This past Wednesday (July 6, 2016) CMS released a 764 page Proposed Rule (CMS-1656-P) that among other things will streamline how Meaningful Use (MU) will be reported for 2016.
90-Day Reporting Period
Probably the most notable change is CMS deviating from what had previously been a decidedly hard stance–that of a full calendar year reporting period for MU. The change to a 90-day reporting period for 2016 for all EPs, EHs and CAHs is a bit surprising, given CMS’ previous inflexibility on this topic (and the subsequent criticism it has received from many groups). Still, this will be a welcome change for most every Eligible Professional and Eligible Hospital, where the EHR reporting period can now be any continuous 90-day period between Jan. 1, 2016 and Dec. 31, 2016.
Note that the 90-day reporting period also applies to clinical quality measure (CQM) attestation for all EPs, EHs and CAHs reporting in 2016–and the 90-day period for CQM data does not have to be the same 90 days as the EHR reporting period for MU.
Changes to MU Measure Thresholds
The proposed rule delineates many other changes to Meaningful Use that modify Stage 2 and Stage 3 requirements. Curiously though, CMS noted that the revised MU requirements will not be the same as those specified for the Merit-based Incentive Payment System (MIPS) program, where MU will become part of the “Advancing Care Information” performance category. This seems directly at odds with CMS’ stated goal for MIPS of converging the various quality and performance programs (including MU) so that they have common metrics and improved administrative simplicity for providers.
Changes recommended in the proposed rule include:
- For modified Stage 2 and Stage 3 (EH and CAH only; for 2017 and subsequent years):
- Elimination of Clinical Decision Support (CDS)
- Elimination of Computerized Provider Order Entry (CPOE)
Note, however, that the above proposed changes would not apply to Eligible Hospitals and CAHs that attest under a state’s Medicaid EHR Incentive Program.
For EHR reporting periods in 2017:
- View, Download and Transmit (VDT): threshold reduced from 5% of patients to one single patient (modified Stage 2 measure and Stage 3 measure). EH and CAH only.
- Patient Electronic Access to Health Information: threshold reduced from 80% to 50% (Stage 3 measure). EH and CAH only.
- Patient Specific Education: threshold reduced from 35% to 10%. EH and CAH only.
- Secure Messaging: threshold reduced from 25% to 5% for Eligible Hospitals and CAHs (Stage 3 measure). EH and CAH only.
- Health Information Exchange (HIE): threshold reduced from 50% to 10%. (Modified Stage 2 measure).
- Health Information Exchange (HIE): (Stage 3 measure–attest to all three; must meet threshold for any two).
- Patient Care Record Exchange Master: reduce threshold from 50% to 10%. EH and CAH only.
- Request / Accept Patient Care Record Master: reduce threshold from 40% to 10%. EH and CAH only.
- Clinical Information Reconciliation Measure: reduce threshold from 80% to 50%. EH and CAH only.
- Public Health and Clinical Data Registry Reporting: reduce reporting requirements from any combination of six measures to any combination of three measures (Stage 3). EH and CAH only.
Changes for New Participants:
- New participants will attest to modified Stage 2 (and not Stage 3) by October 1, 2017 (EPs, EHs and CAHs that have not successfully demonstrated MU in a prior year).
- New participants can apply for a hardship exception from the 2018 payment adjustment, if they intend to attest to MU in 2017 and intend to transition to MIPS. (EPs, EHs and CAHs that have not successfully demonstrated MU in a prior year). CMS did note that they may rescind this hardship exception if they adopt a different performance period for MIPS that does not coincide with that of MU.
Changes to Measure Calculations
CMS is clarifying when actions in the numerator “count” toward a MU measure. With the proposed rule, actions included in the numerator for all meaningful use measures must occur within the EHR reporting period if that period is a full calendar year, or if it is less than a full calendar year, within the calendar year in which the EHR reporting period occurs.
These are significant proposed changes to the reporting requirements for Meaningful Use, and will likely be universally welcomed by EPs and EHs.
The proposed rule essentially “removes the teeth” from Meaningful Use which, given the criticism CMS has received for its rigid stance on MU Stage 2 and Stage 3 seems somewhat surprising, especially this late into the 2016 calendar year.
And yet the deviation from MIPS’ Advancing Care Information standards will most likely add confusion, especially to the 2017 reporting period where the rules for Medicare MU, Medicaid MU and MIPS/MACRA will all intersect–and each with different requirements and slightly different metrics.
Still, this will likely stem the criticism of CMS for the time being (at least until MIPS begins in 2017, and puts those teeth back into CMS’ regulatory efforts) and may successfully keep MU and health care reform issues out of the headlines for the remainder of 2016 (and its upcoming election season).
Finally, note that this is still a proposed rule and CMS is accepting comments until September 6, 2016.