Tag: Meaningful Use
The Centers for Medicare and Medicaid Services on Monday announced a new initiative intended to streamline quality measures, reduce regulatory burden and promote innovation in the healthcare industry as it transitions from fee-for-service to value-based payment.
The effort, called the Meaningful Measures initiative, is being described as a “new approach to quality measurement.” CMS Administrator Seema Verma made the announcement during a plenary session at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Va.
“We need to move from fee-for-service to a system that pays for value and quality—but how we define value and quality today is a problem,” Verma said. “We all know it: Clinicians and hospitals have to report an array of measures to different payers. There are many steps involved in submitting them, taking time away from patients. Moreover, it’s not clear whether all of these measures are actually improving patient care.”
According to the agency, the Meaningful Measures initiative will “involve only assessing those core issues that are most vital to providing high-quality care and improving patient outcomes,” while adding that CMS “aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes.
Verma said CMS is “revising current quality measures across all programs to ensure that measure sets are streamlined, outcomes-based, and meaningful to doctors and patients” and that Meaningful Measures “takes a new approach to quality measures to reduce the burden of reporting on all providers.”
In August, Verma said that CMS would soon be announcing additional initiatives to ease the burden the federal government places on healthcare providers. In particular, she took aim at the burdensome regulations governing electronic health records which have made the practice of medicine difficult.
In her presentation on Monday at the LAN Fall Summit, Verma said that CMS is re-examining its “process for conducting quality measurement across the board,” such as implementing the Medicare Access and CHIP Reauthorization Act (MACRA) in a way that minimizes the burden and costs providers face in meeting the requirements.
“We’ve taken a hard look at MACRA and will continue to do so,” said Verma. “We know that MACRA is a tremendous change, so we’re taking it slow to make the transition as smooth as possible. It’s great that some are ready to move faster, such as larger systems of care. But, we need a system that can work for all providers across the country—urban, rural, small, and large—so that the transition does not push providers out of the system and result in fewer patient choices.”
Reactions from industry groups to the new CMS initiative were generally positive and cautiously optimistic. The potential impact to improve federal oversight of healthcare IT is laudable, some say.
“A quick review of the administrator’s comments are music to our ears,” said Mari Savickis, vice president of federal affairs at the College of Healthcare Information Management Executives (CHIME).
However, Jeff Smith, vice president of public policy for the American Medical Informatics Association, was guarded in his assessment of new CMS initiative.
“The goals are laudable, but the talking points have been with us for several years now,” observed Smith. “Measurement depends on agreed-upon definitions of quality, and in an electronic environment, it requires access to and use of computable data. If CMS is going to turn these talking points into reality, it will need to put forth far more resources and commit additional experts to a complete overhaul of electronic quality measures for value-based payments, as we called for nearly two years ago.”
At the same time, he noted that CMS has a “fairly robust Quality Measures Blueprint and CMS proposed changes to Evaluation & Management documentation guidelines as part of the recent CY 2018 Physician Fee Schedule rule, so there is reason to be optimistic.”
Smith contends that “if CMS makes this more than a passing priority, and if there is a fundamental review of quality measures in an electronic environment, then AMIA gladly supports this initiative.”
Other industry leaders say the intent of the approach is needed in the industry.
“There is growing frustration for those on the front lines providing care in a system that often forces them to spend more time pushing paper rather than treating patients,” said Rick Pollack, president and CEO of the American Hospital Association. “Too often, these regulatory requirements seem detached from good and efficient patient care. The regulatory burden is substantial and unsustainable, and reducing the administrative complexity of healthcare would allow providers to spend more time on patients, not paperwork.”
Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association, said MGMA supports the agency’s efforts to reduce regulatory burdens and ensure Medicare quality measurement is meaningful and actionable for medical practices.
“In a recent survey of our members, (lack of) clinical relevance was ranked as the top concern under the Medicare MIPS program,” added Gilberg. “We expect the 2018 Quality Payment Program Final Rule (implementing MIPS and APMs) to be released this week and are hopeful these new CMS policies will be consistent with this announcement.”
The Meaningful Measures announcement by CMS comes on the heels of the recent public launch of the agency’s Patients Over Paperwork Initiative, which seeks to removing regulatory obstacles that get in the way of providers spending time with patients.
“Regulations have their place and are important to ensuring quality, integrity, and safety in our healthcare system. But, if rules are misguided, outdated, or are too complex, they can have a suffocating effect on healthcare delivery by shifting the focus of providers away from the patient and toward unnecessary paperwork, and ultimately increase the cost of care,” said Verma during her remarks at Monday’s LAN event.
The Office of the National Coordinator for Health IT on Thursday revealed two changes to its certification criteria that officials said are designed to reduce the burden on industry and make the meaningful use program more efficient.
The first is making more than half of test procedures self-declarable and the second is more discretion around randomized surveillance of certified health IT products.
Elise Anthony, director of policy at ONC, and Steven Posnack, director of ONC’s Office of Standards and Technology, wrote on the Health IT Buzz blog that 30 of the 55 criteria were intended to support CMS Quality Payment Program and those are now self-declaration only.
“This means that health IT developers will self-declare their product’s conformance to these criteria without having to spend valuable time testing with an ONC-Authorized Testing Laboratory,” Anthony and Posnack added. “The test procedures for health IT products now designated as ‘self-declaration’ are for functionality-based certification criteria.”
The second change ONC made on Thursday relates to randomized surveillance of ONC-Authorized Certification Bodies. The ACBs are required to conduct randomized surveillance for at least two percent of the health IT products they certify.
“ONC will not, until further notice, audit ONC-ACBs for compliance with randomized surveillance requirements or otherwise take administrative or other action to enforce such requirements against ONC-ACBs,” Anthony and Posnack wrote. “This exercise of enforcement discretion will permit ONC-ACBs to prioritize complaint-driven, or reactive, surveillance and allow them to devote their resources to certifying health IT to the 2015 Edition.”
ONC said that these changes are intended to ease the burden on health IT developers and certification bodies so they can focus more on interoperability.
“This change enables ONC-ATLs and health IT developers to devote more of their resources to the remaining interoperability-oriented criteria, aligning with the tenets of the 21st Century Cures Act,” Anthony and Posnack wrote.
Amid a slew of payment updates released by the Centers for Medicare & Medicaid Services (CMS) last week, one issue was conspicuously absent: relief from Meaningful Use Stage 3 requirements.
Although CMS provided some regulatory relief for physician under a proposed MACRA rule released last month, which allows physician practices to continue using the 2014 Edition Certified EHRs, the agency offered no reprieve in its proposed Outpatient Prospective Payment rule posted last week.
American Hospital Association Executive Vice President Tom Nickels said he was “dismayed” the CMS failed to relieve hospitals of “unrealistic and unachievable” Meaningful Use Stage 3 reporting requirements, which is scheduled to take effect on January 1, 2018.
“The mandate for all hospitals and critical access hospitals to switch to new EHR functionality and report for a full year is unattainable and is at odds with the meaningful use flexibility proposed for eligible clinicians in the Quality Payment Program proposed rule,” Nickels said in a statement.
Numerous health IT organizations have called on CMS to delay the certification requirements and Meaningful Use Stage 3 from six months to a year. Earlier this year, the College of Healthcare Information Management Executives called on HHS Secretary Tom Price to delay MU requirements “indefinitely,” adding to calls from provider organizations like the American Medical Association that argued rushed implementation of EHR upgrades could compromise patient safety.
As if the hefty settlement fine execs had to pay wasn’t enough, the vendor also has to offer free upgrades, transfer customer’s data to rival EHR vendors for free, and employ an independent personal watchdog.
EHR vendor eClinicalWorks got slammed last Wednesday with a $155 million penalty by the federal government, but that is far from the worst part of the deal it struck with officials. Rather, the vendor accepted some curious terms in a 5-year settlement agreement that the Office of the Inspector General called innovative.
The fine stemmed from a whistleblower suit alleging that it falsely obtained certification for meeting certain criteria as part of the meaningful use EHR reimbursement program. eClinicalWorks disputes the charges but said it settled anyway to avoid the “cost and uncertainty inherent in protracted litigation.”
But buried down in the legalese of the settlement notice the Department of Justice posted is the fact that eClinicalWorks agreed to a corporate integrity agreement, or CIA, that mandates the EHR vendor retain an Independent Software Quality Oversight Organization. Such an organization will essentially operate as personal watchdog assessing eClinicalWorks quality control and compiling reports for both eClinicalWorks and the U.S Office of the Inspector General.
Wait, there’s more.
“The CIA also requires eClinicalWorks to allow customers to obtain updated versions of their software free of charge and to give customers the option to have eClinicalWorks transfer their data to another EHR software provider without penalties or service charges,” the notice said. “eClinicalWorks must also retain an Independent Review Organization to review eClinicalWorks arrangements with healthcare providers to ensure compliance with the Anti-Kickback Statute.”
At this point it’s hard to pinpoint which will be worse: Customers leaving for rival EHR vendors or being forced to give those medical practices and hospitals that do stick with them free upgrades.
A new survey from MGMA has found that medical practices have mixed approaches to analyzing their electronic health record data.
The survey found 31 percent said they use their EHR analytics capabilities to the fullest extent; another 31 percent said they deploy a combination of EHR analytics along with help from an external vendor partner; 22 percent said they use some of their EHR’s analytic capabilities; and 5 percent said they rely on an external vendor.
But a not-insubstantial 11 percent of survey-takers said they don’t perform analytics at all on their EHR data, according to the poll.
MGMA Principal Derek Kosiorek said he understands the wide disparity in providers’ analytic maturity. After all, most EHRs weren’t built for data analytics, but as electronic information repositories.
In the post-meaningful use EHR rush, many systems, in order to be more palatable to paper-reliant physicians, were designed to emulate paper records, he said in a blog post, rather than to interpret, aggregate or organize the records.
“For many practices, reports produced by the EHR were either pre-installed with the product or configured by the vendor during implementation,” said Kosiorek. “To these groups, the ability to generate new analytics walks out the door with the product implementation team.”
Even savvy medical staffs are forced to rely on assistance or add-ons from outside vendors to help them with analytics.
But even though many physician practices don’t have the resources to do so, the imperatives of value-based care make the ability to leverage clinical, administrative and financial data vital, he said.
The good news is that EHRs and analytics tools are “improving in exciting ways and will soon live up to the promise that brought us into the electronic age,” said Kosiorek. “I often say that clinical providers do not dislike EHRs as a concept – they dislike the EHRs they have been given. Today, it is more difficult to get the job done with the tool than it is without it. But data analytics have the power to change all that.”
Image from Healthcare IT News
Public health, clinical data or specialized registry electronic reporting options are intended to help with meaningful use requirements.
The Centers for Medicare and Medicaid Services has created a centralized repository for public health agency and clinical data registry reporting to provide an additional, centralized source of information for eligible professionals, eligible hospitals and critical access hospitals.
This will help organizations seeking to comply with Stage 2 Meaningful Use requirements. In the Stage 2 of Meaningful Use final rule, released in 2012, CMS stated it would develop this repository.
The CMS Centralized Repository is not the authoritative source of all reporting options currently available, CMS said. The information within the repository was collected in September and October 2016.
Participation in the repository by public health agencies, clinical data registries and specialized registries is voluntary.
For the Medicare or Medicaid EHR Incentive Programs, the absence of an entry on the CMS Centralized Repository is not sufficient documentation for claiming an exclusion and does not prevent a provider from attesting to reporting to a registry, CMS said. Providers must still check with jurisdictional public health agencies or specialty societies to which they belong and document that information to satisfy Medicare or Medicaid reporting.