Archive for February, 2014

ONC’s Proposed Rule on the Optional 2015 Edition EHR Certification Criteria Released for Public Comment

February 21, 2014 4 comments

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 and alerting sites like if need be.

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 / 202-223-1670.

Categories: EHR, meaningful use, Medicare

SGR and the Merit-Based Incentive Payment System: The Umbrella Carrot-and-Stick Program

February 20, 2014 1 comment

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.

Categories: EHR, meaningful use, Medicare

CMS Extends EHR Incentive Program’s Attestation Deadline for Reporting Periods that Occurred in 2013

February 10, 2014 1 comment

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.

Categories: EHR, meaningful use, Medicare

ONC to Limit HIT Policy Committee Members’ Service

February 6, 2014 1 comment

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.

Categories: EHR, meaningful use, Medicare