Archive for April, 2015

CMS and ONC Meet with AMA, ACR, and Other National Societies On Meaningful Use

April 30, 2015 Leave a comment

On April 29, the American Medical Association (AMA) hosted the American College of Radiology and approximately 25 other specialty societies, for a meeting with the Centers for Medicare and Medicaid Services (CMS) and HHS Office of the National Coordinator for HIT (ONC) on the three recent proposed rules to update the requirements of the EHR Incentive Program (“meaningful use”) and HIT certification program.

CMS and ONC provided presentations covering the three proposed rules and opened the floor for questions. I asked how many eligible professionals were avoiding MU penalties in 2015 through the significant hardship exception mechanism. The answer was roughly 55,000. I believe the 55,000 number must be exclusive to manual applications for hardship—i.e., did not include the automatically-awarded hardship exception for radiologists, pathologists, and anesthesiologists. Otherwise, it would have been much higher.

Under the draft paradigm in the Stage 3 MU proposed rule, any eligible physician who uses significant hardship exceptions to avoid penalties in 2015, 2016, 2017, 2018, and 2019 would need to successfully participate in MU beginning on January 1, 2018 to avoid CY 2020 payment penalties… If 257,000 noncompliant physicians are currently getting Medicare payment penalties, 55,000 are currently avoiding penalties via manual but time-limited hardship exceptions, and roughly 60,000-85,000 are avoiding penalties via the automatic but time-limited hardship exception, 2018 could end up being a much bigger “D-Day” than anyone is currently predicting.

Of course, the Merit-Based Incentive Program (MIPS) mandate from the SGR reform legislation should significantly impact this predicament, hopefully in a positive way.

Categories: EHR, meaningful use, Medicare

ACR Overview of the CMS Proposed Rule to Modify Meaningful Use in 2015-2017

April 16, 2015 3 comments

On April 15, the Centers for Medicare and Medicaid Services (CMS) formally published its proposed rule to modify the EHR Incentive Program requirements in 2015 through 2017. As with the recent proposals for 2017 and beyond, the latest proposed rule would create a smaller set of Meaningful Use (MU) objectives, revise several (not all) of the problematic requirements, and establish a ninety-day reporting period in calendar year (CY) 2015 for all participants.

Reporting Period Changes
For 2015 only, the reporting period for all participants would be any continuous 90 days in the CY. This change was promised back in January via a CMS staff blog announcement.

As a technicality, CMS’ revisions to the online attestation system would not roll out until January 1, 2016. Thus, first-year participants in 2015 would attest by the end of February 2016 to avoid 2016 payment reductions. These rookies would also have a period of time in which they receive payment reductions. CMS would reprocess and reconcile those reduced Medicare payments when rookies’ 2015 MU attestations are processed.  Veteran participants would be unaffected by this technicality.

MU Objectives for 2015, 2016, and (optional) 2017
The proposed rule would eliminate the concept of “core” and “menu” objectives, instead requiring all participants, regardless of Stage, to complete the Stage 2 MU objectives listed below.

Stage 1 participants in 2015 could use the Stage 1 thresholds through “alternative measures.” These participants would have new exclusions available to them to negate increased thresholds and new requirements taken from Stage 2.

  1. Protect health information/HIPAA
  2. Enable CDS functionality
  3. Meds, labs, and radiology orders captured using CPOE
  4. E-Prescribing
  5. Summary of care creation/transmittal for transitions of care and referrals (modified)
  6. Patient specific educational resources
  7. Medications reconciliation for received transitions of care
  8. View/Download/Transmit (modified to reduce reliance on patient action)
  9. Secure electronic messaging (modified to only require enabling the functionality)
  10. Public health/registries (modified to consolidate the registry-related objectives – choose to actively engage with 2 or 1 registries depending on MU Stage)

As proposed, most diagnostic radiologists would likely need to complete the measures of four total MU objectives: (1) protect health information, (2) CDS, (8) patient view/download/transmit (if exclusion not met), and (10) public health/registries (if exclusions not met).

The “imaging results access” Stage 2 objective is one of the many objectives that would be eliminated by the proposed rule.

Although it is unclear if this was intended by CMS, the proposed language appears to separately define and no longer explicitly include referrals as transitions of care in the “medications reconciliation” objective. On the flip side, referrals would be included alongside transitions of care in the “summary of care” objective for referring providers.

CQM Reporting
The component of MU that requires reporting of clinical quality measures (CQMs) would mostly remain the same. Veteran participants could choose to report CQMs for their 90-day reporting period via attestation in 2015 (as first-year participants do) versus one of the other CQM reporting options.

Significant Hardship Exceptions
CMS does not propose any changes to the hardship exceptions currently in the regulations. Therefore, radiologists would continue to avoid penalties automatically for up to 5 years per individual.

“Hospital-Based” Determination / Eligibility
CMS requested public comment on whether Place of Service Code 22, or other settings, should be used in the hospital-based determination.

Next Steps
Following the close of the sixty-day public comment period, CMS will review the submissions and draft a final rule for promulgation later in 2015. American College of Radiology members who wish to submit feedback for potential inclusion in ACR’s future comments should please contact Michael Peters, ACR Director of Regulatory and Legislative Affairs, at or 202-223-1670.

Categories: EHR, meaningful use, Medicare

CMS Releases Proposed Rule to Revise Meaningful Use for 2015-2017

April 13, 2015 Leave a comment

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule to modify the EHR Incentive Program (“meaningful use”) participation requirements for the period between 2015 and 2017. The “MU fix” rulemaking is intended to increase flexibility and reduce the reporting burden for participating physicians and hospitals and is separate from the “Stage 3” proposed rule published a few weeks ago. It will be published in the Federal Register on April 15 for a 60-day comment period.

The American College of Radiology Government Relations team is currently reviewing the content.

Categories: EHR, meaningful use, Medicare

SGR and the Merit-Based Incentive Payment System Revisited

April 8, 2015 3 comments

Legislation to replace the Sustainable Growth Rate (SGR) formula passed the U.S. House of Representatives on March 26, and could pass the Senate following the Congressional recess. As with last year’s failed legislation to permanently fix the SGR, certain language meant to encourage “pay for performance” would significantly impact the landscape of health IT policy.

The included “Merit-Based Incentive Payment System (MIPS)” concept would consolidate the three active Medicare incentive programs—the Physician Quality Reporting System (PQRS), EHR Incentive Program (“meaningful use”), and Value Based Modifier (VBM)—into an umbrella carrot-and-stick program that eligible professionals could do as an alternative to mandated participation in alternative payment models (APMs). MIPS would award incentive payments or payment reductions 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. This score-based system would replace the current Medicare programs’ payment adjustments with potentially bigger reductions for some physicians; however, most physicians would avoid penalties or obtain incentive bonuses.

As was the case last year, the bill directs regulators to consider the applicability of the various requirements that comprise the composite performance score to “non-patient-facing” professionals and others. This language could conceivably result in alternative pathways to compliance, removal of individual programs (such as MU and VBM) from the score for certain professionals, or even 1:1 replacement requirements for non-patient-facing professionals that fulfill the same goals.

Categories: EHR, meaningful use, Medicare