- A CMS proposed rule intended to change the Medicare Shared Savings Program (Shared Savings Program) to prioritize beneficiary engagement, EHR interoperability, curbing opioid misuse, and other federal initiatives will require that eligible clinicians participating in accountable care organizations (ACOs) use ONC certified EHR technology (CEHRT.)
According to CMS, accountable care organizations are groups of physicians, hospitals, and other healthcare providers who come together voluntarily to deliver high-quality, coordinated care to Medicare patients with the goal of reducing healthcare spending.
Deemed “Pathways to Success,” the new direction for the Shared Savings Program is designed to increase savings for the Trust Funds and reduce losses, cut gamin opportunities, increase program integrity, and promote regulatory flexibility, among other objectives.
As part of new program requirements, eligible clinicians participating in ACOs would be required to utilize CEHRT.
“Specifically, we propose to use an interoperability criterion regarding the use of CEHRT to determine eligibility for initial program participation and as part of an ACO’s annual certification of compliance with program requirements,” explained CMS in a proposed Pathways to Success for the Shared Savings Program fact sheet.
CMS outlined specific requirements for ACOs participating in advanced alternative payment models (APMs). Advanced APMs provide an opportunity for participating providers to earn additional incentive payments for high-quality, cost-efficient care delivery.
“ACOs that are participating in a track or a payment model within a track that is not an Advanced APM would be required to attest that at least 50 percent of their eligible clinicians use CEHRT,” continued CMS.
ACOs participating in a track or payment model part of an advanced APMs would be required to attest to either 50 percent or the CEHRT threshold required for advanced APMs if the CEHRT threshold is higher, CMS clarified.
Additionally, the federal agency proposed policies that aim to reduce administrative burden by eliminating meaningful use quality measures.
“We also propose to discontinue the use of the meaningful use electronic health record quality measure and to require instead that ACOs attest that a specified percentage of their eligible clinicians use CEHRT in order to be eligible for the program and certify annually thereafter,” wrote CMS.
Stakeholders are invited to submit public comments to inform the development of the program’s quality measure set in alignment with the CMS Meaningful Measures initiative.
“We seek comment on approaches to developing the program’s quality measure set in response to the agency’s Meaningful Measures initiative as well as to support ACOs and their ACO providers/suppliers in addressing opioid utilization within the FFS population,” stated CMS.
“We also seek comment on quality measures that could be used to assess factors related to opioid utilization,” the federal agency added.
This newest CMS proposed rule is the latest in a series of recently-released rulemaking from the federal agency.
On August 2, CMS issued the 2019 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System final rule.
The final rule includes policies that rebrand the meaningful use programs as the promoting interoperability (PI) program and emphasize quality measures that incentivize interoperability and health data exchange.
The final rule is also designed to be more flexible and less burdensome than previous regulations to advance the aims of the CMS Patients Over Paperwork initiative.
In total, 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.