On Tuesday, April 24, the Centers for Medicare & Medicaid Services (CMS) published the 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM), which includes modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, and other proposed changes to interoperability initiatives at CMS.
At the HIMSS18 Global Conference & Exhibition, CMS Administrator Seema Verma announced that the agency was going to overhaul meaningful use. In this proposed rule, CMS is prioritizing interoperability in the overhaul and moving the program beyond the existing requirements of meaningful use to a new phase of EHR measurement. This new phase includes an increased focus on interoperability and improving patient access to health information, as well as placing a strong emphasis on measures that require the exchange of health information between providers and patients. To better reflect this focus, CMS is renaming the EHR Incentive Programs as the Promoting Interoperability (PI) Programs for eligible hospitals, critical access hospitals (CAHs) and Medicaid providers.
Other key takeaways from the NPRM include the following.
Revamped PI Programs Include Fewer Measures and Less Burden
For the PI Programs, CMS is proposing a new performance-based scoring methodology with fewer measures and moving away from the threshold-based methodology currently in use. The agency believes this change would provide a more flexible, less burdensome structure, allowing eligible hospitals and CAHs to put their focus back on patients. CMS is proposing to reduce the total number of required measures from 16 to six, and introduce a performance-based scoring methodology, which provides flexibility not provided under the existing meaningful use Stage 3 scoring methodology.
The proposed six objectives, scored on a pass/fail basis, would include:
- Health information exchange (HIE)
- Provider to patient exchange
- Public health and clinical data exchange
CMS is proposing these objectives to promote specific HHS priorities, where the core goals promote interoperability between healthcare providers and health IT systems to support safer, more coordinated care.
An eligible hospital or CAH would need to earn a total Promoting Interoperability score of 50 points (out of a possible 100 points) or more in order to satisfy the requirement to report on the objectives and measures of the new program.
For the HIE objective, CMS is proposing to change the name of the existing Send a Summary of Care measure to Support Electronic Referral Loops by Sending Health Information, and proposing a new measure which combines the functionality of the existing Request/Accept Summary of Care and Clinical Information Reconciliation measures into a new measure, Support Electronic Referral Loops by Receiving and Incorporating Health Information.
In order to meet statutory requirements on EHR reporting and HHS priorities, the eligible hospital or CAH would need to report on all of the required measures across all objectives in order to earn any score at all. Failure to report any required measure, or reporting a “no” response on a yes/no response measure (unless an exclusion applies) would result in a score of zero. CMS acknowledges that, in this way, the program still maintains a certain “all-or-nothing” element, but the agency believes that the fewer number of measures adds flexibility and reduces burden.
Use of 2015 Certified EHR Technology (CEHRT) is Reaffirmed
In this proposed rule, CMS is aligning the PI Programs with the Hospital Inpatient Quality Reporting (IQR) Program, to require hospitals to use only the 2015 Edition certification criteria for CEHRT beginning with the calendar year 2019 reporting period/fiscal year 2021 payment determination. For the objectives under the revamped program, CMS noted that the proposals under the HIE objective require only consolidation of existing workflows and actions, while the certification criteria and standards remain the same as finalized in the October 16, 2015 final rule.
Addressing the Opioid Crisis is Now Part of Medicare Payment Policy
In terms of addressing new areas in the PI Programs, CMS is proposing to include two measures under the e-Prescribing objective focused on querying a Prescription Drug Monitoring Program (PDMP), and verifying the existence of an opioid treatment agreement. CMS aims to align the PI Programs with the overall agency initiatives directed to the treatment of opioid and substance use disorders.
The PDMP measure is focused on encouraging hospitals and CAHs to query the PDMP, as it is important for tracking prescribed controlled substances and improving prescribing practices. The intent of the opioid treatment agreement measure is for eligible hospitals and CAHs to identify whether there is an existing opioid treatment agreement when they electronically prescribe a Schedule II opioid using CEHRT, if the total duration of the patient’s Schedule II opioid prescriptions is at least 30 cumulative days.
CMS is not proposing to require these two new measures in 2019, although eligible hospitals and CAHs may choose to report them and earn up to five bonus points for each measure. CMS is proposing to require these measures beginning with the EHR reporting period in 2020.
CMS is Requesting Information on Changing the Medicare and Medicaid Conditions of Participation to Include Interoperability
CMS included a request for information (RFI) in this NPRM to obtain feedback on positive solutions to better achieve interoperability or the sharing of healthcare data between providers. Specifically, CMS is requesting stakeholder feedback on the possibility of revising Conditions of Participation related to interoperability as a way to increase electronic sharing of data by hospitals. The RFI will inform the agency’s next steps on future regulatory action related to inpatient and long-term hospitals. CMS will not respond to RFI comment submissions in the final rule, but rather will actively consider all input in developing future regulatory proposals or future sub-regulatory guidance.
Look for additional resources from HIMSS on this proposed rule in the coming days.
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