CMS Hospital OPPS NPRM Calls for 90-Day Meaningful Use Reporting Period in 2016

On Wednesday, July 6, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) Notice of Proposed Rulemaking (NPRM), which proposes 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 proposes to use 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.


CMS is also proposing to eliminate the Clinical Decision Support (CDS) and Computerized Provider Order Entry (CPOE) objectives and measures for EHs and CAHs attesting under the Medicare EHR Incentive Program and reduce the thresholds for a subset of the remaining objectives and measures in Modified Stage 2 for 2017 and Stage 3 for 2017 and 2018. These proposed changes would not apply to reporting under the Medicaid EHR Incentive Program.

For new program participants in 2017, CMS is proposing that EPs, EHs, and CAHs that have not successfully demonstrated meaningful use in a prior year would be required to attest to Modified Stage 2 by October 1, 2017.  In 2017, returning EPs, EHs, and CAHs will report to different systems and would not be affected by this proposal.


The agency is also proposing a significant hardship exception for new program participants transitioning to the Merit-Based Incentive Payment System (MIPS) in 2017.  EPs that have not successfully demonstrated meaningful use in a prior year, intend to attest to meaningful use for an EHR reporting period in 2017, and intend to transition to MIPS and report on measures specified for the advancing care information performance category under the MIPS as proposed in 2017, can apply for a significant hardship exception from the 2018 Meaningful Use payment adjustment. 


For the Hospital VBP Program, CMS is proposing to remove 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. 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.  Additional changes to the program requirements will be includes in other proposed rules released around August 1.

For the Hospital OQR Program, CMS is proposing to add 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.