CMS Finalizes Changes to Interoperability Initiatives and EHR Incentive Program for Hospitals

On Thursday August 2, 2018 the Centers for Medicare and Medicaid Services (CMS) posted the final rule on the 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Prospective Payment System. The final rule modifies the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, and other proposed changes to interoperability initiatives at CMS.

CMS expects the final rule to further advance the priority of creating a patient-centered healthcare system by achieving greater price transparency, interoperability and significant burden reduction so that hospitals can operate with better flexibility and patients have what they need to be active healthcare consumers.

The changes made in this final rule will affect approximately 3,330 acute care hospitals and approximately 420 long-term care hospitals, apply to discharges occurring on or after October 1, 2018.

Interoperability

CMS makes changes to the Promoting Interoperability Programs (formerly known as the EHR Incentive Programs) 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. Key provisions that are overhauled in this final rule include:

• 90-Day Reporting: CMS confirmed an EHR reporting period of a minimum of any continuous 90-day period in each of calendar years (CYs) 2019 and 2020 for new and returning participants attesting to CMS or their State Medicaid agency.
• Performance-Based Scoring Methodology: 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 critical access hospitals (CAHs) to place their focus back on patients.
• E-Prescribing of Controlled Substances and Opioid Crisis: CMS finalizes two new e-prescribing measures related to e-prescribing of opioids (Schedule II controlled substances).
  • The query of prescription drug monitoring programs 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 allowing 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.
• Measure Changes: The final rule makes changes to measures, including removing certain measures that do not emphasize interoperability and the electronic exchange of health information.
  • The rule renames several EHR meaningful use measures. For example, "send a summary of care" becomes "support electronic referral loops by sending health information," while the "patient electronic access to health information" objective becomes "provider to patient exchange."
• 2015 Certification Requirement for EHRs: CMS confirmed that beginning with an EHR reporting period in CY 2019, all eligible hospitals and CAHs under the Medicare and Medicaid Promoting Interoperability Programs are required to use the 2015 Edition of certified electronic health record technology (CEHRT).

Electronic Clinical Quality Measures for Eligible Hospitals and CAHs

For eligible hospitals and CAHs that report electronic clinical quality measures (eCQMs), the reporting period for the Medicare and Medicaid Promoting Interoperability Programs will be one, self‑selected calendar quarter of CY 2019 data, reporting on at least four self-selected eCQMs from a set of 16. In this rule, CMS finalized the submission period for the Medicare Promoting Interoperability Program as the two months following the close of the calendar year 2019, ending February 29, 2020. In addition, beginning with the reporting period in 2020, CMS will remove eight of the 16 eCQMs, consistent with their commitment to producing a smaller set of more meaningful measures that are also in alignment with the Hospital Inpatient Quality Reporting (IQR) Program.

Meaningful Measures

The FY 2019 IPPS/LTCH PPS final rule provides an approach to quality measurement in which CMS maintains patient safety measures, while removing measures that add limited value. The final rule reduces the total number of measures acute care hospitals are required to report across the four quality and value-based purchasing programs (Inpatient Quality Reporting, Value-Based Purchasing, Hospital-Acquired Conditions (HAC) Reduction, and Readmissions Reduction Programs). Measures were proposed for removal if they met the criteria for removal under one of the measure removal factors that CMS had either adopted previously or was proposing to adopt in the proposed rule.

Examples of criteria that CMS considered when selecting measures for removal were that the measures were duplicative, showed no meaningful distinction in performance (meaning that the overwhelming majority of providers are performing highly on them), or were overly costly to maintain and report when compared with the benefit of retaining them in a program.

The final rule will eliminate a significant number of measures hospitals are required to report and “de-duplicate” measures across hospital quality programs while maintaining measures that stakeholders feel are important. Specifically, this final rule will remove a total of 18 measures from CMS quality programs and will de-duplicate another 25 measures.

CMS did not finalize its proposal to remove patient safety measures that are in more than one value-based purchasing program, based on its feedback from commenters, however they did finalize the removal of these measures from the Hospital IQR Program (with a delayed removal by one year) in order to reduce some cost and burden for hospitals in having to track these measures in multiple programs, a proposal that HIMSS opposed in our June 2018 comment letter.

Hospital IQR Program

In the FY 2019 IPPS/LTCH PPS final rule, CMS finalizes its proposals, to update the Hospital IQR Program’s measure set and measure removal factors. Specifically, they finalize its proposals to remove certain measures from the Hospital IQR Program, while retaining the same measures in one of the value-based purchasing programs (Hospital Value-Based Purchasing, Hospital Readmissions Reduction, and Hospital-Acquired Condition Reduction Programs). Removing these measures is consistent with CMS’ commitment to prioritizing patients and using a smaller set of more meaningful measures. CMS is focusing on measures that provide opportunities to reduce both paperwork and reporting burden on providers and on patient-centered outcome measures, rather than process measures. To accomplish these goals, CMS finalizes its proposals to adopt a new measure removal factor and to update the Hospital IQR Program’s measure set.