Just three months after issuing a proposal, the Centers for Medicare & Medicaid Services (CMS) has finalized a rule late this afternoon that will overhaul the meaningful use program with a core emphasis on advancing health data exchange among providers.
The final rule issued today makes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) that will incentivize value-based, quality care at these facilities.
“We’re excited to make these changes to ensure care will focus on the patient, not on needless paperwork,” CMS Administrator Seema Verma said in a statement. “We’ve listened to patients and their doctors who urged us to remove the obstacles getting in the way of quality care and positive health outcomes. Today’s final rule reflects public feedback on CMS proposals issued in April, and the agency’s patient-driven priorities of improving the quality and safety of care, advancing health information exchange and usability, and removing outdated or redundant regulations on healthcare providers to make way for innovation and greater value.”
According to CMS, the rule applies to about 3,300 acute care hospitals and 420 long-term care hospitals, and will take effect Oct. 1
Indeed, CMS’ proposed rule in April re-named the meaningful use program to “Promoting Interoperability,” while also requesting stakeholder feedback through a request for information (RFI) on the possibility of revising Conditions of Participation to revive interoperability as a way to increase electronic sharing of data by hospitals.
As Healthcare Informatics has reported, health IT policy experts have pointed out that if the Conditions of Participation were to get changed down the line, clinicians who do not engage in certain data sharing activities would be forced out of Medicare. During the public feedback period, industry groups and stakeholders had varying opinions on this potential change.
But this final rule, which is nearly 2,600 pages in length, doesn’t have any update on if that RFI CMS issued in April will lead to anything further. In a fact sheet accompanying the final rule, CMS said that it issued the RFI “to obtain feedback on positive solutions to better achieve interoperability, or the sharing of healthcare data between providers, which will inform next steps in advancing this critical initiative.”
Meanwhile, CMS is finalizing changes to the Promoting Interoperability programs (formerly known as the EHR Incentive Programs, or meaningful use) “to increase interoperability and flexibility while reducing burden and placing a strong emphasis on measures that require the exchange of health information between providers and patients,” the agency stated. Key provisions of this overhaul include the following:
- The rule finalizes an EHR reporting period of a minimum of any continuous 90-day period in each of calendar years 2019 and 2020 for new and returning participants attesting to CMS or their state Medicaid agency.
- Importantly, CMS also reiterated that beginning with an EHR reporting period in CY 2019, all eligible hospitals and CAHs (critical access hospitals) under the Medicare and Medicaid Promoting Interoperability Programs are required to use the 2015 Edition of CEHRT.
- For the Medicare Promoting Interoperability Program, the rule finalizes a new performance-based scoring methodology consisting of a smaller set of objectives that CMS believes will provide a more flexible, less-burdensome structure, allowing eligible hospitals and CAHs to place their focus back on patients.
- CMS is finalizing two new e-prescribing measures related to e-prescribing of opioids (Schedule II controlled substances). The Query of PDMP measure will be optional in CY 2019 and will be required beginning in CY 2020. “This will allow additional time to develop, test, and refine certification criteria and standards and workflows, while taking an aggressive stance to combat the opioid epidemic. The Verify Opioid Treatment Agreement will be optional for both CYs 2019 and 2020. We believe that extending the optional reporting status will allow healthcare providers additional time to research and implement methods for verifying the existence of an opioid treatment agreement, expansion of the use of such agreements in practice, and development of system changes and clinical workflows,” CMS said.
The agency also finalized changes to measures, including removing certain measures that it believes do not emphasize interoperability and the electronic exchange of health information. Building on CMS’ Meaningful Measures initiative, the final rule additionally eliminates a number of measures acute care hospitals are currently required to report across the four hospital pay-for-reporting and value-based purchasing quality programs. It also “de-duplicates” certain measures that are in multiple programs, keeping them in the program where they can “best incentivize improvement and maintaining transparency through public reporting,” CMS said.
In all, these changes will remove a total of 18 measures from the programs and de-duplicate another 25 measures.
What’s more, while CMS previously required hospitals to make publicly available a list of their standard charges or their policies for allowing the public to view this list upon request, the federal agency has updated its guidelines to specifically require hospitals to post this information on the Internet in a “machine-readable format.” CMS said it is considering future actions based on the public feedback it received on ways hospitals can display price information that would be most useful to stakeholders and how to create patient-friendly interfaces that allow consumers to more easily access relevant healthcare data and compare providers.