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 In the meantime, the unpublished version is available to download as a PDF file from the online Federal Register public inspection desk.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 Office of the National Coordinator for Health IT (ONC) held a joint meeting of its Health IT Policy Committee and Health IT Standards Committee on June 23 in Washington, DC. The committees approved final comments addressing the Centers for Medicare and Medicaid Services’ proposed rule to implement the Quality Payment Program (i.e., Alternative Payment Models [APMs] and Merit-based Incentive Payment System [MIPS]). The approved comments included the following recommendations:
MIPS: Advancing Care Information (ACI, formerly “Meaningful Use”)
- Shorten the performance period to 6 months
- Reduce the number of objectives/measures
- Reweight ACI to the other MIPS categories until 2019 for physicians not previously in the EHR Incentive Program
- Award bonus points for marked improvement in high-priority areas
MIPS: Clinical Practice Improvement Activities (CPIA)
- Additional integration of health IT
- Use CPIA as a “test bed” for practicing APM activities
- Enable more of a buffer between MIPS (automatic success) and Advanced-APM participation for QPs
- Additional information about new models with Advanced-APM status
The ONC’s Chief Privacy Officer, Interoperability Experience Task Force, and Interoperability Standards Advisory Task Force also provided updates on their respective activities. The committees will jointly convene their next business meeting via webcast on July 27.
Last week, the American College of Radiology (ACR) and thirty other national specialty societies co-signed a letter by the American Medical Association (AMA) responding to the HHS Office of the National Coordinator for Health IT’s (ONC) April 2016 Request for Information (RFI) on “assessing interoperability for Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).” The letter encouraged ONC to measure interoperability with respect to usefulness, accuracy, timeliness, cost-effectiveness, specialty-specific use cases, etc., rather than volume. The expectation is if ONC focused on interoperability/exchange issues and capabilities that matter to physicians and patients in the real world, vendors would be incented to take a more holistic view of data-sharing, and get out of the rut of developing to the minimum health IT certification criteria requirements.
A provision of MACRA mandated ONC to determine whether EHR technology is successfully enabling widespread health information exchange by the end of 2018. ONC’s RFI asked respondents about considerations for nationwide interoperability metrics to make this determination. Many physician stakeholder groups were concerned that ONC’s RFI focused on a Meaningful Use-style approach of tallying the number of summary of care records sent to exchange partners in order to determine “widespread interoperability.”
The HHS Office of the National Coordinator for Health IT (ONC) held its annual meeting in Washington, DC on May 31 to June 2. The emphasis of this year’s conference was on ONC’s efforts as a grantor and convener, rather than the office’s primary role as a regulator and policymaker.
Centers for Medicare and Medicaid Services (CMS) representatives participated in a couple sessions, but the payor’s presence was noticeably dialed back from that of previous years. With only one dedicated breakout session on CMS’ Alternative Payment Models (APMs) and Merit-based Incentive Payment System (MIPS) proposed rule, and a few indirectly related breakout sessions, the hottest healthcare policy topic in years was severely underrepresented. The few sessions that were directly or indirectly related to MACRA implementation were packed with attendees.
Dr. Karen DeSalvo (National Coordinator for Health IT, ONC) used the plenary session to announce a new certified health IT product transparency tool. The general idea is to empower purchasers of certified health IT with plain language information about a product’s certification status and pricing, per the 2015 Edition certification requirements and the March 2, 2016 proposed rule on enhanced certification program oversight/transparency. The new tool shows if a vendor has “attested” to make future efforts to provide more information to prospective customers per 45 CFR 170.523(k)(2), and provides links (if available) to vendors’ public disclosure pages. Most of these links simply go to vendors’ certification criteria coverage information, and a few go to completely barren placeholder pages. Some vendors provide “price transparency disclosure” information regarding fee timetables, but these often do not list the associated dollar amounts. Only one or two of the vendor resources I found thus far list fee totals in their current price disclosures. So, the transparency tool is severely limited for now but will hopefully improve.
The third and final day of the conference (tomorrow, June 2) will focus on patient/consumer access to data. Dr. DeSalvo will provide closing remarks around 1:30PM Eastern. Interested individuals can view the main plenary portions of the event online.
The U.S. Government Accountability Office (GAO) announced its selections for three open seats on the Office of the National Coordinator for Health IT (ONC) Health IT Policy Committee (HITPC). Jamie Ferguson (Kaiser Permanente, and formerly serving on the Health IT Standards Committee), Carolyn Petersen (Mayo Clinic), and Karen van Caulil, PhD (Florida Health Care Coalition) have been chosen to serve in the two patient/consumer advocate seats and one employer seat.
The HITPC is a federal advisory committee that provides policy recommendations for ONC; however, GAO is technically responsible under ARRA/HITECH for appointing the majority of seats on the committee. The HITPC has been the source of many controversial health IT policy issues since its establishment in 2009, including conceiving the ideas behind CMS and ONC’s now infamously prescriptive regulatory implementation of the HITECH’s Medicare/Medicaid EHR Incentive Program (or “Meaningful Use”).
CMS Proposes to Not Require MU (Advancing Care Information) for Non-Patient-Facing MIPS Eligible Clinicians
The proposed rule released yesterday by the Centers for Medicare and Medicaid Services (CMS) to establish the foundation of the Merit-based Incentive Payment System (MIPS) includes a proposal to reweight the “Advancing Care Information” performance category the MIPS Composite Performance Score (CPS) to zero for non-patient-facing participants. The Advancing Care Information performance category is essentially a rebranding and simplification for the MIPS era of the prior EHR Incentive Program’s “meaningful use” requirements.
Generally speaking, payment adjustments under MIPS would be determined by the relative CPS of MIPS eligible clinicians. The CPS would be comprised of performance in four categories: quality, resource use, clinical practice improvement activities, and advancing care information.
The Advancing Care Information performance category would, by default, count for up to 25 percent of an eligible clinician’s CPS. However, CMS proposes that non-patient-facing MIPS eligible clinicians would have their Advancing Care Information performance category automatically reweighted to zero, thus basing their CPS on other performance categories (some of which also have reweighting). The end result is that the CPS of non-patient-facing MIPS eligible clinicians would not be influenced by the Advancing Care Information performance category—at least not initially (CMS indicated that they would revisit this issue in future rulemakings).
CMS proposes that “non-patient-facing MIPS eligible clinicians” would be defined as individual MIPS eligible clinicians or groups that bill 25 or fewer patient-facing encounters during a performance period. A “patient-facing encounter” would be an instance in which MIPS eligible clinician or group billed for services such as general office visits, outpatient visits, and surgical procedure codes under the Physician Fee Schedule. CMS plans to publish a proposed list of these patient-facing encounter codes online.
The current assumption (without the aforementioned list of encounter codes to verify) is that most of ACR’s diagnostic radiologists and nuclear medicine physicians would meet the proposed “non-patient-facing” definition, and thus would have their Advancing Care Information performance category automatically reweighted to zero. At this writing, it is unclear (again, without that list of encounter codes) if interventional radiologists would also meet the proposed “non-patient-facing MIPS eligible clinician” definition.
As anticipated, the Centers for Medicare and Medicaid Services publicly released the proposed rule titled,”Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models.” The proposed rule will be formally published in the Federal Register on May 9.