Category: News & Events
January 13 2016
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Update: As a follow-up to his remarks at last week’s JP Morgan Annual Health Care Conference, Acting CMS Administrator Slavitt, joined by Acting HHS Assistant Secretary for Health Information Technology Karen DeSalvo, posted an entry on The CMS Blog yesterday. 

 Here are highlights:

  • Meaningful use is not dead. It likely serves as the starting point for what Medicare Access and CHIP Reauthorization Act (MACRA) will incorporate as a component part of the composite measure for the Merit based Incentive Payment System (MIPS). To quote the blog post, “[MACRA] does not eliminate it [the EHR incentive program], nor will it instantly eliminate all the tensions of the current system. . . . The approach to meaningful use under MACRA won’t happen overnight. . . . We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect.”
  • Administrator Slavitt’s remarks focused on what was to come for physicians. While there are no immediate changes to hospital-related policies for meaningful use, change is possible. “The MACRA legislation only addresses Medicare physicians. . . . The EHR incentive programs for Medicaid and Medicare hospitals have a different set of statutory requirements. We will continue to explore ways to align with principles we outlined . . . for hospitals. . . .”

Acting Administrator Slavitt and Acting Assistant Secretary DeSalvo also emphasized what they believe CMS and ONC signaled regarding future policy development. These anticipated developments will inform the role of health IT in support of payment reform in line with CMS’s overall policy goals to transform payment policies. Key points on this topic are as follows:

  • Providers should be rewarded for the positive outcomes achieved through the use of health IT.
  • Providers should have the ability to customize health IT to their practice needs.
  • The technology playing field should be leveled to promote innovation and “unlock” electronic health information through open application programming interfaces (APIs), enabling consumer access and improving the portability and liquidity of electronic health information.
  • Efforts related to interoperability should focus on high-value, real-world uses of technology and on the elimination of business models and practices that inhibit the flow of health data needed to support patient care.

The takeaway? “Meaningful use as we know it seems to be the point of departure for MIPS and is not going away in the foreseeable future,” said John Travis, vice president, Regulatory and Compliance Strategy. “Acting Administrator Slavitt’s remarks focused on what is to come with the changes to physician payment under MACRA. Still, there is good reason to expect some commensurate changes for hospitals as well, both from Congress and from CMS.”

As suggested in earlier commentary, the key is to stay the course within existing legislation and regulation, to remain watchful and to read beyond the headlines.

A number of industry media outlets covered statements made by Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS), on Monday, Jan.11 at the J.P. Morgan Healthcare Conference indicating significant changes were in the future for Meaningful Use (MU). For reference, review “Meaningful use will likely end in 2016, CMS chief Andy Slavitt says” in HealthcareITNews.

“We believe that some of these media reports were misleading in their coverage,” said John Travis, vice president, Regulatory and Compliance Strategy, Cerner.  For Eligible Professionals (EP), MU will become the Merit-Based Incentive Payment System (MIPS) in a few years. For Eligible Hospitals (EH), there are no changes at this point. “MIPS is not the end of MU. MIPS is the beginning of a new regulatory program that includes provisions related to MU attestation,” Travis said.

Slavitt’s statements referred to pending regulatory developments on how the use of Certified Health Information Technology (CHIT) by EPs will be a component part of the MIPS under the Medicare Access and CHIP Reauthorization Act of 2015.

Slavitt reinforced what we already know as to how use of CHIT will evolve over the next few years.

  • For EPs, 2016 will stand to be the last year of MU as a distinct incentive program under Medicare, and also the last year that an EP’s ability to be a meaningful user would affect payment adjustment for professional services under the Physician Fee Schedule in a future calendar year (2018).  
  • MIPS will combine the current separate Medicare payment adjustments for EPs related to meaningful use, the Value Based Payment Modifier and for the Physician Quality Reporting System into one composite payment adjustment.

It is accurate to say that 2016 will be the last year for meaningful use as we know it for EPs. But Cerner emphasizes to clients and associates that the use of CHIT is central to many CMS program requirements, and if anything, is only becoming increasingly significant. There are also several details that remain to be defined:

  • Whether the use requirements for CHIT by EPs under MIPS will initially be the same as those applicable for meaningful use under the recent  Modified Stage 2 and Stage 3 final rule.
  • Whether we will see new statutory developments that will have similar impact for EHs and Critical Access Hospitals relative to meaningful use and future payment system requirements as MIPS has for EPs.
  • What requirements will emerge requiring use of CHIT that CMS may choose to incorporate in other program requirements and the Conditions of Participation requirement, and that may be mandated by Congress or CMS.  For example, it is feasible for CMS to associate use of CHIT transition of care capabilities and care planning capabilities to meet the recently proposed CMS Conditions of Participation proposed rulemaking for discharge planning.
  • To what degree use of CHIT is linked to Medicaid program requirements for other program purposes or how the future of the Medicaid EHR incentive program plays out in context of what CMS may be planning to do.

CMS has indicated we should expect rule making for MIPS sometime in mid-2017 and observers expect to see details emerge regarding requirements for the use of CHIT under MIPS.

“We advise our clients to stay watchful of CMS policy developments as to the future requirements for the use of CHIT,” Travis said. “This does not mean the significance of CHIT is going to somehow go away. It likely means that how it is referenced and required will change, resulting in an improved scope of applicability for its use and appropriate scoping for what it must be used for.”

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