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Early Praise for CMS Proposed Rule to Promote Interoperability

The CMS proposed rule transforms the meaningful use program into ‚ÄúPromoting Interoperability‚ÄĚ and reduces administrative burden.

CMS changes meaningful use to promoting interoperability in proposed rule.

Source: Thinkstock

By Kate Monica

- As part of a new proposed rule, CMS is re-naming the meaningful use program “Promoting Interoperability” to reflect the federal agency’s focus on improving health data exchange and reducing administrative burden on providers, CMS Administrator Seema Verma said during an April 24 media call.

“The proposed rule overhauls the meaningful use program to make it work for providers and be more beneficial for patients,” said Verma.

The 1,800-page proposed rule affects the EHR Incentive Programs, as well as Medicare payment policy rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCHPPS) in fiscal year 2019.

The proposed rule would implement a 90-day EHR reporting period for providers participating in the EHR Incentive Programs in 2019 and 2020. Additionally, the rule mandates that providers use 2015 edition certified EHR technology (CEHRT) starting in 2019 to demonstrate meaningful use and avoid a reduction in Medicare reimbursement. 

“Our goal is to provide a brand new structure that allows for eligible hospitals and critical access hospitals to attest to objectives and measures that are most applicable to their particular setting,” Verma emphasized. “To avoid a payment penalty, providers will have to give patients electronic access to their health information.”

READ MORE: CMS Proposes Meaningful Use Changes to Promote Interoperability

The policy changes are also designed to carry out the aims of the MyHealthEData, Patients Over Paperwork, and Meaningful Measures initiatives.

According to Verma, “the proposals we are releasing this year are informed by the great feedback we received” on how to best execute the goals of all three initiatives.

To further the priorities of the MyHealthEData initiative, Verma stated CMS plans to put out a request for information (RFI) to gain feedback from stakeholders about how to improve interoperability and encourage providers to electronically share health data with patients. Mandating that providers prioritize EHR patient data access will help to ensure health information follows the patient wherever they go.

In an effort to carry out the aims of the Patients Over Paperwork initiative, Verma announced CMS plans to remove outdated and unnecessary regulations from federal reporting programs.

“Some highlights include removing redundant reporting in Part A certifications and admission orders, providing more flexibility to urban teaching hospitals to accommodate the cross training of residents, and reducing documentation requirements and increasing flexibility for some hospitals in regards to some wage index geographic reclassification requirements beginning in fiscal year 2021,” said Verma.

READ MORE: CMS Offers $30M for Quality Payment Program Measures Development

Finally, the proposed rule will advance the Meaningful Measures initiative by streamlining quality measure sets to ensure providers are only required to report on the most critical and relevant measures.

“We are removing measures that are topped-out — meaning the overwhelming majority of providers are performing well on them — duplicative measures, and measures that are excessively burdensome to report,” stated Verma.

Ultimately, the proposed rule removes a total of 19 measures from hospital quality programs and de-duplicates another 21 measures, Verma said.

“We’re keeping measures that are critical to patient safety and areas where CMS can drive improvement,” clarified Verma. “We’re eager to get comments back as we work to ensure we strike the right balance in structuring effective quality reporting programs.”

In total, Verma said the proposed rule will save providers $75 million in costs and eliminate more than 2 million administrative hours in burden reduction over the next two years.

READ MORE: CMS Shares Plans to Enable Interoperability, Value-Based Care

So far, a handful of stakeholders have responded positively to the proposed policy changes. Healthcare industry leaders from organizations including CHIME, AHA, and DirectTrust expressed appreciation for the federal agency’s interest in improving interoperability. 

“We appreciate that CMS has considered the potential burdens as well as benefits that policy changes involving healthcare IT can impose on hospitals and healthcare systems,” said CHIME Board of Trustees Chair Cletis Earle. “We have long advocated for interoperability in our healthcare systems and commend CMS for making interoperability a focus.”

“We continue to urge caution as CMS moves ahead with changes to ensure that they facilitate quality care and lead to measurable improvements,” he continued.

DirectTrust CEO David Kibbe commended the federal agency’s efforts to simplify the meaningful use program for hospitals and promote improvements in health data exchange.

“I know that some people wanted HHS and ONC to revamp the certification criteria for EHRs, but given that quite a few vendors have already gone down the road of certification under the 2015 Edition certification criteria, the decision to apply them in 2019 makes a lot of sense,” said Kibbe in a statement sent to EHRIntelligence.com.

“I also believe the new rule’s encouragement of using the CCDA’s shorter version referral note will reduce some of the overhead burden and help to streamline health information exchanges between providers using Direct exchange with attachments,” he continued.

While Kibbe supports CMS’ interest in encouraging the development of new APIs and applications to allow patients to consolidate health data from multiple sources, he emphasized that existing methods of health data exchange are already effective in allowing patients to control their data.

“However, I do wish that CMS had also promoted the use of DirectTrust addresses by patients and consumers as another alternative for patient direction and control as to where their medical information is transported and stored,” said Kibbe.

“It is so easy for providers whose EHRs already send and receive Direct messages and attachments on a national basis to extend this sharing to patients themselves, and Direct exchange is very, very secure,” he continued. “Giving patients choices as to what technologies they use to manage their health information is quite important, as one-size app or transport via FHIR and APIs doesn’t necessarily fit all needs. “

AHA Executive Vice President Tom Nickels applauded the federal agency’s efforts to further the aims of the Patients Over Paperwork initiative.

“The AHA appreciates the Administration working with the hospital field to reduce the administrative complexity of health care and allow providers to spend more time on patients, not paperwork,” said Nickels in a public statement.

“Specifically, we are pleased that in today’s proposed rule, the agency would permanently revoke the 25% Rule for long-term care hospitals,” he continued. “This will help ensure that patients get the care they need when they need it without facing arbitrary restrictions by non-patient-centered regulations.”

Nickels also stated AHA’s approval of CMS’ decision to reduce the number of quality measures for providers and ensure measures only address core issues most critical to delivering high-quality care and improving patient health outcomes.

“Additionally, the AHA is pleased that CMS has proposed a more flexible, performance-based approach to determine whether a hospital has met meaningful use requirements,” stated Nickels. “CMS has also reduced burden by limiting the reporting periods to 90-days in 2019 and 2020."

"We are disappointed, however, that the agency will require use of 2015 Edition Certified EHR Technology beginning in 2019," noted Nickels. 

The comment period for stakeholders to submit feedback about the proposed rule closes on June 25, 2018. 



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