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ACR Overview of Meaningful Use Stage 3 and 2015 Edition HIT Certification Criteria Proposed Rules

March 25, 2015 4 comments

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 mpeters@acr.org / 202-223-1670.

Categories: EHR, meaningful use, Medicare

HHS Publishes Highly Anticipated Proposed Rules to Update Meaningful Use Requirements

March 20, 2015 Leave a comment

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.

The American College of Radiology Government Relations team is currently reviewing both proposed rules.

Categories: EHR, meaningful use, Medicare

Bipartisan Call for ‘Reboot’ of Meaningful Use at Senate HELP Committee Hearing

March 17, 2015 1 comment

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.

Categories: EHR, meaningful use, Medicare

Next Gen ACO Model: More Risk for More Optionality

March 12, 2015 Leave a comment

As the health IT policy world awaits the future publication of the Stage 3 EHR Incentive Program and 2015 Edition EHR Certification Criteria proposed rules, the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity, coined the “Next Generation Accountable Care Organization (ACO) Model.”

CMS indicated that Next Gen ACOs will take on a more “performance risk” than ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program. The primary benefits of assuming greater risk will be “a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure.” Additionally, the Next Gen ACOs will have more of a focus on patient communication, provider preferences, and other enhancements aimed directly at beneficiaries.

CMS will accept two rounds of Next Gen ACO applications (in 2015 and 2016) for 5-year-long programs. For the first round, interested ACOs must submit Letters of Intent by May 1, 2015, and applications by June 1, 2015. CMS provides an introductory webpage with basic resources about this opportunity, including the full RFA and some initial FAQs/guidance.

Categories: Medicare, research