The Centers for Medicare and Medicaid Services (CMS) released its final rule this morning to implement the Medicare Access and CHIP Reauthorization Act (MACRA). The final rule establishes the regulatory framework of the Quality Payment Program and its two pathways: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS).
Most radiologists will be in the MIPS pathway of the QPP and many will likely be defined as “non-patient-facing” eligible clinicians. The non-patient-facing determination will be applied to individuals who provide fewer than 100 patient-facing encounters (determined by codes listed in the future on QualityPaymentProgram.cms.gov), and groups with more than 75% of the individual NPIs billing under their TIN determined as non-patient-facing eligible clinicians.
Final rule and executive summary: https://qpp.cms.gov/education
The HHS Office of the National Coordinator for Health IT (ONC) released two free resources for healthcare providers on September 26. The new EHR contract guide and interactive Health IT Playbook are designed to provide supplementary guidance for those with decision-making influence over EHR technology acquisitions in their practices. The contract guide expands upon ONC’s 2013 explanation of common EHR contract terms to provide more information about purchasing, upgrading, or replacing EHR technology. The Health IT Playbook expands upon the earlier Patient Engagement Playbook to provide adoption information and references for end-users. These documents are purely informational and not intended to provide compliance guidance or indicate government/regulatory policy.
Additionally, the Government Accountability Office (GAO) released a report on September 26 titled, “Electronic Health Information: HHS Needs to Strengthen Security and Privacy Guidance and Oversight.” The report outlines cyber-based security threats to patient data and recommends that HHS update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program.
The American College of Radiology (ACR) submitted comments on September 6 to the Centers for Medicare and Medicaid Services (CMS) in support of the proposed ninety-day reporting period for participants in the EHR Incentive Program in 2016. Currently, Meaningful EHR Users beyond their first year of participation in the program are required to report data from the full calendar year.
The proposed change was included in the agency’s 2017 Hospital Outpatient Prospective Payment System proposed rule. If finalized as anticipated, 2016 would be the third straight year CMS has shortened the EHR reporting period for all participants.
In mid-July, the U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) released long-awaited Health Insurance Portability and Accountability Act (HIPAA) guidance on ransomware. The guidance addresses healthcare sector ransomware prevention, recovery, and breach notification processes.
The HHS Office of the National Coordinator for Health IT (ONC) and Assistant Secretary for Preparedness and Response (ASPR) released two funding opportunity announcements last week specific to the establishment of an Information Sharing and Analysis Organization (ISAO). The ISAO would be a single entity charged with IT security education, outreach, warnings and threat information dissemination across the healthcare/public health domain.
The American College of Radiology responded July 22 to a Request for Information (RFI) from the White House Office of Science and Technology Policy (OSTP) on “Artificial Intelligence.” RFI comments will inform the deliberations and future recommendations of the National Science and Technology Council Subcommittee on Machine Learning and AI. The subcommittee was recently created to explore the potential application of this technology to enhance federal government services in a variety of fields, including health care.
The ACR’s comment submission focused on the safety, efficiency, and effectiveness of AI, including: standardized data sets for training and testing, measurement of effectiveness and outcomes, validation and certification of algorithms, clarification of patient consent issues/appropriate methods, and more. The ACR encouraged federal support and partnership with professional associations and other stakeholders to address these issues.
The ACR Commission on Informatics-Clinical Data Science Committee and staff from the Research, MIS, and Government Relations teams informed the comment development efforts.
The Centers for Medicare and Medicaid Services (CMS) will publish its Hospital Outpatient Prospective Payment System (HOPPS) proposed rule for calendar year (CY) 2017 on July 14, 2016. In the meantime, the unpublished version is available to download as a PDF file from the online Federal Register public inspection desk.
The HOPPS proposed rule included several proposals for the Medicare EHR Incentive Program (or “Meaningful Use”), most of which focus on the hospital/CAH version of the program. These include various favorable tweaks to the thresholds of MU objectives/measures, as well as elimination of the CDS and CPOE objectives (functionality certified to the CDS and CPOE health IT certification criteria would still be required of “certified EHR technology” as before).
CMS proposed several revisions applicable to the physician version of the program as well….
The most important proposed change is a 90-day EHR reporting period in CY 2016 (instead of the full CY) and corresponding reduction in the eCQM reporting timeframe. If finalized, this would be the third year in a row CMS has moved to a 90-day reporting period for the EHR Incentive Program.
CMS also proposed a new significant hardship exception category to allow physicians participating in the Advancing Care Information (ACI) measures of the Merit-based Incentive Payment System (MIPS) in CY 2017, who did not participate in previous years of MU, to avoid MU penalties in CY 2018 by applying for a hardship exception by October 1, 2017. This is limited to first year participants because prior MUsers would already avoid the 2018 payment adjustments by virtue of their 2016 MU participation. In other words, this proposed hardship exception allows ACI participation in CY 2017 to substitute for first-year MU participation in order to avoid the CY 2018 MU penalties. The existing MU significant hardship exception options would remain the same for avoiding 2018 penalties, so nearly all ACR members would not need/use the proposed new option.
CMS also proposed a clarification to resolve a previous misunderstanding regarding numerator actions outside of reporting periods. Specifically, CMS clarified that unless otherwise specified, actions included in the numerators of measures must occur within the reporting period if that period is a full CY; or if it is less than a full CY, within the CY in which the reporting period occurs. The misunderstanding was apparently caused by misleading wording in a CMS FAQ.
Looking ahead beyond this HOPPS proposed rule, CMS is expected to publicly release the CY 2017 Medicare Physician Fee Schedule proposed rule in the near future—perhaps as early as this afternoon (July 7).
Update: CMS’ Medicare Physician Fee Schedule proposed rule was indeed released today and is scheduled for formal publication in the Federal Register on July 15, 2016.
The White House Office of Science and Technology Policy (OSTP) is requesting feedback from public stakeholders on the broad topic of “Artificial Intelligence (AI).” The OSTP’s formal Request for Information (RFI), published in the Federal Register on June 27, solicits comments (limited to 2,000 words) on the current and future needs for AI across all sectors. Responses are specifically requested on the following eleven AI topics:
- The legal and governance implications of AI;
- the use of AI for public good;
- the safety and control issues for AI;
- the social and economic implications of AI;
- the most pressing, fundamental questions in AI research, common to most or all scientific fields;
- the most important research gaps in AI that must be addressed to advance this field and benefit the public;
- the scientific and technical training that will be needed to take advantage of harnessing the potential of AI technology, and the challenges faced by institutions of higher education in retaining faculty and responding to explosive growth in student enrollment in AI-related courses and courses of study;
- the specific steps that could be taken by the federal government, research institutes, universities, and philanthropies to encourage multi-disciplinary AI research;
- specific training data sets that can accelerate the development of AI and its application;
- the role that “market shaping” approaches such as incentive prizes and Advanced Market Commitments can play in accelerating the development of applications of AI to address societal needs, such as accelerated training for low and moderate income workers (see https://www.usaid.gov/cii/market-shaping-primer); and
- any additional information related to AI research or policymaking, not requested above, that you believe OSTP should consider.
Additionally, the RFI formally notified the public of OSTP’s establishment of the National Science and Technology Council (NSTC) Subcommittee on “Machine Learning and AI” to examine the state of things and develop a report to coordinate the Administration’s efforts. This subcommittee was informally announced via White House press release in early May, and has since held a series of four broad workshops on AI. The NSTC is a Cabinet-level council and its subcommittees are interagency bodies not subject to public transparency requirements that govern normal federal advisory committees, so this RFI may serve as the only formal opportunity for members of the public to chime in prior to future publication of the report.
The ultimate goal is that the work of the NSTC Subcommittee on Machine Learning and AI could lead to increased use of these technologies to improve the delivery of government services. Despite the inherently inward focus on government, the subcommittee’s report could also potentially influence agencies that regulate and/or fund the private sector, thereby having some impact downstream on the private sector itself.