Washington Debrief: MU Modification Receives Mixed Reviews

Sept. 2, 2014
CMS finalized several new pathways for providers to meet Meaningful Use in 2014, if they can demonstrate they are unable to fully implement 2014 Edition CEHRT. The agency also named 2017 as the beginning date for Stage 3 of the EHR Incentive Program.

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New MU ‘Modifications’ Rule Receives Mixed Reviews from Industry Stakeholders

Key Takeaway:  CMS finalized several new pathways for providers to meet Meaningful Use in 2014, if they can demonstrate they are unable to fully implement 2014 Edition CEHRT.  The agency also named 2017 as the beginning date for Stage 3 of the EHR Incentive Program.  

The final rule lacked a key provision for the 2015 reporting period, which will require a full reporting year, rather than the quarter reporting period offered in 2014.  For roughly 3,800 hospitals, this means having 2014 Edition CEHRT implemented and configured for Stage 2 measures and objectives by October 1, 2014.  More than 237,000 physicians will need to be similarly positioned by January 1, 2015. 

Why it Matters:  Government policymakers are betting that enough providers will take advantage of the new options to stave off a dramatic participation decline in 2014.  Given the late date of this final rule, the regulatory complexity of the options and the technical incapacity of many EHR systems to run retrospective reports against historic performance, it is unclear how many providers will be able to take advantage of this “regulatory relief.”  Meanwhile, Congressional overseers probably will use this opportunity to drive further scrutiny of how the Meaningful Use approach has been implemented by the Obama administration.

A rule that had the entire health IT world watching published late Friday afternoon before the Labor Day weekend.  The rule, which becomes effective October 1, 2014, will give hospitals and physicians a number of additional pathways to meet Meaningful Use in 2014, depending on which Stage they were scheduled to meet and what combination of Certified EHR Technology (CEHRT) they have.  For example, if a hospital was scheduled to meet Stage 2 this year, but did not receive 2014 Edition CEHRT in a timely manner, it could opt to meet Stage 1 requirements with any combination of 2011 and/or 2014 Edition CEHRT.  The rule’s additional pathways, while complicated, were supported by nearly every stakeholder group, including CHIME.

However, most stakeholders also identified the reporting requirements for 2015 to be problematic, given the number of providers expected to be Stage 2-ready within the next 30 days.  A recommendation offered by CHIME, and echoed by the AHA, HIMSS, AMA and many other groups, asked CMS to change the reporting requirements of 2015 from a full year to a quarter, similar to the reporting period set for 2014.  CMS did not accept this recommendation, saying that such a change “would put the forward progress of the program at risk, and cause further delay in implementing effective health IT infrastructure.”  CMS also cited “misalignment” with reporting programs such as IQR and PQRS as a reason for not allowing providers to submit a quarters’ worth of MU data, instead of a full year.

In response, CHIME President and CEO Russell Branzell said, “This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014.”  CHIME felt a shorter reporting period in 2015 would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar, without pushing them too fast; and it would have ensured the long-term vitality of the program itself.  “Now,” Branzell continued, “the very future of Meaningful Use is in question.”


ICD-10 Testing Dates Announced

Key Takeaways: CMS announced three weeks of ICD-10 stakeholder testing before the October 1, 2015, implementation deadline with the intention of ensuring industry preparedness and building confidence within the provider community.

Why It Matters: After being forced to extend the ICD-10 implementation date by Congress, stakeholders, including CHIME, have urged CMS to conduct extensive testing. This announcement is a welcome step towards ensuring a smooth rollout of ICD-10 in October 2015.

CMS announced last week three opportunities for stakeholders to engage in national-level tests for ICD-10. The three testing weeks will be: November 17 to 21; March 2 to 6, 2015; and June 1 to 5, 2015.  The tests are intended for the use of physicians, other providers and suppliers submitting claims to Medicare Administrative Contractors for services provided to Medicare beneficiaries.  In addition to the three scheduled weeks of testing, submitters may acknowledgement test ICD-10 claims at any time through implementation. CMS explains that the ICD-10 testing weeks have been created to generate awareness and interest, and to build confidence in the provider community that CMS and the Medicare Administrative Contractors (MAC) are ready for implementation of  ICD-10.

The testing weeks will allow trading partners to have access to MACs and Common Electronic Data Interchange (CEDI) for testing with real-time help desk support. The event will be conducted virtually and will be posted on the CMS website, in addition to the CEDI website and each MAC's website.

Blue Button Pilot Sharing Immunization History

Key Takeaway: ONC and CDC are partnering to conduct a pilot in Alaska, Arizona, Louisiana, Washington and West Virginia to use Blue Button technology to share children’s immunization records with schools. This effort could increase immunization rates, help schools track immunizations for accountability purposes, and reduce reporting burdens on providers and parents.

Why It Matters: Patients and providers will have digital access to immunization records so they can easily print immunization reports for schools or other purposes. ONC hopes other states will leverage the findings from this pilot to increase immunization rates.

ONC and CDC are targeting pediatric practices, Federally Qualified Health Centers (FQHC), and health clinics. The Blue Button-enabled portal will automatically update when immunizations are complete and will send reminders when immunizations need to be brought up-to-date, enabling patients and parents to keep track of immunization history, and reduce the burden obtaining an immunization record from a provider’s office and providing it to the school each year. In turn, if immunizations for more students are up-to-date, this will put fewer children at risk for contracting preventable diseases. This pilot is just another example of how health IT can improve public health and reduce healthcare costs in the US. The pilots are scheduled to end in spring 2016. Read this ONC Buzz Blog (http://www.healthit.gov/buzz-blog/consumer/making-blue-button-access-immunization-records-quick-easy-convenient/) to learn more about the initiative.

AHRQ Requests Scientific Information on Health Information Exchange

Key Takeaway: On Friday, the Agency for Healthcare Research and Quality (AHRQ) published a request for studies done on health information exchange to put together a comprehensive report on research related to HIEs.

Why It Matters: This request may lead to the creation of best practices for exchanges and provide evidence about how health information exchanges are lowering costs and improving care quality.  This work also may serve as a foundation for new HIE funding opportunities.

From the website, “The motivation to increase the use of health IT in health care is grounded in evidence that health IT can improve the quality, safety, satisfaction, and efficiency of health care, as reported in recent systematic reviews. A key challenge to effective use of health IT, however, is the fact that most Americans, especially those with multiple illnesses, receive care in multiple settings… This presents a challenge if we are to meet the goal stated by former AHRQ Director Dr. Carolyn Clancy that, ‘data should follow the patient’ wherever they get their care.” AHRQ hopes the collection of health information exchange studies will show HIE effectiveness in improving outcomes, shed light out HIE usability and sustainability, and provide insight about barriers to health information exchange. Check out AHRQ’s Effective Health Care Program website for more information about this request for scientific information.

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