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CMS Final Rule Incentivizes Interoperability, Health Data Exchange

In the IPPS/LTCH final rule, CMS overhauls the EHR Incentive Programs to promote interoperability and health data exchange.

CMS finalized the IPPS and LTCH rules to promote interoperability.

Source: Thinkstock

By Kate Monica

- The CMS final rule for the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System includes policies that rebrand the meaningful use programs as the promoting interoperability (PI) program and emphasize measures that incentivize interoperability and health data exchange.

The final rule is also designed to be more flexible and less burdensome than in previous years to advance the aims of the CMS Patients Over Paperwork initiative. 

“We’re excited to make these changes to ensure care will focus on the patient, not on needless paperwork,” said CMS Administrator Seema Verma. “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of improving the quality and safety of care, advancing health information exchange and usability, and removing outdated or redundant regulations on healthcare providers to make way for innovation and greater value,” Verma continued.

Specifically, the final rule establishes an EHR reporting period of a minimum of any continuous 90-day period in 2019 and 2020 for new and returning program participants.

“For the Medicare Promoting Interoperability Program, the rule finalizes a new performance-based scoring methodology consisting of a smaller set of objectives that will provide a more flexible, less-burdensome structure, allowing eligible hospitals and CAHs to place their focus back on patients,” wrote CMS in an IPPS/LTCH fact sheet.

The final rule includes two new e-prescribing measures related to opioids. Additionally, the Query of PDMP measure will be optional in 2019 but required beginning in 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,” stated CMS.

The federal agency also reduced measures that do not emphasize interoperability or health data exchange.

The final rule reiterates the mandates that require providers to use 2015 edition certified EHR technology (CEHRT) starting in 2019. Requiring providers to use the most updated version of certified EHR technology aligns with the federal agency’s mission to promote the use of application programming interfaces (APIs), which can help to streamline the flow of clinical information between providers, patients, and healthcare facilities.

APIs can also help patients collect their own health information from disparate sources and providers into a single patient portal, application, program, or other software. By promoting the use of APIs, CMS is working to carry out the goals of the MyHealthEData initiative.

The final rule also eliminates redundant, unnecessary, and process-driven measures from some pay-for-reporting and pay-for-performance quality programs per the Meaningful Measures initiative.

“The final rule 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,” clarified CMS in a press release.

“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,” the federal agency continued.

All told, the final rule removes a total of 18 measures from the programs and de-duplicates another 25 measures. The measures that remain are only those most critical to promoting high quality care and patient safety.

“Lastly, CMS is making a variety of other changes to reduce the hours providers spend on paperwork,” stated CMS. “This new flexibility will allow hospitals to spend more time providing care to their patients, thereby improving the quality of care their patients receive.”

CMS projects these efforts to reduce administrative burden will cumulatively save healthcare providers more than 2 million hours of paperwork and $75 million annually once the changes go into effect.

The Skilled Nursing Facilities (SNF) PPS, Inpatient Psychiatric Facility (IPF) PPS, and Inpatient Rehabilitation (IRF) PPS final rules similarly include policies that promote patient-centered, outcome-driven measures rather than process-driven measures.

Aspects of the SNF PPS final rule also ease documentation requirements.

Finalized policies part of the IPPS/LTCH final rule were informed by stakeholder feedback and responses to an April request for information (RFI) from the federal agency.

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