eMeasures News You Can Use:  MU Hardship Exceptions, IQR Exemptions, Draft Legislation and more…


Encore’s eMeasure Research and Review Board (eMRB) provides direction and common perspective on how eMeasures are applied in a value-based reimbursement environment.  To help keep others informed and share our knowledge of recent activities relevant to eMeasures, eMRB provides this high level monthly recap.

In the update below, covering activities for the month of January, we recap CMS and legislative activities in Washington, D.C., including the new flexibility in applying for MU hardship exceptions; CMS’ guidance on eCQM exemption criteria for the IQR Program in 2016; the draft Health IT legislation introduced by the Senate HELP Committee; and the CMS blogs on MACRA and status of EHR Incentive Programs going forward.  We also provide a link to the February 3rd Webinar with Encore and clients JPS Health Network and BJC.

Reading time:  10 minutes

Watch List 2016

This new year has definitely started out with quite a bit of activity in Washington D.C. … 

… here’s a recap of what we’ve seen:

1. Meaningful Use (MU) Hardship Exception:  On December 28, President Obama signed into law the S.2425 — Patient Access and Medicare Protection Act (PAMPA); and on January 22, CMS posted details for implementing its provisions on the EHR Incentive Program (MU), Payment Adjustments & Hardship Information web page.

What is PAMPA?

  • Section 4 of the bill ensures flexibility in applying the hardship exception for meaningful use for the 2015 EHR reporting period for 2017 payment adjustments.
  • The Secretary may now consider hardship exceptions for “categories” of eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs); rather than submit and review applications on a “case-by-case” basis.
  • The streamlined hardship exception application must be submitted by these dates:  for EPs, March 15, 2016; and for EHs & CAHs, April 1, 2016.

Why should you care?

  • Section 2.2d of the new application (Medicare EHR Hardship Exception Application) covers EHR issues that could be considered a hardship exception.  They include:
    • Issues with the certification of the EHR product or products such as delays or decertification
    • Issues with the implementation of the Certified EHR Technology (CEHRT) such as switching products, or
    • Issues related to insufficient time to make changes to the CEHRT to meet CMS regulatory requirements for reporting in 2015.

eMRB’s take:  the ability to apply for a MU hardship exception for all EPs in a group practice, or all eligible hospitals within a health system, will ease the submission process; and reason #3 will help many organizations be able to apply for a hardship exception for the 2015 reporting year.  It is not, however, a blanket exception covering all circumstances.

2. IQR Program 2016 eCQM reporting exemptions and extensions.  CMS has also provided some guidance on the exemption process for hospital eCQM reporting in 2016 with the hospital inpatient quality reporting (IQR) program.  This information was provided in CMS’ IQR Measure Waivers and Extraordinary Circumstances Exemption (ECE) Webinar held on January 19, 2016.

What did they say?

  • Specific to the electronic clinical quality measures (eCQM) requirement for the 2016 reporting year, they said:

    As provided in the January 19, 2016 Webinar IPPS Measure Waivers and Extraordinary Circumstance Exemptions Presentation Transcript, page 8

    • In regards to the infrastructure barriers, if you are a hospital, especially a smaller or rural hospital that does not have the capability to support the necessary infrastructure of an Electronic Health Record (such as wiring and/or telecommunications to support an exchange of data between facilities, or to support a patient portal) you may be eligible to obtain an exemption and/or extension for the submission of the eCQMs.
    • Additionally, if you are a hospital that is in the process of upgrading or changing EHR systems to make sure that you are 2014 or 2015 ONC-certified but are not able to have that change completed in time to meet the 2016 eCQM submission deadline, that may also be a reason to fill out the Extraordinary Circumstances Request Form.
    • We (meaning CMS) would recommend that, if you are a hospital participating in the IQR Program that does not have the necessary networking or infrastructure available to support the use of a 2014 or 2015 ONC-certified EHR system and that is preventing you from being able to meet the requirement for eCQM data submission, that you should fill out the ECE for CMS to review and make a determination.

Additionally, the Q&A Transcript covers more questions specific to EHRs:  IPPS Measure Waivers and Extraordinary Circumstances Exemptions, Questions and Answers

Why should you care?

  • For the IQR program, it is a requirement for hospitals to electronically submit 4 eCQMs in this 2016 reporting year.  If an eligible hospital is planning to apply for a hardship exception to meaningful use in 2016 reporting year, they may also need to obtain an exemption for the IQR program eCQM reporting requirements.

3. And then there was the flurry of news generated by Andy Slavitt, acting administrator of CMS, resulting from his presentation at the J.P. Morgan 34th Annual Health Care Conference.  His news catcher statement was that CMS is “now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation.  The Meaningful Use program as it has existed, will now be effectively over and replaced with something better.”

  • That was on January 11, 2016 and the blog with his transcript was posted on January 12th (Comments of CMS Acting Administrator Andy Slavitt at the J.P. Morgan Annual Health Care Conference, Jan. 11, 2016).  In his presentation he talked about the MACRA impact on the EHR Incentive Program (Meaningful Use) for physicians, but the message was not very clear.
  • eMRB posted an InfoAlert on January 18th providing some context to the statements Andy Slavitt made on the EHR Incentive Program; you will find it on our website at:  eMRB InfoAlert: Special Update on EHR Incentive Program.  The context being that his focus was on the MACRA legislation and impacts to the EP MU program; but change to the eligible hospital MU program was not referenced.
  • Subsequently the CMS blog was posted on January 19th clarifying status of the EHR Incentive Program:  EHR Incentive Programs: Where We Go Next.

    Here CMS let us know:

    • The current law requires that we continue to measure the meaningful use of ONC Certified Health Information Technology (Certified HIT) under the existing set of standards.
    • The MACRA legislation only addresses Medicare physician and clinician payment adjustments.  The EHR incentive programs for Medicaid and Medicare hospitals have a different set of statutory requirements.
    • The approach to meaningful use under MACRA won’t happen overnight.  … in the meantime, our existing regulationsincluding meaningful use Stage 3are still in effect.

…and there’s more:

4. The Senate HELP Committee released a draft of Health IT legislation.  On January 20, the Senate Committee on Health, Education, Labor and Pensions (HELP) released a discussion draft bill to improve Federal requirements relating to the development and use of electronic health records (EHR) technology.

What about this bill?

  • You can read a summary of the draft bill provided by the Senate HELP committee in its January 20 Press Release.
  • And, the discussion draft bill is slated for review in the February 9 committee meeting.

Why should you care?

Here are some highlights from the summary of what the bill proposes to do …

  • Allow non-physician members of the care team, such as nurses, to document on behalf of physicians.
  • Encourage the certification of HIT for specific specialty providers, like pediatricians.
  • Establish a rating system for HIT products to help providers better choose HIT products.
  • Provide authority to investigate and establish deterrents to information blocking practices that interfere with appropriate sharing of electronic health information.
  • Create a digital provider directory to both facilitate exchange and allow users to verify the correct recipient.
  • Establish an initial set of common data elements, such as a standard format for entering date of birth, to facilitate interoperability and streamline quality reporting.
  • Require that certified HIT transmit and receive data from certified physician registries and that registries be certified to transmit and receive from certified HIT.
  • Direct the Government Accountability Office (GAO) to conduct a study to review methods for securely matching patient records to the correct patient.

Announcements and Events

On Wednesday, February 3, the healthsystemCIO.com held an All-Star panel of experts session titled “Preparing for an eCQM World.”

  • Encore’s Liz Richard joined the All-Star panel that also included Encore clients Melinda Costin, VP/CIO of JPS Health Network, and Dr. Keith Woeltje, VP & CMIO of BJC.
  • The session was recorded; so you can still register and listen if you were unable to attend the live session.
  • Registration link is:  http://healthsystemcio.com/23973-2/


Centers for Medicare and Medicaid Services (CMS); Certified Electronic Health Record Technology(CEHRT); Critical Access Hospital (CAH); Electronic Clinical Quality Measures (eCQMs); Electronic Health Record (EHR); Eligible Hospital (EH); Eligible Professional (EP); eMeasure Research and Review Board (eMRB); IQR Program Extraordinary Circumstances Exemption (ECE); Government Accountability Office (GAO); Hospital Inpatient Quality Reporting Program (IQR); Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA); Medicare Electronic Health Record (EHR) Incentive Program / Meaningful Use (MU); Office of the National Coordinator for Health Information Technology (ONC); Patient Access and Medicare Protection Act(PAMPA); Senate Committee on Health, Education, Labor and Pensions (Senate HELP Committee).

To read previous versions of the eMeasures News You Can Use, you can locate them on Encore’s Website under the Press Room.

Points of view and interpretation were relevant at time of authorship; however, they are subject to change over time.

Encore’s eMeasure Research and Review Board is made up of Encore’s industry thought leaders and eMeasure experts who are responsible for understanding the current state and future direction of quality and value-based programs for Encore’s business. 

eMeasure Research and Review Board
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