The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that affirms a 90-day reporting for hospitals attesting to the meaningful use program in 2018.
Overall, the final rule—the FY 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule—updates Medicare payment and polices when patients are discharged from hospitals from October 1, 2017, to September 30, 2018. “The final rule relieves regulatory burdens for providers; supports the patient-doctor relationship in healthcare; and promotes transparency, flexibility, and innovation in the delivery of care,” according to a CMS fact sheet of the rule.
For 2018, CMS is finalizing the modification to the electronic health record (EHR) reporting periods for new and returning participants attesting to CMS or their state Medicaid agency from the full year to a minimum of any continuous 90-day period during the calendar year.
What’s also of major significance, with this rule CMS is now not requiring hospitals to meet meaningful use Stage 3 objectives and measures until 2019, a year later then originally planned. Indeed, hospitals and critical access hospitals will have the option to report modified stage 2 for the 2018 reporting period. This represents a change of course from the MU timeline that federal officials had previously outlined.
Also, CMS is finalizing the addition of a new exception from the Medicare payment adjustments for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that demonstrate through an application process that compliance with the requirement for being a meaningful EHR user is not possible because their certified EHR technology has been decertified under ONC’s (the Office of the National Coordinator for Health IT) Health IT Certification Program.
Further, CMS is adopting final policies to allow healthcare providers to use either 2014 Edition CEHRT (certified EHR technology), 2015 Edition CEHRT, or a combination of 2014 Edition and 2015 Edition CEHRT, for an EHR reporting period in 2018. CMS officials noted that this policy is based on the ongoing monitoring of progress on the deployment and implementation status of EHR technology certified to the 2015 Edition, as well as feedback by stakeholders expressing the need for more time and resources are needed for the transition process.
The combination of a continuous 90-day MU reporting period along with giving providers another year before they have to switch to 2015 CEHRT will likely make most stakeholders happy in the short term. The American Hospital Association (AHA) said in a statement, “[W]e appreciate the agency allowing hospitals and critical access hospitals to report meaningful use modified Stage 2 in 2018, as well as implementation of a 90-day meaningful use reporting period in fiscal year 2018.”
Added the College of Healthcare Information Management Executives (CHIME), "CMS took into account that both hospitals and vendors need more time to prepare for 2015 certified EHRs. By no longer requiring these new systems be in place by the start of 2018, a huge weight has been lifted off our collective shoulders.”
Mari Savickis, vice president, federal affairs at CHIME further tells Healthcare Informatics how important it was that CMS listened to stakeholders and implemented some of these changes. She says that CHIME pushed very hard in particular for the changes to CEHRT because so many of its members (some 70 percent) had not received their 2015 CEHRT, or if they did it was not yet fully installed because they received it so late.
Says Savickis, “The stories from the field depicted a state of non-readiness that was not for lack of trying. Most of our members had inked the agreements for 2015 CEHRT with their vendors, but given all of the changes the vendors needed to make to accommodate Stage 3—which is a very complex build— the vendors have been struggling to keep up. This added time will provide a safer and better glide-path as we shift to the next stage. Further, it aligns with what CMS plans to do for the Medicare clinicians.”
Indeed, recently, on the physician practice front, as proposed in the Quality Payment Program rule for 2018 that CMS recently released, the use of 2014 Edition CEHRT would continue to be allowed to meet MIPS requirements, while the use of 2015 edition CEHRT would be encouraged, but not required.
Additionally in the rule, CMS finalized a reduction in the electronic clinical quality measure reporting requirement for the 2017 Hospital Inpatient Quality Reporting program. Hospitals will be required to report on at least four self-selected eCQMs for a reporting period of one self-selected quarter of CQM data in CY 2017 as opposed to the earlier adopted number of eight in 2017 and 2018.
What’s more, related to the Hospital Readmissions Reduction Program (HRRP), CMS is finalizing the socioeconomic adjustment approach mandated by the 21st Century Cures Act. CMS will now assess penalties based on a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid.
More specifically, CMS is taking steps to level the playing field for the program such as stratifying hospitals into five peer groupings according to their dual-eligible inpatient stay ratio. Within each peer group, hospitals' excess readmission ratio for each of the program's six conditions will be compared to the group's median excess readmission ratio for that condition. This modification was something that healthcare stakeholders have long been calling for, as they attest that the HRRP disproportionately penalizes institutions that serve low-income and clinically complex patient populations.
In a statement last night from the Charlotte, N.C.-based Premier, Inc. Blair Childs, the association’s senior vice president of public affairs said, “We applaud CMS’s first steps in adjusting for socio-economic status in the hospital readmissions reduction program. By measuring hospitals against other hospitals with a similar proportion of dual eligible patients, CMS is taking needed steps to fairly assess hospital performance. Longer term, however, we believe that CMS should continue to refine these payment adjustments to reflect other factors that are associated with higher rates of readmissions, including race/ethnicity, income, education, marital status, payer type and patient travel distance to providers.”
Overall, in the final rule, CMS is increasing the amount of uncompensated care payments made to acute care hospitals by $800 million to approximately $6.8 billion for fiscal year 2018. Uncompensated care represents healthcare services provided by hospitals or providers for which they don't get reimbursed. Often uncompensated care arises when people don't have insurance and cannot afford to pay the cost of care. CMS is also providing further clarification about discounts given to uninsured patients who meet the hospital’s charity care policy.
“This final rule will help provide flexibility for acute and long-term care hospitals as they care for Medicare’s sickest patients,” CMS Administrator Seema Verma said in a statement. “Burden reduction and payment rate increases for acute care hospitals and long-term care hospitals will help ensure those suffering from severe injuries and illnesses have access to the care they need.”
Due to the combination of payment rate increases and other policies and payment adjustments, particularly in changes in uncompensated care payments, CMS has estimated that acute care hospitals will see a total increase in Medicare spending on inpatient hospital payments of $2.4 billion in fiscal year 2018. Based in part on the changes included in the final rule, overall payments to long-term care hospitals will decrease by $110 million in fiscal year 2018, the agency stated.