eMeasures News You Can Use – October Final Rules, MU Fun Facts, and More

Introduction

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 October, we discuss the legislative activities in Washington, D.C., including three Final Rules (EHR Incentive Program, Physician Fee Schedule, and the Outpatient Prospective Payment System), and a deeper dive into the EHR Incentive Program Final Rule.  We cover a question of the month on hardship exceptions for switching EHR vendors, and we provide a summary of the healthsystemCIO.com All Stars webinar.  We also include a link to the September updates in case you missed them.

Reading time:  14 minutes

Watch List Update

We felt as though it was Christmas in October …

… that was on October 6th when CMS and ONC published the EHR Incentive Program and the 2015 Edition final rules.  We’re pretty sure you already know that, but if you missed the eMRB InfoAlert providing a summary of the two rules, here’s a link to it.  eMRB InfoAlert: Highlights and Takeaways from CMS and ONC Final Rules.

And the end of October brought activity from Washington, D.C. as well…

CMS also filed two new final rules, both with comment period, on October 30, 2015:

1) CY 2016 PFS Final Rule with Comment Period – This is the Physician Fee Schedule final rule.  Another one that we’ve been waiting for and will be providing more detail about in the future.

  • What’s included in this rule that we should care about? This final rule with comment period finalizes changes to several of the quality reporting initiatives that are associated with Physician Fee Schedule (PFS) payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov.
  • Impact: This is the first fee schedule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  Through the final rule, CMS is beginning implementation of the new payment system for physicians and other practitioners, the Merit-Based Incentive Payment System (MIPS), required by the legislation.
  • Source:  Medicare Program: Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016.  Pre-publication version filed on 10/30/2015; scheduled to be published in Federal Register on 11/16/2015.

2) CY 2016 Final Rule with Comment Period, Final Rule, OPPS/ASC – This is the outpatient prospective payment system and ambulatory surgical center payment systems final rule.  Here’s a brief description of what’s included and where you can find it.

  • What’s included in this rule? The CY 2016 OPPS/ASC final rule updates Medicare payment policies and rates for hospital outpatient departments (HOPDs), ASCs, and partial hospitalization services provided by community mental health centers (CMHCs), and refinements to programs that encourage high-quality care in these outpatient settings.  The OPPS provides payment for most HOPD services, including partial hospitalization services furnished by HOPDs and CMHCs.  The final rule also includes important changes to the Two Midnight Rule effective beginning in CY 2016.
  • Impacts: Two areas to highlight in this final rule are some clarifications on the chronic care management (CCM) services and the Two Midnight rule.
    • Although CMS finalized payment for CCM services in the hospital outpatient setting for CY 2015, some hospitals have found implementing certain aspects of the policy confusing.  For CY 2016, CMS provides clarification of the hospital’s role in furnishing CCM services and defines scope of service elements for the hospital outpatient setting that are analogous to the scope of service elements finalized as requirements to bill for CCM services in the CY 2015 Medicare Physician Fee Schedule final rule with comment period.  CMS also worked with ONC to address technical questions on the EHR criteria.
    • In the CY 2016 OPPS final rule, CMS maintains the benchmark established by the original Two Midnightrule, but permits greater flexibility for determining when an admission that does not meet the benchmark should nonetheless be payable under Part A on a case-by-case basis.  CMS is also shifting enforcement of the Two Midnight Rule from Medicare Administrative Contractors (MACs) to Quality Improvement Organizations (QIOs).
  • Source:  Medicare Program: Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review.  Pre-publication version filed on 10/30/2015; scheduled to be published in Federal Registeron 11/13/2015.

Back to the EHR Incentive Program and Meaningful Use

As intended, we’ve been busy deciphering the CMS Meaningful Use (MU) final rule …

It got a little interesting when CMS released FAQ12985 in response to inquiries about the public health reporting objective for Modified Stage 2 in 2015.  The final rule initially provided no alternate exclusions for the public health measures.  The CMS FAQ clarifies that alternate exclusions have been made available now for providers in 2015.  This was promising to see as CMS made some changes to the public health objective requirements from what they had proposed in April to what they finalized — and meeting the revised objective was going to be challenging for providers.  Now, not quite so much in 2015.  The interesting part was the scurry in which CMS posted the FAQ.  One day it was up (October 19) and the next day it disappeared, only to reappear again on October 21.  Obviously CMS was actively working it.  So there we have it; already one clarification / update to the final rules that are just a month old.

Source:  CMS FAQ12985, Alternate Exclusions for the Public Health Reporting Objective in 2015

What immediate impacts are providers seeing under Modified Stage 2? We have heard questions and issues raised around the public health measures.  Due to what was finalized versus proposed, for hospitals that were planning to take exclusions for this objective, it has put them into the last 90 day reporting time period due to the new letter of intent and active engagement requirements.  This was not something anyone anticipated.

Some other key considerations for providers for Modified Stage 2 and planning for Stage 3 include:

  • Timing to report 90 days
    • Providers need to determine if they should choose their 90 days from prior 365 days (Oct. 1, 2014 to Sept. 30, 2015 for eligible hospitals) or if they need additional time in the last quarter of the year to meet thresholds.
  • Providers are allowed to take alternate exclusions depending on the Stage the eligible hospital (EH) or eligible professional (EP) is slated for attesting to, but they should also take advantage of the time to adopt these objectives:
    • Patient Specific Education – Focus on providing electronically which will be required for Stage 3
    • Medication Reconciliation – Need to adopt in 2016 at 50% rate
    • Clinical Decision Support (CDS) Interventions – Need to have at least 5 by 2016
    • Electronic Prescribing (eRx) – Adoption is not required until 2017 with a threshold of 10%; take 2016 to implement and begin adoptions across all specialties
    • Patient Electronic Access objective, measure 2 (View, Download, or Transmit, VDT) – Focus on adoption in 2016 to get above 5% as the rate will be 10% in 2018
    • Secure Messaging – Focus on adoption in 2016 to get above 5% as the rate will be 25% in 2018

What are some MU fun facts to know?

Here are some talking points that might come in handy.

A Meaningful Use Verse 4 U (we and us = eligible hospitals)

In 2014, we were reporting for MU

Beginners in Stage 1 Year 1 for only 90 days

and those in Stage 2 for 365

In April 2015, CMS proposed to relieve the reporting period burden

And then on October 6, we came to believe in a this-year reprieve

But much to our amaze,

CMS combined the relief with MU Stage 3

And we now have two phases to read and to grasp

Modified Stage 2, sooner than later

And MU Stage 3 pending with comment period

That we hope to see finalized by end of this year

Instead of MU Stage 1 and MU Stage 2

CMS created Modified Stage 2 with no more core or menu

Instead of 16 objectives for MU Stage 1

11 core and 5 of 10 menu

We now have 9 objectives for Modified Stage 2 MU 1ers

With 16 measures, but only 6 required

That’s 10 alternate exclusions with no requirement to report

Instead of 19 objectives for MU Stage 2

11 core and 3 of 6 menu

We now have 9 objectives for Modified Stage 2 MU 2ers

With 16 measures, and 14 required

That’s 1 alternate exclusion with no requirement to report, plus an exclusion for public health measure 3

Not much relief for MU Stage 2ers

Except for the 90 day reporting period for all-stage reporters

And a harmonization to cheer

Is the EH alignment with the EP calendar year

Where we’ll all be attesting MU for this year

Somewhere between January 4 and leap year day 2016

And one more before ending, perhaps did you know

That Summary of Care for Transitions of Care

Is now an HIE objective measure to bear

Susan Rivers

October 29, 2015

Information Sources for the CMS and ONC Final Rules:

eMRB Information Sources

And the question of the month is…

This month, we cover a question on hardship exceptions for organizations who have switched EHR vendors during the reporting year.

Question

  • Are there currently any hardship exceptions for eligible hospitals that have had to switch EHR vendors?

 

eMRB provides reference to four sources

For supporting sources, we reference two FAQs and the Meaningful Use Stage 2 Final Rule.

  • Based on CMS FAQ12653 posted on 9/23/2015, a provider who switches EHR vendors during the program year and is unable to demonstrate meaningful use, can apply for a hardship exception to avoid the Medicare payment adjustment.
  • The Meaningful Use Stage 2 final rule
    • Page 142 of 196.  The rule would classify this circumstance as possibly falling under extreme circumstances beyond the hospital’s control, but the hospital would need to demonstrate that switching vendors would prevent them from reaching meaningful use.
    • Page 181 of 196.  The extreme circumstance time period would have occurred during the fiscal year that is 2 fiscal years before the payment adjustment year for hospitals that have previously demonstrated meaningful use.  Applications requesting this exception must be submitted by April 1 (eligible hospitals) of the year before the applicable payment adjustment year.
  • Additionally, CMS FAQ8277 posted on 4/22/2013, states that the count of unique patients does not need to be reconciled when combining from the two EHR systems.  If the menu objectives and/or clinical quality measures used are also being changed when switching vendors, the menu objectives and/or quality measures collected from the EHR system that was used for the majority of the program year should be reported.

Announcements and Events

Did you catch the Encore sponsored healthsystemCIO.com All Stars Webinar held on Tuesday, October 27th?  If not, a link to it is posted on our Website where you can still listen to the panel discussion.

Title and link to recording:  Ask the healthsystemCIO.com All Stars: The State of ACOs(Sponsored by Encore, A Quintiles Company)

The All Stars:  Chuck Christian, VP, Tech & Engagement at Indiana Health Information Exchange; Liz Johnson, CIO, Acute Care Hospitals & Applied Clinical Informatics at Tenet Healthcare; and Rick Schooler, VP and CIO at Orlando Health.  Providing a Word From the Sponsor was Randy Thomas, Managing Director of Value Realization Solutions, at Encore.

  • The Webinar was moderated by Anthony Guerra, Editor-in-Chief of healthsystemCIO.com.  It started with background information providing definition and sources covering Accountable Care Organizations (ACOs) and population health, then moved into debate and discussion on the concept of ACOs being grappled within HIT.  This was followed by Randy Thomas providing Encore’s view of eMeasures and performance measurement for ACOs and population health.  Key points noted by the All Stars were on the importance of clinical integration, access to information, patient engagement, and the ability to stratify risk.  In conclusion, the value-based payment model is not going away – even if the current models take on a different form, new ones will keep coming and they will all have the same underlying principles.

Also, in addition to the eMRB InfoAlert noted above (providing a summary of the CMS and ONC final rules), here is a link to the September eMeasures News You can Use, posted to our Website onOctober 7.

eMeasures News You Can Use:  MU, MACRA RFI, Interoperability Roadmap and More

  • In this update, covering activities for the month of September, we discuss status of the EHR Incentive Program (Meaningful Use) Final Rules, provide a review of the MACRA RFI, and include some links to ICD-10 sources.  We also provide commentary on ONC’s Draft Interoperability Roadmap and cover our question of the month on value-based programs focused on case threshold exemption policy as it relates to the IQR program.

Acronyms

Accountable Care Organizations (ACO); Ambulatory Surgical Center (ASC); Calendar Year (CY), January – December; Centers for Medicare and Medicaid Services (CMS); Chronic Care Management (CCM); Clinical Decision Support (CDS); Electronic Clinical Quality Measures (eCQMs);Electronic Prescriptions (eRx); Eligible Hospital (EH); Eligible Professional (EP); Fiscal Year (FY), October – September; Frequently Asked Question (FAQ); Health Information Exchange (HIE);Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015(MACRA); Medicare Administrative Contractors (MACs); Medicare Electronic Health Record (EHR) Incentive Program / Meaningful Use (MU); Meaningful Use Stage 1 (MU 1); and Meaningful Use Stage 2 (MU 2); Office of the National Coordinator for Health Information Technology (ONC);Outpatient Prospective Payment System (OPPS); Physician Fee Schedule (PFS); Physician Quality Reporting System (PQRS); Physician Value-Based Payment Modifier (Value Modifier); Sustainable Growth Rate (SGR); View, Download, Transmit (VDT).

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.

eMRB
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
Encore, A Quintiles Company
[email protected]ources.com
www.EncoreHealthResources.com