The Advancing Care Information (ACI) category in the Merit-Based Incentive Payment System (MIPS) can be “reweighted to zero” under certain circumstances. This is functionally similar to obtaining an exclusion from the ACI portion of MIPS. If ACI is reweighted to zero, the category’s full weight (25% of the MIPS final score) is then reallocated to the Quality category (with an exception I won’t dive into here).
The various options to reweight ACI to zero are essentially based on the eligibility criteria and the significant hardship exception options that were present in the Medicare EHR Incentive Program (or “Meaningful Use”).
- Non-patient-facing (NPF) MIPS eligible clinicians will have their ACI category automatically reweighted to zero by CMS. The agency will determine them to be NPF if they have fewer than 100 “patient-facing encounters” during the corresponding determination period. In terms of group reporting, a group would be “non-patient-facing” if more than 75 percent of the NPIs billing under that group’s TIN meet the NPF definition. The specific patient-facing encounter codes have not yet been identified publicly by CMS, but we are told the agency could release that code list as early as this month, or perhaps even notify participants of their NPF determination before the code list itself is released… Stay tuned…
- Hospital-based MIPS eligible clinicians will also have the ACI category automatically reweighted to zero by CMS. Hospital-based ECs are those who provide 75 percent or more covered professional services in the inpatient hospital (POS 21), on campus outpatient hospital (POS 22), or emergency room (POS 23) settings. This is substantially different from the MU definition of “hospital-based” in that CMS lowered the threshold from 90 percent to 75 percent, and included POS Code 22 as a hospital setting. Thus, many more physicians will end up being “hospital-based” under the MIPS/ACI definition than there were for MU.
- Non-physician MIPS eligible clinicians (nurse practitioners, physician assistants, etc.) will also have ACI reweighted to zero if they choose not to report any ACI data.
- Other MIPS eligible clinicians not covered by bullets #1-3 above can manually apply to reweight ACI to zero if they meet any of the following criteria (based on the corresponding MU significant hardship exceptions):
- Insufficient broadband availability
- Faced extreme and uncontrollable circumstances
- Lacked influence over certified EHR technology availability
The HHS Office of the National Coordinator for Health IT (ONC) recently published its final rule to enhance the oversight and accountability of the ONC’s Health IT Certification Program. The rule establishes processes and related requirements for the agency’s direct review of certified health IT modules post-certification, and creates additional transparency on the Certified Health IT Product List (CHPL or “the chapel”), among other enhancements. While the regulatory improvements codify ONC’s procedures leading up to certification termination, the rule explicitly does not cover the impact of certification termination on physician customers who rely on their certified health IT modules for participation in federal programs, such as the Quality Payment Program/Merit-based Incentive Payment System (MIPS).
ONC also recently released a brief fact sheet on general health IT considerations in the MACRA/Quality Payment Program final rule. We should expect to see more detailed guidance from the Centers for Medicare and Medicaid Services and (potentially) ONC in the near future.
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 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.
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.”