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BREAKING NEWS: CMS Proposes MU Program Changes, Including 90-Day Reporting Period in 2016

July 6, 2016
by Mark Hagland and Rajiv Leventhal
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New proposed rule also includes various threshold reductions to MU objectives and measures

On Wednesday afternoon, July 6, the federal Centers for Medicare and Medicaid Services (CMS) announced that it was streamlining reporting requirements for hospitals and eligible providers (EPs) participating in the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act, by proposing a 90-day electronic health record (EHR) reporting period in 2016, rather than a full calendar-year one, as the agency had earlier seemed to be insistent on.

“These changes include a proposal for clinicians, hospitals and critical access hospitals to use a 90-day EHR reporting period in 2016—down from a full calendar year for returning participants,” the agency said in its announcement. “This increases flexibility and lowers the reporting burden for hospital providers.” As a result of this proposed change, the EHR reporting period for any hospital or eligible provider could now be any continuous 90-day period between Jan. 1, 2016 and Dec. 31, 2016.

According to the full text of the proposed rule, which can be read here, the proposed rule “would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.”

CMS said that this new proposed rule is a result of the federal agency’s review of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) proposed rule.

The Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), proponents of a shorter reporting period ever since the meaningful use final rules came out last fall, released a statement applauding CMS. It read, “We are pleased that the Centers for Medicare & Medicaid Services today recommended a 90-day reporting period in 2016 for hospitals in the Meaningful Use program. CHIME and its members have been leading advocates for a more realistic reporting period. Shortening the reporting period to 90-days from the current 365 days will allow hospitals and health systems to continue making progress in adopting technology systems that support new payment and care delivery models.”

The proposed rule also encompasses proposed changes to a number of other federal programs under Medicare, including outcomes measures around solid organ transplant programs; the proposed removal of the HCAHPS pain management dimension from the Hospital Value-based Purchasing (VBP) program, and small changes to payments to off-campus outpatient departments.

CMS also proposed a myriad of other changes to modified Stage 2 and Stage 3 of the MU program in the proposed rule. For most of these proposed modifications, CMS said that it has been listening to health IT stakeholders. Importantly, CMS noted in the rule that if finalized, these requirements would be different than those requirements for Merit-based Incentive Payment System (MIPS) eligible clinician EHR use and reporting for the advancing care information performance category, a new program that the government announced within the MACRA proposed rule. Some of the major changes announced by CMS yesterday include:

  • For modified Stage 2 and Stage 3, eliminating the Clinical Decision Support (CDS) and Computerized Provider Order Entry (CPOE) objectives and measures for eligible hospitals and critical access hospitals (CAHs), due to these rules having “topped out.” These 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 calendar year 2017, adjusting the threshold of the modified Stage 2 view, download, transmit (VDT) measure under the Patient Electronic Access objective from 5 percent of patients having to VDT their health information to one single patient. This threshold originally was scheduled to increase from one patient in 2016 to 5 percent in 2017, and 10 percent for Stage 3, per the final rules from last fall. But now, under the new proposal, this patient engagement requirement will be just one patient.

To this end, CMS said in the rule: “We are proposing to reduce the threshold because we have heard from stakeholders including hospitals and hospital associations that they have faced significant challenges in implementing the objectives and measures that require patient action.  These challenges include, but are not limited to, patients who have limited knowledge of, proficiency with, and access to information technology, as well as patients declining to access the portals provided by the eligible hospital or CAH to view, download, and transmit their health information via this platform.  We recognize that eligible hospitals and CAHs may need additional time to educate patients on how to use health information technology and believe that reducing the threshold for 2017 would provide additional time for eligible hospitals and CAHs to determine the best ways to communicate the importance for patients to access their medical information.”

  • For the Secure Messaging measure under Stage 3, reducing the threshold for eligible hospitals and CAHs attesting from more than 25 percent to more than 5 percent, noting that the reason for the reduction is that for patients who are in the hospital for an isolated incident, the hospital may not have significant reason for a follow up secure message. Also, patients may decline to access the messages received through this platform.
  • For the Health Information Exchange (HIE) objective, which includes a measure that requires providers to create a summary of care record using certified EHR technology, and to electronically exchange the summary of care record, reducing the threshold from more than 50 percent to more than 10 percent.
  • For the Patient Electronic Access to Health Information objective in Stage 3, reducing the Patient Access measure from 80 percent down to more than 50 percent.  Here, CMS said, “We continue to hear from health IT vendors through correspondence regarding concerns about the implementation of APIs for Stage 3, indicating, in part that application development is in a fledgling state, and thus it might be very difficult for hospitals to be ready to achieve the 80 percent threshold by the time Stage 3 is required starting in January 2018.  Additional concerns were stated by vendors through written correspondence to CMS that stated in part that API requirements outlined in the 2015 EHR Incentive Programs Final Rule could place an excessive burden on hospitals because application development has not been entirely market tested and widely accepted amongst the entire industry.”
  • For the Public Health and Clinical Data Registry Reporting Requirements under Stage 3, reducing the reporting requirement from any combination of six measures to any combination of three measures.
  • EPs, eligible hospitals, and CAHs that have not successfully demonstrated meaningful use in a prior year would be required to attest to modified Stage 2 by October 1, 2017. Returning EPs, eligible hospitals, and CAHs will report to different systems in 2017 and therefore would not be affected by this proposal. CMS said, “After the publication of the 2015 EHR Incentive Programs Final Rule, CMS determined that, due to cost and time limitation concerns related specifically to 2015 Edition CEHRT updates in the  EHR Incentive Program Registration and Attestation System, it is not technically feasible for EPs, eligible hospitals, and CAHs that have not successfully demonstrated meaningful use in a prior year (new participants) to attest to the Stage 3 objectives and measures in 2017 in the EHR Incentive Program Registration and Attestation System.”
  • EPs, who have not successfully demonstrated meaningful use in a prior year, intend to attest to meaningful use for an EHR reporting period in 2017, and intend to transition to MIPS, under MACRA, and report on measures specified for the advancing care information performance category under the MIPS as proposed in 2017, can apply for a significant hardship exception from the 2018 payment adjustment as authorized under section 1848(a)(7)(B) of the Act.

Interested parties will have until September 6 to comment. Healthcare Informatics will continue to update readers on ongoing developments around this announcement.




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