On Tuesday, November 1, 2016, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) final rule, which finalizes changes to the Electronic Health Record (EHR) Incentive Program, Hospital Value-Based Purchasing (VBP) Program, and the Hospital Outpatient Quality Reporting (OQR) Program.
For the EHR Incentive Program, CMS finalized a 90-day EHR reporting period in 2016 for all eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs)—which would be any continuous 90-day period between January 1, 2016 and December 31, 2016. CMS believes it would continue to assist health care providers by increasing flexibility in the program. In 2015, the reporting period was also 90 days, which enabled health care providers to accommodate the changes to the program that were not finalized in rulemaking until the end of 2015.
For new program participants in 2017, CMS is requiring EPs, EHs, and CAHs that have not successfully demonstrated meaningful use in a prior year and are looking to avoid a 2018 payment adjustment to attest to Modified Stage 2 by October 1, 2017. The final rule also creates a one-time hardship exemption from 2018 meaningful use penalties for doctors who are new to the EHR Incentive Program and transitioning to the new Merit-Based Incentive Payment System (MIPS) in 2017 in an effort to continue advancement of certified EHR technology utilization.
CMS also eliminated the Clinical Decision Support (CDS) and Computerized Provider Order Entry (CPOE) objectives and measures for eligible hospitals (EHs) and critical access hospitals (CAHs) attesting under the Medicare EHR Incentive Program and reduced the thresholds for a subset of the remaining objectives and measures in Modified Stage 2 for 2017 and Stage 3 for 2017 and 2018. The revised requirements for hospitals are an effort to reduce hospital administrative burden and allow hospitals to, “focus more on providing quality patient care.” Based on public comment, CMS is also finalizing a policy that will apply these changes to objectives and measures to all EHs and CAHs that attest to CMS, including EHs and CAHs that are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs.
For the Hospital VBP Program, CMS is removing the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the Hospital VBP Program, beginning with the FY 2018 program year, leaving 8 dimensions in the HCAHPS Survey. In future rulemaking, CMS intends to propose to adopt modified pain management questions for the HCAHPS Survey when they become available for use in the Hospital VBP Program. The VBP Program is funded by a 2 percent reduction from participating hospitals’ base operating diagnosis-related group (DRG) payments each year, and requires CMS to redistribute a portion of the Medicare payments to hospitals for inpatient services based on performance.
For the Hospital OQR Program, CMS is adding a total of seven measures to the Hospital OQR Program for the CY 2020 payment determination and subsequent years. These include: two claims-based measures, and five Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey-based measures. The OQR Program is a pay for quality data reporting program for outpatient hospital services—it requires hospital outpatient facilities to meet administrative, data collection, and submission, validation, and reporting requirements, or receive a reduction of 2.0 percentage points in their annual payment update for failure to meet these requirements. This final rule with comment period and the interim final rule with comment period become effective on January 1, 2017. You may submit electronic comments on this regulation to http://www.regulations.gov.