During a U.S. House Energy Subcommittee on Health hearing this week on the implementation of Medicare payment reforms, organizations representing hospitals and the CIOs and health information technology leaders who work at hospitals called for more flexibility under the Meaningful Use program and the removal of the existing pass/fail scoring approach.
The hearing in the House subcommittee on Health, which is a subcommittee within the Energy and Commerce committee, focused on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and progress on implementing Medicare payment reforms. During the hearing, Patrick Conway, M.D., deputy administrator for Innovation and Quality and Chief Medical Officer at the Center for Medicare & Medicaid Services (CMS), updated subcommittee members about efforts to transform meaningful use through the Merit-based Incentive Payment System (MIPS) and asserted that MIPS will be “meaningful to physicians” and flexible.
“The statute gives us flexibility to really focus on interoperability, outcomes for patients, simplifying the program to make it as meaningful as possible to physicians, clinicians and the patients they serve,” he said during the hearing.
Subcommittee members specifically asked Conway about meaningful use reporting periods. Conway noted that CMS would release proposed MIPS rules this spring and was currently looking at the reporting period to determine the right structure. “A few years ago, we asked physician and clinician groups if they wanted to do quarterly reporting like hospitals, which allows for more rapid feedback, and we heard at the time that they did not. But we’ll be making a proposal on the performance period,” he said.
Both the College of Healthcare Information Management Executives (CHIME), which represents CIOs, and the American Hospital Association (AHA) released statements during the hearing calling for more flexibility under the Meaningful Use program and reducing unnecessary data collecting and reporting burden.
CHIME specifically asked CMS to create parity for both eligible providers (Eps) and eligible hospitals (EHs) by removing the existing pass/fall or “all-or-nothing” construct and add additional flexibility under the Meaningful Use program.
CHIME noted that CMS officials have alluded to forthcoming flexibility for physicians, including a change to the pass/fail construct, while also stating that the same authority does not enable similar changes for hospitals.
“The agency’s consideration of removing the pass/fail construct for eligible providers is welcome, however, leaving it in place for hospitals will introduce a level of complexity that will be very difficult for providers and CMS to manage. This is especially important as payment models evolve to necessitate greater coordination between hospitals and physician offices---delivery systems reforms encourage a longitudinal approach to patient care, rather than episode by episode,” CHIME stated.
“Further, having a different set of program expectations for different providers could jeopardize attempts by Accountable Care Organizations (ACOs) or bundled payment models to better coordinate care,” the organization stated.
CHIME also called “reduce the burden of quality measure reporting for providers by streamlining reporting redundancies and refrain from requiring data collection and submission on measures that do not directly advance patient care.”
CHIME cited a study published in Health Affairs this month, and reported by Healthcare Informatics, that showed medical practices in just four specialties spend an estimated $15.4 billion each year reporting whether they are meeting their quality targets, which on average costs them $40,069 per physician or 785 manpower hours. And the organization also said that individual healthcare delivery organizations submit more than 20 reports across federal, state and private sector programs for various clinical quality measures (CQMs) each month.
“Efforts to reduce provider burden by streamlining reporting redundancies must be a priority and requiring data collection and submission on measures that do not advance patient care must cease. Access to real-time, actionable data will be critical for success in the Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs), thus we must ensure that policies are supported to enhance the capabilities of EHRs in this area and free vendors to pursue innovative solutions that best meet provider and patient needs,” CHIME stated.
CHIME urged committee members to promote standards-based interoperability.
In its statement, AHA urged the adoption of a MIPS that “measures providers fairly, minimizes unnecessary data collection and reporting burden, focuses on important quality issues, and promotes collaboration across the silos of the healthcare delivery system.”
Specifically, AHA also called on CMS to align electronic health record (EHR) incentive program changes for physicians with those of eligible hospitals, and refrain from adopting an “all or nothing” scoring approach.
AHA also would like to see CMS allow hospital-based physicians to use their hospital’s quality reporting and pay-for-performance program measure performance in the MIPS. And, AHA called on CMS to focus the MIPS measures required for reporting on national priority areas and consider limiting the number of measure reporting options over time as well as employ risk adjustment rigorously—“including sociodemographic adjustment, where appropriate---to ensure providers do not perform poorly in the MIPS simply because they care for more complex patients.”