radiology) into separate CPOE criteria; something ACR has advocated for years to enable enhanced radiology CPOE software to obtain modular certification.
- Requesting comments on (but not actually proposing for the 2015 Edition) the following three questions as they relate to imaging data and the “patient view/download/transmit” criterion: 1) whether images for patients need to be of diagnostic quality; 2) whether they should be viewable and downloadable; and 3) whether cloud-based technology could allow for a link to the image to be made accessible.
- Overhauling the CDS criterion to align with the Health eDecisions initiative.
- Recording user “ignore” responses to drug-drug/drug-allergy interaction alerts during medication orders.
If you would like to submit comments to ACR for consideration and potential use in ACR’s future comments on this NPRM, please contact me at email@example.com / 202-223-1670.
There has been a lot of talk, and rightfully so, about the “Merit-Based Incentive Payment System (MIPS)” concept included in the SGR Repeal and Medicare Provider Payment Modernization Act (the permanent SGR fix bill) currently in play on the Hill. As with the “Value Based Performance (VBP) Payment System” proposal (the earlier iteration of MIPS released for comment last October, presumably renamed to avoid confusion with the Value Based Modifier), MIPS would consolidate the three current Medicare incentive programs—Physician Quality Reporting System (PQRS), the EHR Incentive Program (“meaningful use”), and the Value Based Modifier (VBM)—into an umbrella carrot-and-stick program that eligible professionals would participate in if they do not receive a significant portion of their revenue through participation in alternative payment models (APMs). In other words, think of MIPS as a “pay for performance” alternative to APMs.
Similar to the previous VBP proposal, MIPS would award incentive payments or payment reductions to eligible professionals based on a “composite performance score” of 0-100 comprised of activities in four areas: quality, resource use, meaningful use, and clinical practice improvement activities. As with VBP, these score-based bonuses and payment reductions would effectively replace the penalties in each of the current three incentive programs with potentially bigger penalties—BUT, there would also be an opportunity for no penalties or even incentive bonuses depending on the professional’s score relative to everyone else. Unlike VBP, the legislative language for MIPS is far more explicit about how the incentives and penalties should be assigned to professionals relative to their score.
Importantly, the MIPS language also includes helpful provisions that implore regulators to consider the applicability of the various items that comprise the composite performance score to so-called “non-patient-facing” professionals and others. This language could conceivably result in alternative pathways to compliance with PQRS, MU, and/or VBM; removal of individual programs from the score for certain professionals; or even 1:1 replacement requirements for these professionals that fulfill the same goals. Regardless of the fate of the bill, this should send (yet another) message to the regulatory agencies involved that more consideration and flexibility is required in these programs for those who practice specialized medicine.
CMS Extends EHR Incentive Program’s Attestation Deadline for Reporting Periods that Occurred in 2013
The Centers for Medicare and Medicaid Services (CMS) recently announced the agency will be accepting eligible professional (EP) attestations until March 31, 2014 for Medicare EHR Incentive Program reporting periods that occurred in CY 2013. In other words, the attestation deadline has been pushed back one month to give EPs additional time to complete the administrative process of demonstrating meaningful use (MU) to CMS.
Successful CY 2013 compliance will determine whether or not prior MU participants will get the payment adjustments in 2015. EPs who have not yet participated in MU can still begin by July 1, 2014 and complete their attestations by October 1, 2014 to avoid the 2015 payment adjustments. The other option for avoiding the payment adjustments in 2015 is to obtain a significant hardship exception.
Please see “How to Avoid Meaningful Use Penalties” for additional information.
The Office of the National Coordinator for HIT (ONC) announced during yesterday’s monthly meeting of the HIT Policy Committee (HITPC) that membership on that federal advisory committee will be limited to six years. While the establishing language in the American Recovery and Reinvestment Act of 2009 limited HITPC members’ term lengths to three years, it did not mandate a hard cap of two consecutive terms.
This announcement is significant because the HITPC’s advisory efforts have played a key role in setting the priorities of ONC and the Centers for Medicare and Medicaid Services when it comes to the EHR Incentive Program (or “meaningful use”). Up until this point, it has been very challenging for physician stakeholders to get adequate consideration of the HITPC and its various workgroups. The common criticism is that the HITPC is “open to public comments, but not to different ideas.”
Historically, the expired terms of HITPC members were automatically renewed by the Government Accountability Office (GAO) and ONC without formal notice or an opportunity for nominations from the public. The GAO and ONC only published formal calls for HITPC nominations when members resigned from the committee. This practice of automatic term renewal without public notice, while not uncommon for federal advisory committees with consecutive term caps, is arguably not aligned with the spirit of the Federal Advisory Committee Act or general government transparency.
To its credit, ONC instituted an informal self-application process for some of the workgroups and task forces under the full HITPC and HIT Standards Committee a couple years ago. However, the most important workgroups have usually been closely guided by the lead members of the full committees, resulting in a continuity of advice since 2009 that has largely been deaf to external criticisms of the EHR Incentive Program.
With a rolling membership, as was seemingly intended (but not required) by the Recovery Act’s staggering of HITPC member terms, the advisory committee’s culture now has the opportunity to evolve in the best interests of stakeholders. ONC staff and leaders should be applauded for this much needed change in direction.
On January 29, the Certification Commission for Health Information Technology (CCHIT) announced it will no longer provide services as an Accredited Testing Laboratory and ONC-Approved Certification Body for EHR technology. Instead, CCHIT will encourage its HIT industry customers to explore ICSA Labs testing and certification for products used in the Medicare/Medicaid EHR Incentive Program. The organization will also discontinue its voluntary certification programs that have been around since 2006, but have not been especially applicable in the post-Recovery Act era.
CCHIT was extremely well positioned in 2009 to dominate the certification business for products used in the EHR Incentive Program. However, the Office of the National Coordinator for HIT’s (ONC) certification program rules, which established multiple testing and certification bodies, had the intentional effect of generating competition for government-sanctioned HIT product certification.
Moving forward, CCHIT plans to get into the crowded market of third-party consultation services for providers and industry on HIT regulatory issues.
I will participate in the Radiology Business Journal webinar, Navigating the Meaningful Use (MU) Pathway: Stages 1 and 2 (sponsored by FUJIFILM Medical Systems, USA, Inc.), at 2PM (Eastern) on January 29. Attendees are encouraged to pre-register for the event.
My plan is to discuss the current requirements for participants in the Medicare EHR Incentive Program. The presentation will be followed by a Q&A.
The American College of Radiology (ACR) recently released “ACR’s Pocket Guide to Meaningful Use (MU) in 2014,” a three-page overview of Medicare EHR Incentive Program requirements for radiologists. This free educational resource will be enhanced over time with new information and links to additional materials.
A special thank you to Dr. Adeel Siddiqui (University of Tennessee Health Sciences Center and member of ACR’s Subcommittee on Meaningful Use) for providing helpful recommendations.
The HIT Standards Committee (HITSC) Clinical Operations Workgroup presented its latest recommendations regarding standards for image sharing at the monthly HITSC meeting on December 18. Aspects of the workgroup’s recommendations will be included in the HIT Policy Committee’s and HITSC’s advice to the HHS Office of the National Coordinator for HIT (ONC) regarding future regulatory updates to meaningful use (MU) and the EHR certification criteria.
The workgroup identified imaging data standards for each of four different scenarios, or “tiers” of use:
- Exchange of text-based reports
- Exchange of non-radiology/cardiology medical images (such as pictures used in dermatology, etc.)
- Exchange of full radiology/cardiology imaging studies
- Exchange of key images from radiological/cardiology imaging studies
The slide displaying the workgroup’s current recommendations for each tier is available here.
The recommendations are the product of several months of workgroup deliberations and presentations from a variety of players in the imaging standards arena, such as the Radiological Society of North America, radiology IT industry representatives, NIH, and others. Dr. Keith Dreyer, Chair of ACR’s IT and Informatics Committee, presented to the workgroup back in June 2013.
Late last week, the Centers for Medicare and Medicaid Services (CMS) and the HHS Office of the National Coordinator for HIT (ONC) announced plans to extend Meaningful Use (MU) Stage 2, delay the upcoming Stage 3 and 2017 Edition certification criteria rulemakings, and implement a 2015 Edition of EHR certification criteria.
The most noteworthy piece of the announcement was that CMS will delay the “Stage 3 MU” rulemaking by several months. The agency is now targeting a fall 2014 release of the proposed rule and a mid-2015 release of the final rule. ONC plans to release the “2017 Edition EHR certification criteria” proposed and final rules on the same timeline.
Additionally, ONC will conduct an extra, off-cycle rulemaking to establish so-called 2015 Edition EHR certification criteria. They plan to use that rulemaking to fix problems EHR developers might be having with the 2014 Edition requirements, as well as modify the way standards and implementation specifications are referenced in ONC’s regulations. The 2015 Edition will apparently be an optional alternative of sorts to the 2014 Edition.
The Stage 2 “extension” piece of the announcement will be a third year for participants who entered Stage 2 in 2014 (i.e., those physicians and hospitals who began MU in 2011 or 2012). This is akin to the Stage 1 extension that 2011 participants were able to receive for 2013. As described, the plan does not appear to delay the beginning of Stage 2 for those participants who are moving up next year. It also does not seem to delay the mandatory implementation of 2014 Edition certified products in 2014. Delays of that nature would require a rulemaking to modify the existing regulations; a process that would take considerably more time than what we have left.