The day after the federal Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would make changes in the second year of the Quality Payment Program (QPP) under the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law, affecting Medicare-participating physicians covered either under the MIPS (Merit-based Incentive Payment System) program, or participating in APMs (advanced payment models), healthcare industry leaders are reacting to the content of the proposed rule, mostly with a sense of relief, or of broad satisfaction, even as they wonder exactly how the final rule will play out.
In interviews with Healthcare Informatics editors, industry leaders say that the broad outlines of the proposed rule appear to be reasonable, and that it appears that CMS officials have taken a middle path as they try to prod U.S. practicing physicians forward into value-based reimbursement and quality measurement in the context of a rapidly shifting Medicare payment environment. Issues around pace, incentives, specificity of measurement, and the welter of data gathering- and information technology-related issues to consider, are keeping industry leaders focused on both the broad outlines and the complex details embedded in the 1,058-page proposed rule, which dropped late in the afternoon on June 20.
HIMSS and CHIME Weigh In
Leaders at the major healthcare IT professional associations expressed satisfaction over the moderate elements related to data and information technology in the proposed rule. Jeff Coughlin, senior director of federal and state affairs at the Chicago-based Healthcare Information and Management Systems Society (HIMSS), says, “I would say that the biggest takeaway is the flexibility that’s provided for providers, that’s in the rule. HIMSS spent time earlier this year, in 2017, talking about 2015 edition certified electronic health record technology (CEHRT) and about how where we were in terms of the level of adoption and availability of 2015-edition CEHRT products, and how we didn’t think we could get to the place we needed to be,” says the Washington, D.C.-based Coughlin. “This is one example of the flexibility in terms of allowing more time for providers to adopt 2015-edition CEHRT.”
What’s more, Coughlin says, “CMS also spent a lot time, in the rule, talking about the benefits of 2015 edition certified EHRs, and how important it is to transition and all the benefits from that transition for providers, and at the same time, providing more time for those providers, mostly likely small providers, that need the extra time to implement 2015 edition CEHRT products. But it does have bonus points, in the ACI [Advancing Care Information] performance category related to adopting and using that [2015-edition CEHRT] to report in 2018. It is, directionally, the right place to be,” he says. “I would emphasize,” he adds, “that we thought it was great to see the amount of time that CMS spent in the rule singing the praises of the 2015 edition CEHRT and what that transition would mean for providers and patients. There are several pages in the proposed rule focused on that, and that’s exactly the message that we tried to get across in April, that the 2015 edition CEHRT is definitely a step that we need to take, we just need a longer on-ramp to get there. I think at this point, I think it’s probably directionally appropriate.”
Leslie Kriegstein, vice president for congressional affairs at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), said that, “Overall, it looks like CMS heeded a lot of the provider community’s calls for another transition year. So going from the minimum necessary of 3 points to 15 points, seems reasonable in terms of keeping people in the program and marching in the right direction,” said the Washington, D.C.-based Kriegstein. “The fact that 2015-certified technology would be bonus instead of mandatory, was positive, but also leaves a lot of questions for hospitals still participating in meaningful use,” under a program that was bifurcated when the meaningful use program for physicians was incorporated into the MIPS program after the passage of the MACRA law. “And you still have hospital-based and employed physicians leveraging technology they need for MIPS,” she noted.
Meanwhile, despite the complexity of different sets of requirements for hospitals and physicians in terms of using federally certified electronic health record (EHR) technology under the terms of two different programs, Kriegstein says she is glad that this proposed rule does not require 2015 certification on the part of practicing physicians. “The extra time to be able to use 2014-certified technology was an imperative,” she says. “When we surveyed our members, a sizable proportion of our membership won’t have access to 2015 cert even before the end of the year. So in our IPPS [Inpatient Prospective Payment System rule-making] comment, we said, per CEHRT, that that’s a huge problem. So that should be a huge relief to the doctors that they can use 2014. Because it’s a huge fallacy that large numbers of doctors could use 2015 this year. So that gives us hope regarding what they might do for the hospitals.”