MACRA Released

On Friday, CMS released the MACRA final rules, its innovative payment system for Medicare replacing the sustainable growth rate formula and the EHR Incentive Program for Medicare providers.

MACRA creates the framework for providers to participate in the CMS Quality Payment Program through either the Advanced Alternative Payment Models (Advanced APMS) or the Merit-based Incentive Payment System (MIPS). The goal of these models is to reward value and outcomes, specifically supporting CMS’ goal of paying for quality and value. The MIPS program importantly consolidates components of PQRS, the Physician Value-based Payment Modifier (“VM”), and the EHR Incentive Program (aka meaningful use).

“As prescribed by Congress, MIPS will focus on: quality – both a set of evidence-based, specialty-specific standards as well as practice-based improvement activities; cost; and use of certified electronic health record (EHR) technology (CEHRT) to support interoperability and advanced quality objectives in a single, cohesive program that avoids redundancies. Many features of MIPS are intended to simplify and integrate further during the second and third years.”

Though the new rule becomes effective on January 1st, 2017, clinicians will be given a transition period in which to prepare for MIPS, with negative payment adjustments not occurring until January 1, 2019. MACRA will sunset payment adjustments under the Medicare EHR Incentive Program, PQRS and VM after CY2018. For those clinicians not ready to start on January 1st, 2017 they have until October 2, 2017 to commence participation. Regardless of when a clinician starts he/she needs to submit performance data by March 31, 2018.

CMS’ Quality Payment Program has the following strategic objectives:

(1) to improve beneficiary outcomes and engage patients through patient-centered Advanced APM and MIPS policies;

(2) to enhance clinician experience through flexible and transparent program design and interactions with easy-to-use program tools;

(3) to increase the availability and adoption of robust Advanced APMs;

(4) to promote program understanding and maximize participation through customized communication, education, outreach and support that meet the needs of the diversity of physician practices and patients, especially the unique needs of small practices;

(5) to improve data and information sharing to provide accurate, timely, and actionable feedback to clinicians and other stakeholders; and

(6) to ensure operational excellence in program implementation and ongoing development.

CMS also launched a new website with graphics to aid in understanding the MACRA regulations. The view the interactive website click here.

CMS has also provided a 24-page executive summary. Click here to view the executive summary.

If you have questions about MACRA please contact Elana Zana.

 

Updated Meaningful Use Rules Released

After months of waiting, CMS and ONC finally issued final rules (with comment) pertaining to Stage 3 Meaningful Use, 2015-2018 EHR Incentive Program and 2015 edition of CEHRT certification.  CMS announced that the rules, numbering 750+ pages, are designed to “simplify requirements and add new flexibilities for providers to make electronic health information available when and where it matters most.”  CMS’ announcement also signaled more rules to come, CMS has opened a 60-day comment period for additional feedback about the EHR Incentive Programs and in particular the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), “which established the Merit-based Incentive Payment System and consolidates certain aspects of a number of quality measurement and federal incentive programs into one more efficient framework.” Expected release for MACRA is spring 2016.

Highlights of the final rule include:

  • 2015 reporting for EPs and EHs is any continuous 90 day period within CY 2015 by Feb. 29. 2016, which may be extended to March if providers need additional time.
  • 2016 & 2017 new Medicare and Medicaid providers (and 2018 Medicaid providers) may report on any 90 days.
  • Most changes in the rule will not be required until 2018 (but providers who are ready may transition to the next phase in 2017).
  • 2015-2017 EPs will report on 10 objectives, EHs on 9 objectives, including one public health reporting objective.
  • Modified patient action measures in Stage 2 objectives.
  • 90 day reporting period for any provider moving to Stage 3 in 2017.
  • Finalization of the use of application program interfaces (APIs) which allow the use of new programs/functions that will help patients have access to their healthcare records, including on mobile devices.
  • Focus on interoperability in Stage 3 rules.

The final rules will be officially published in the Federal Register on October 16, 2015.

For more information regarding the EHR Incentive Program and these new rules please contact Elana Zana.

CMS Announces Intent to Modify Meaningful Use

CMS announced today its intent to make significant changes to the EHR Incentive Program beginning in 2015.  The proposed changes, though not yet codified in a proposed rule, include a much desired ease of the program requirements in 2015.  They include:

  1. Aligning hospital EHR reporting periods to the calendar year (rather than the fiscal year) to allow hospitals to have more time to incorporate 2014 CEHRT into their workflows;
  2. Shortening the EHR reporting period in 2015 to 90 days to accommodate these changes; and
  3. Adjusting other portions of the program to “match long-term goals, reduce complexity, and lessen providers’ reporting burdens.”

These new rules are expected this spring.  CMS clarified in its announcement that these proposed modifications will not be forthcoming in the Stage 3 proposed rule which is expected to be released in early March.  CMS also indicated that it proposes to limit the scope of the Stage 3 proposed rule to criteria for meaningful use in 2017 and beyond.

To learn more about meaningful use and the EHR Incentive Program contact Elana Zana.

Patient Engagement and Meaningful Use

I am very excited this week to present with my colleague Dave Schoolcraft at MGMA in Las Vegas.  We have two presentations on Tuesday, the first at 10:15 entitled the Legal Aspects of Meeting Patient Engagement, the second at 2:45 entitled Double Dipping for EHR Funding.

Vegas is all about the money, and Double Dipping for EHR Funding will focus on how physician practices can still obtain money for Electronic Health Record systems.  The presentation will focus on Stark/Anti-Kickback Donation Arrangements and Meaningful Use dollars.  If you are looking to upgrade to 2014 CEHRT this is a presentation you don’t want to miss. Prior to joining our presentation, I suggest reading two articles we published earlier in the year: Understanding Stark/Anti-Kickback Compliant EHR Donation Arrangements and Key Lessons Related to Stark Compliant EHR Donation Arrangements.

As for Legal Aspects of Meeting Patient Engagement – this presentation focuses both on HIPAA Compliance and Meaningful Use. Stage 2 Meaningful Use includes five patient engagement related objectives, and this time CMS means business.  Two of these five objectives include measures requiring that at least 5% of patients take an action.  These five measures makes the implementation and use of patient portals essential, as portals are a key means of communication with patients and is an appropriate mechanism for each of these Meaningful Use objectives.

The relevant patient engagement Meaningful Use objectives I am referring to here include:

I have added links to the CMS Eligible Professional Specification Sheets for Stage 2 above because I find them very helpful in deciphering what each of these measures require.  Meeting these requirements is not a walk in the park, and my clients have expressed difficulty getting patients to send secure messages or login to  a portal.  Often the CEHRT itself makes these tasks quite difficult.  Patient engagement is core to growing a practice, especially as patients begin to pay for their healthcare and start to demand physician interaction via e-mail and other technologies.

If you are interested in learning more about these patient engagement requirements in Meaningful Use stop on by our presentation, or contact me directly.

 

Meaningful Use Hardship Exception Deadline Extended to November 30, 2014

Still not able to meet meaningful use this year? CMS recently announced that it has reopened submission and extended the deadline for eligible professionals and eligible hospitals to submit a hardship exception application for not demonstrating “Meaningful Use” of Certified Electronic Health Record Technology (CEHRT). The CMS hardship application can be found here.

Under the HITECH Act, eligible hospitals, critical access hospitals, and eligible professionals had to demonstrate “meaningful use” of a CEHRT, or face reductions in their Medicare payment. Under certain circumstances, the Secretary of Health and Human Services has discretion to consider hardship exceptions on a case-by-case basis to avoid payment penalties, including issues related to difficulties with vendors obtaining certification.

The original hardship exception application deadlines of April 1, 2014 (for eligible hospitals) and July 1, 2014 (for eligible professionals) were extended to November 30, 2014.

According to CMS, the reopened hardship exception application submission period applies to eligible professionals and eligible hospitals that:

  • Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability; AND
  • Eligible professionals who were unable to attest by October 1, 2014, and eligible hospitals that were unable to attest by July 1, 2014, using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

For more information about the EHR Incentive Programs and meaningful use please contact Elana Zana.

Meaningful Use Audit Outcomes – Guest Blog Post

October brings a flurry of Meaningful Use attestations, and this October is no different.  Eligible Hospitals finished up their attestation and are wrapping up the 2014 year; Eligible Professionals are checking their numbers and gearing up for their last run at achieving Meaningful Use before the end of the year.  Lingering in the background is ensuring that you have maintained documentation sufficient to meet the auditor’s standards.

Our guest blog post author, Steve Spearman from Health Security Solutions, researched the CMS audit results, and for hospitals the results are not too bad – but the same can’t be said for Eligible Professionals.  Here are the highlights:

Prepayment Audits for Eligible Professionals: 21.5% failed the audit.

Post-Payment Audits for Eligible Professionals:  24% failed the audit.

Post-Payment Audits for Hospitals:  4,7% failed the audit.

Steve’s blog article provides a deep dive into the audit results and the reasons for failure for both Eligible Professionals and hospitals.  To read his terrific blog article click here.  If you are interested in learning more about the audit statistics click here for Jim Tate’s blog article as well.

More audits are coming and making sure that you have double checked your numbers before attesting and performed your security risk analysis, including an implementation plan and completion dates, is necessary.  For assistance in preparing for audits or if you recently received an audit please contact Elana Zana.

 

Meaningful Use Attestation in 2014 – Picture Update

CMS and the Office of the National Coordinator (ONC) recently announced modifications to the meaningful use attestation requirements for 2014. Following significant lobbying from EHR vendors, eligible professionals (EPs), and hospitals, CMS issued a brief reprieve to meeting Stage 2 meaningful use in 2014 – for some lucky participants. Recognizing that EPs and hospitals may still be using 2011 certified EHR technology (CEHRT) or a mixture of 2011 and 2014 CEHRT, CMS created a chart of decision points meant to enable flexibility for EPs and hospitals alike. These options also accommodate EPs and hospitals that have upgraded to the 2014 CEHRT but are still unable to meet the Stage 2 requirements within the mandatory timetables.

However, this flexibility comes with a caveat: EPs and hospitals must explain that their failure to meet Stage 2 in 2014 as scheduled is because they could not “fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.” So who is allowed to claim this exception? Though CMS does not provide an exhaustive list of examples, its published comments in the final rule provide some insights and helpful explanations.

Below are maps of decision points and examples of acceptable and unacceptable justifications for not meeting an EP’s scheduled meaningful use stage in 2014, whether it be the 2014 Stage 1 or Stage 2 objectives and measures. Any EPs or hospitals that attest for a different stage than what they were scheduled for must be prepared to defend this decision in an audit, understanding that each case will be evaluated individually; this defense should therefore be very well documented.

MU_GRAPHIC_FIRST OR SECOND YEAR-FINALMU_GRAPHIC_THIRD OR FOURTH YEAR_FINAL

Michelle Holmes, consultant with ECG Management Consultants co-authored this post.

Meaningful Use EP Hardship Exception Deadline – July 1, 2014

Not able to meet meaningful use this year?  You may qualify for a hardship exception.  Eligible professionals that qualify for certain hardship exceptions can avoid the meaningful use payment adjustments in 2015 by submitting to CMS the 2015 Hardship Exception Application.  CMS has permitted the EPs to apply for a hardship exception based on the following reasons:

  • Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).
  • New Eligible Professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.
  • Unforeseen Circumstances: Examples may include a natural disaster or other unforeseeable barrier.
  • Patient Interaction: Lack of face-to-face or telemedicine interaction with patient or lack of follow-up need with patients.
  • Practice at Multiple Locations: Lack of control over availability of CEHRT for more than 50% of patient encounters.
  • 2014 EHR Vendor Issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays. (Note that CMS has published a proposed rule regarding lack of availability of 2014 CEHRT proposing to permit EPs in certain situations to attest to Stage 1, click here for further information).

Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals.  This tip sheet further describes the payment adjustments and includes frequently asked questions.

The following categories of EPs do not have to apply for a hardship exception but will automatically be granted one based on their status with CMS:

  • New providers in their first year (both eligible professionals and eligible hospitals).
  • Eligible professionals who are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23) of a hospital.
  • Eligible professionals with certain PECOS specialties (Anesthesiology-05, Pathology-22, Diagnostic Radiology-30, Nuclear Medicine-36, Interventional Radiology-94).

Eligible professionals that have not participated in the EHR Incentive Program in the past have the option of avoiding the 2015 payment adjustment if they successfully attest to meaningful use by October 1, 2014.  Those eligible professionals that qualify for any of the above hardship exceptions and will not be able to attest to meaningful use by October 1, 2014 may still apply for a hardship exception, but must do so by July 1, 2014.

For more information about the EHR Incentive Programs and meaningful use please contact Elana Zana.

 

 

Meaningful Use Exception Includes EHR Vendor Delays

Following its announcement at HIMSS, CMS has published its hardship exception application for 2014 along with its new exception due to vendor delays.  The new exception permits eligible hospitals and eligible professionals to request an exception from the 2015/2016 payment adjustments due to 2014 EHR Vendor Issues.  Specifically, CMS now permits an exception due to the inability of the vendor to obtain 2014 certification or if the hospital or EP was unable to implement meaningful use due to 2014 EHR certification delays.  Along with filling out the EP or Hospital exception forms, those requesting the exception must submit a notification from the EHR vendor.

For EPs and hospitals who are demonstrating meaningful use for the first time, they may apply for this hardship exception to avoid the 2015 payment adjustments.  For those EPs and hospitals who have previously demonstrated meaningful use, they may use this hardship exception to avoid 2016 payment adjustments.

For hospitals, the hardship exception request for 2015 payment adjustments is due April 1, 2014.  For eligible professionals, the hardship exception request for 2015 payment adjustments is due July 1, 2014.  However, for those EPs that have not previously participated in the Medicare EHR Incentive Program they can submit attestation by October 1, 2014 and also avoid the payment adjustments.  CMS has also issued guidance for applying for the EHR Vendor hardship exception for EPs and hospitals.

For more information about the Medicare or Medicaid EHR Incentive Program or applying for these hardship exceptions please contact Elana Zana.

Medicare EHR Incentive Program Deadline Extended

CMS announced last week that it has extended the registration and attestation deadline for the Medicare EHR Incentive Programs to March 31, 2014 for eligible professionals.  This month long extension will aid eligible professionals in compiling their meaningful use data from 2013 and filling out the registration process (which can be time consuming).

In addition, CMS is offering to assist eligible hospitals who experienced difficulty with their attestation.  This assistance will allow eligible hospitals to submit their attestation retroactively to avoid the 2015 payment adjustment.  To do so, hospitals must contact CMS by March 15, 2014.  Eligible hospitals are instructed to contact CMS at EH2013Extension@Provider-Resources.com  no later than 11:59 PM EST on Marfch 15, 2014.

  1. Type “EH 2013 EXTENSION” in the subject line of the email note
  2. Include the following information:
    • CCN;
    • hospital name;
    • contact person name;
    • contact person email; and
    • contact person phone number.

CMS will then contact the designated individual to discuss the retroactive extension.

As a reminder, these extensions are for the Medicare EHR Incentive Program only, and do not apply to the Medicaid EHR Incentive Program.  In Washington, the deadline to apply for the Medicaid EHR Incentive Program remains February 28, 2014.

For more information about the EHR Incentive Programs or meaningful use generally please contact Elana Zana.