On Dec. 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule Final Regulation for Calendar Year (CY) 2021. This regulation included numerous changes to connected health policy, including on telehealth and remote physiologic monitoring (RPM) reimbursement. In addition, CMS finalized several policies for the Quality Payment Program (QPP) and other payment-related policy changes.
HIMSS worked with the Personal Connected Health Alliance (PCHAlliance) to respond to the Proposed Regulation’s Public Comment Period in September 2020.
Over the last 11 months, CMS received extensive waiver authority around connected health under the COVID-19 Public Health Emergency (PHE) declaration, albeit on a temporary basis. While CMS made many changes in the Physician Fee Schedule Final Regulation, the agency is still largely limited by statute as to what it can and cannot make permanent, particularly around telehealth. Ensuring that patients and providers continue to have access to the broad range services utilized during the COVID-19 pandemic after the PHE ends will require Congressional action.
The 2021 Physician Fee Schedule Final Regulation includes the following changes.
CMS had previously finalized that QPP participation through MVPs would begin with the 2021 performance period. However, the agency recognized stakeholder concerns about this timeline, even more so now that clinicians are working hard to address the spread of COVID-19 within their practices and communities. Therefore, CMS decided not to introduce any MVPs into the program for the 2021 Performance Period. Instead, it is finalizing additions to the framework’s guiding principles and development criteria to support stakeholder engagement in collaborating with CMS to develop MVPs and establishing a clear path for MVPs candidates to be recommended through future rulemaking.
In our HIMSS and PCHAlliance Proposed Regulation comment letter, we supported a delay in the timeline for starting the implementation of the MVP Program to at least the 2022 Performance Period. Fundamentally, we expressed support for the MVP Program concept connecting quality, cost, and improvement activity measures around specific chronic conditions or specialty cohorts. We believe that more constrained measurement for each specialty and chronic care condition would reduce variability and reliability of measures and create more effective benchmarking mechanisms for driving care quality and performance transparency for patients.
HIMSS and PCHAlliance encouraged this change primarily due to the lack of information available about the development of the MVP Program. HIMSS has consistently recommended that any measures reported to CMS should be fully-tested (including field testing) with actual patient data to produce meaningful, clinically-appropriate measures of care quality, which can be reported with minimal burden.
In the Proposed Regulation, CMS included the requirement that technology used to meet the certified electronic health record (EHR) technology (CEHRT) definitions must be certified in accordance with the updated certification criteria in the Office of the National Coordinator for Health Information Technology (ONC) 21st Century Cures Act Final Regulation. The agency proposed that eligible clinicians (ECs) must adopt and use 2015 Cures Edition Update CEHRT criteria after August 2, 2022, to meet Promoting Interoperability and Quality performance category requirements of the MIPS program as well as other QPP components.
CMS used the Final Regulation to clarify that health IT developers have until December 31, 2022, to make technology certified to the updated criteria available to their customers—after this date, technology that has not been updated in accordance with the 2015 Edition Cures Update will no longer be considered certified by ONC. ONC’s Final Regulation provided that developers of certified health IT have 24 months from the publication date of the Final Regulation to make technology certified to new or updated criteria available and ONC subsequently extended the timeline until December 31, 2022. ONC stated that in order to reduce confusion, it has aligned these dates to the calendar year where they impact CMS program participants as aligning these compliance dates to the calendar year, also aligns them to the CMS program annual cycle.
ONC expects and requires that developers will notify customers when technology certified to the updated criteria is available, and that developers will introduce these updates into certified health IT products in the manner most appropriate for their customers, such as through the course of normal maintenance.
CMS finalized its proposed revisions to the quality reporting requirements under the Shared Savings Program effective for the 2021 Performance Year and subsequent performance years. The revisions align the Shared Savings Program quality reporting requirements with the requirements that will apply under the Alternative Payment Model (APM) Performance Pathway (APP) in QPP. The Final Regulation also includes a requirement that Shared Savings Program Accountable Care Organizations (ACOs) will report quality data for purposes of the Shared Savings Program via APP. In order to meet the quality reporting requirements under the Shared Savings Program, ACOs must meet certain program requirements.
HIMSS supported these changes in this Proposed Regulation as they would ensure greater alignment and integration between QPP and the Shared Savings Program, including revising the quality performance standard. The idea of APP replacing the Shared Savings Program quality measure set would reduce reporting burden, create new scoring opportunities for participants in MIPS APMs, encourage more participation in APMs, and serve as a suitable complementary path to the MVP Program.
HIMSS will provide further information about the 2021 Physician Fee Schedule.
The HIMSS policy team works closely with the U.S. Congress, federal decision makers, state legislatures and governments, and other organizations to recommend policy, and legislative and regulatory solutions to improve health through information and technology.