As Smith further explains, on the one hand, [the government] has tried to be responsive to the complaints and concerns about the burden that providers have discussed relative to view, download and transmit, but on the other hand, “I couldn’t imagine that many hospital executives would trade meaningful use Stage 3 patient data access measures and objectives for the Conditions of Participation. That raises the stakes significantly.”
To this point, CMS Administrator Seema Verma’s tweet indicates that per the proposed revisions to the Conditions of Participation, penalties will indeed be forthcoming for those providers who don’t provide their patients with electronic access to their data.
To avoid a payment penalty, providers will have to provide patients with electronic access to their health information. #MyHealthEData
— Administrator Seema Verma (@SeemaCMS) April 24, 2018
Mari Savickis, vice president of federal affairs at the College of Healthcare Information Management Executives (CHIME), notes that when it comes to interoperability, and how much participation the government might mandate, many of these components—TEFCA, the promoting interoperability proposed rule, and a data blocking rule, which is forthcoming later this year—are all intertwined. “There are lots of moving interoperability pieces, and generally we appreciate with that the government is trying to do, and [for now], it is still voluntarily and not in a punitive manner. But if CMS says that if you don’t participate in TEFCA, that means you are a data blocker—well that would be a big concern of ours,” she says.
A New Scoring System
Beyond removing the view, download and transmit aspect of meaningful use, CMS is also proposing in the rule a major change around how eligible hospitals will be scored in the new program. Previously under meaningful use, participants would be subjected to a pass/fail system, which drew the ire of many folks. But with a new scoring system that will rate responding providers on a 100-point scale, with 50 points needed to avoid Medicare payment adjustments (and qualify for what CMS calls a “meaningful EHR user”), it’s expected that program participants will respond favorably to this aspect of the regulation. What’s more, CMS is proposing to remove 19 measures across value-based purchasing programs and to de-duplicate another 21 measures.
Indeed, in a statement responding the proposed rule, CHIME’s board of trustees chair, Cletis Earle, “While we are still digesting the changes to the scoring methodology, CMS has exercised the flexibility given to them by Congress last year which permits them to remove the ‘pass/fail’ policy—something CHIME has long requested be removed. Adds Savickis, speaking to the change in the scoring methodology, “The agency is now proposing a scoring system that is more akin with what they do with MIPS [the Merit-based Incentive Payment System].”
As far as how the new program compares with meaningful use Stage 3—which eligible hospitals are required to begin no later than 2019—CMS is proposing that existing Stage 3 measures of the EHR Incentive Program will be broken into a smaller set of four objectives and scored based on performance and participation. The smaller set of objectives would include e-prescribing, health information exchange, provider to patient exchange, and public health and clinical data exchange.
Smith agrees with Savickis that the new scoring system is essentially taking a page out of the MIPS playbook. He notes, “The point system that they’ve outlined here seems to be pretty rational, and I would argue getting 50 out of the available maximum points is probably pretty doable.”
Smith adds that the Bipartisan Budget Act of 2018 has allowed CMS to propose policies that are not intrinsically more difficult over time by giving people the ability to submit data on fewer measures and by setting the overall composite score at 50. “So, again, it borrows from the MIPS playbook by recalibrating a composite score and I think this will be largely helpful for those who are worried about the all-or-nothing component of meaningful use,” he says. “How much extra work and headache it’s going to save, well, that is still another question.”
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