The CMS has acted to substantially decrease burdens on hospitals targeting to acquire the meaningful use programs of electronic health records (EHRs).
Hospitals are being given another year to use the 2014 Edition of Certified EHR Technology (CEHRT) software. Facilities also now have the option of continuing to meet modified Stage 2 measures for meaningful use programs, instead of being required to move to Stage 3 in 2018. Under the new final rule, hospitals now are not required to meet Stage 3 until the year of 2019.
Hospitals, at their option, also can use a combination of the 2014 and 2015 editions of meaningful use software.
The revisions to meaningful use regulations were issued today in a final rule covering the Fiscal Year 2018 Inpatient Prospective Payment System, which broadly covers payments to providers under Medicare.
Moreover, hospitals will be needed to report only four electronic clinical quality measures (eCQMs) in 2017 and 2018, rather than eight measures. And, providers can select any quarter of data for eCQM reporting for both years.
Also under the final rule, CMS is developing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.
The College of Healthcare Information Management Executives, an expert group that represents chief information officers and other healthcare IT professionals, highly praised the new policies.
“CMS took into account that both hospitals and vendors require more time to prepare for 2015 certified EHRs,” stated Liz Johnson, CHIME board chair and CIO of acute hospitals and applied clinical informatics at Tenet Healthcare. “Taken together, the common sense changes CMS made will give greater stability and certainty to hospitals, permitting them to continue to forge ahead using technology to better treat the patients they serve.”
The 2,456-page final rule, of which just a small portion addresses the meaningful use programs changes, is available here.
Showing posts with label CMS. Show all posts
Showing posts with label CMS. Show all posts
Tuesday, August 1, 2017
Thursday, July 20, 2017
OIG decides to inquire $15B in meaningful use payments
The Department of Health and Human Services Office of Inspector General will analyze the accuracy of $14.6 billion in meaningful use payments made to hospitals by Medicare between 2011 and 2016. Initially this year, the OIG estimated physicians were wrongfully paid $729 million under meaningful use payments.
Medicare incentive payments were authorized over a 5-year period to hospitals that adopted electronic health record (EHR) technology. From January 1, 2011, through December 31, 2016, the Centers for Medicare and Medicaid Services made Medicare EHR incentive payments to hospitals totaling $14.6 billion, the OIG stated.
The Government Accountability Office recognized wrong incentive payments as the primary risk to the Medicare EHR incentive program. An OIG report described the obstacles that CMS faces in overseeing the Medicare EHR incentive program. In addition, previous OIG reviews of Medicaid EHR incentive payments found that state agencies overpaid hospitals by $66.7 million and would in the future overpay these hospitals an additional $13.2 million, the OIG claimed.
“These overpayments resulted from inaccuracies in the hospitals’ calculations of total incentive payments,” the OIG said. “We will review the hospitals’ incentive payment calculations to identify potential overpayments that the hospitals would have received as a result of the inaccuracies.”
On another front, the OIG will be analyzing the precision of telemedicine payments under Medicare.
Medicare Part B covers expenses for telehealth services on the telehealth list when those services are delivered via an interactive telecommunications system, provided few conditions are met. To support rural access to care, Medicare pays for telehealth services provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner situated at a distant site.
Medicare incentive payments were authorized over a 5-year period to hospitals that adopted electronic health record (EHR) technology. From January 1, 2011, through December 31, 2016, the Centers for Medicare and Medicaid Services made Medicare EHR incentive payments to hospitals totaling $14.6 billion, the OIG stated.
The Government Accountability Office recognized wrong incentive payments as the primary risk to the Medicare EHR incentive program. An OIG report described the obstacles that CMS faces in overseeing the Medicare EHR incentive program. In addition, previous OIG reviews of Medicaid EHR incentive payments found that state agencies overpaid hospitals by $66.7 million and would in the future overpay these hospitals an additional $13.2 million, the OIG claimed.
“These overpayments resulted from inaccuracies in the hospitals’ calculations of total incentive payments,” the OIG said. “We will review the hospitals’ incentive payment calculations to identify potential overpayments that the hospitals would have received as a result of the inaccuracies.”
On another front, the OIG will be analyzing the precision of telemedicine payments under Medicare.
Medicare Part B covers expenses for telehealth services on the telehealth list when those services are delivered via an interactive telecommunications system, provided few conditions are met. To support rural access to care, Medicare pays for telehealth services provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner situated at a distant site.
Tuesday, June 27, 2017
Medicaid data not still available for system and oversight
A system developed to make better the completeness, precision and timeliness of Medicaid data is not yet getting the job done, in accordance with a new audit by the Department of Health and Human Services’ Office of Inspector General.
Information from the Transformed Medicaid Statistical Information System (T-MSIS) was supposed to assist ensures the effective administration and oversight of the Medicaid data program, involving enhancing the ability to recognize potential fraud while improving program efficiency.
Although, while the CMS (Centers for Medicare and Medicaid Services) had planned to implement T-MSIS with states on a rolling basis, with the aim of having all states submitting data monthly by July 2014, the OIG notes in its report that early implementation challenges have resulted in delays with T-MSIS.
“These delays were caused by technological issues during data testing and by competing priorities for states' IT resources,” according to the OIG’s audit. “As a result, the goal for when T-MSIS will contain data from all state Medicaid programs has been repeatedly postponed.”
Previous year, the federal government and states spent $574 billion on Medicaid, benefitting more than 74 million enrollees. But, without T-MSIS data, the ability to recognize trends or patterns demonstrating potential fraud, waste, and abuse in the program—as well as stop or mitigate the impact of these activities—is primarily diminished.
However, CMS expects that all states will be reporting to T-MSIS by the end of 2017, auditors reveal that just 21 of 53 state programs were submitting data to T-MSIS as of December 2016, and that it is unclear whether an end-of-the-year target date can be met.
“As states and CMS sustain to work together to submit Medicaid data into T-MSIS, they continue to raise concerns about the completeness and reliability of the data,” the report warns. “Particularly, states indicate that they are unable to report Medicaid data for all the T-MSIS data elements. Furthermore, even with a revised data dictionary that gives definitions for each data element, states and CMS report concerns about states’ varying interpretations of data elements. If states don’t have uniform interpretations of data elements, the data they submit for these elements won’t be consistent across states, making any analysis of national trends or patterns inherently unreliable.”
“Successfully getting all states’ data into T-MSIS needs states and CMS to prioritize T-MSIS implementation,” summarizes the report. “Because of CMS’s history of delaying target dates for execution, OIG is concerned that CMS and states will delay further instead to assign the resources required to deal the outstanding challenges.”
Auditors continue to suggest that CMS develop a deadline for when T-MSIS data will be available for program analysis and other management functions, contending that “without a fixed deadline, some states and CMS may not make the full implementation of T-MSIS a management priority.”
CMS officials weren’t immediately available for comment. However, in its written response to the OIG, the agency reported that since December 2016 more states—40 altogether—have successfully started submitting data to T-MSIS.
Nevertheless, while progress has been made on the number of states submitting data to T-MSIS, CMS concurred with OIG on the requirement for reliable data. In its written comments, the agency highlighted its ongoing work to improve data quality.
Specifically, CMS demonstrated that it has 2 major goals for T-MSIS data quality: transparency for users, and a continuous, ongoing improvement process with states to strengthen the Medicaid data quality. To realize these aims, the agency said it is undertaking a variety of actions, involving information for users on data quality, one-on-one technical assistance to states to ensure their data will be usable, as well as a post-production data quality review with a subset of states to establish an effective working process for improving data quality.
Additionally, CMS informed the OIG that it convened a Technical Evaluation Panel to gain initial feedback on data quality and usability. In accordance with the agency, the panel assessed a subset of T-MSIS data to identify anomalies in the data and potential challenges with using the data for analysis. CMS intends to use the panel’s findings to inform efforts to improve the states’ data quality.
Information from the Transformed Medicaid Statistical Information System (T-MSIS) was supposed to assist ensures the effective administration and oversight of the Medicaid data program, involving enhancing the ability to recognize potential fraud while improving program efficiency.
Although, while the CMS (Centers for Medicare and Medicaid Services) had planned to implement T-MSIS with states on a rolling basis, with the aim of having all states submitting data monthly by July 2014, the OIG notes in its report that early implementation challenges have resulted in delays with T-MSIS.
“These delays were caused by technological issues during data testing and by competing priorities for states' IT resources,” according to the OIG’s audit. “As a result, the goal for when T-MSIS will contain data from all state Medicaid programs has been repeatedly postponed.”
Previous year, the federal government and states spent $574 billion on Medicaid, benefitting more than 74 million enrollees. But, without T-MSIS data, the ability to recognize trends or patterns demonstrating potential fraud, waste, and abuse in the program—as well as stop or mitigate the impact of these activities—is primarily diminished.
However, CMS expects that all states will be reporting to T-MSIS by the end of 2017, auditors reveal that just 21 of 53 state programs were submitting data to T-MSIS as of December 2016, and that it is unclear whether an end-of-the-year target date can be met.
“As states and CMS sustain to work together to submit Medicaid data into T-MSIS, they continue to raise concerns about the completeness and reliability of the data,” the report warns. “Particularly, states indicate that they are unable to report Medicaid data for all the T-MSIS data elements. Furthermore, even with a revised data dictionary that gives definitions for each data element, states and CMS report concerns about states’ varying interpretations of data elements. If states don’t have uniform interpretations of data elements, the data they submit for these elements won’t be consistent across states, making any analysis of national trends or patterns inherently unreliable.”
“Successfully getting all states’ data into T-MSIS needs states and CMS to prioritize T-MSIS implementation,” summarizes the report. “Because of CMS’s history of delaying target dates for execution, OIG is concerned that CMS and states will delay further instead to assign the resources required to deal the outstanding challenges.”
Auditors continue to suggest that CMS develop a deadline for when T-MSIS data will be available for program analysis and other management functions, contending that “without a fixed deadline, some states and CMS may not make the full implementation of T-MSIS a management priority.”
CMS officials weren’t immediately available for comment. However, in its written response to the OIG, the agency reported that since December 2016 more states—40 altogether—have successfully started submitting data to T-MSIS.
Nevertheless, while progress has been made on the number of states submitting data to T-MSIS, CMS concurred with OIG on the requirement for reliable data. In its written comments, the agency highlighted its ongoing work to improve data quality.
Specifically, CMS demonstrated that it has 2 major goals for T-MSIS data quality: transparency for users, and a continuous, ongoing improvement process with states to strengthen the Medicaid data quality. To realize these aims, the agency said it is undertaking a variety of actions, involving information for users on data quality, one-on-one technical assistance to states to ensure their data will be usable, as well as a post-production data quality review with a subset of states to establish an effective working process for improving data quality.
Additionally, CMS informed the OIG that it convened a Technical Evaluation Panel to gain initial feedback on data quality and usability. In accordance with the agency, the panel assessed a subset of T-MSIS data to identify anomalies in the data and potential challenges with using the data for analysis. CMS intends to use the panel’s findings to inform efforts to improve the states’ data quality.
Friday, May 26, 2017
Deficiency of access to health information said to restrict potential of machine learning technology
As machine learning technology sustains to advance at a rapid pace, providers are excited by the potential of this kind of artificial intelligence to predict which sufferers are most at risk for clinical events that need early intervention.
Although, these medical breakthroughs are being hampered by the deficiency of health data necessary to learn the complex patterns needed to positively affect patient care.
That is the consensus of healthcare stakeholders who gathered at Wednesday’s Machine Learning in Healthcare: Industry Applications conference in the Boston to discuss the technology’s promise and challenges.
Research released earlier this month by MarketsandMarkets projected that the healthcare artificial intelligence market is hoped to grow from $667.1 million in the year of 2016 to more than $7.9 billion by the year of 2022, a compound yearly growth rate of 53% over the forecast period. Machine learning technology is accelerating at a rate beyond Moore’s Law, with algorithms and models doubling in capability every 6 months.
Among the potential applications: medical imaging, drug discovery, diagnostics, precision medicine, as well as patient information and risk analysis. In fact, a study presented this week at the American Thoracic Society International Conference in Washington demonstrated that a machine-learning algorithm has the capability to recognize hospitalized patients at risk for severe sepsis and septic shock using information from electronic health records (EHRs).
In accordance to Russ Wilcox, partner of venture capital firm Pillar, machine learning technology is presently benefitting from a “trifecta” of technology trends—big data (a flood of digital information that doubles every 3 years), better hardware (optimized processors and storage) and smarter algorithms.
“90% of the world’s digital information is less than 2 years old, and (that trend) is accelerating even faster,” Wilcox told the Machine Learning conference.
Yet, in healthcare, he lamented the fact that much of the information is trapped in silos, which is stifling machine learning’s promising applications in medicine.
“So several of the other industries are way ahead of us in terms of considering about how to bring automation and digital tools to personalize our access” to data, stated John Brownstein, chief innovation officer at Boston Children’s Hospital, who summed up the issue in healthcare as being a deficiency of data accessibility and quality.
On the flip side, Brownstein pointed out that the large consumer technology companies have access to good quality information that enables automation and machine learning, resulting in a high level of personalization.
In the public sector, AI isn’t on the agenda of the Centers for Medicare and Medicare Services (CMS), even though the agency has increasingly been issuing updated healthcare data to improve transparency in the Medicare program and to provide more timely data for providers, researchers and beneficiaries, claims Niall Brennan, former chief data officer at CMS.
“While we did a ton of data work and re-centered and reengineered CMS as a more data-driven organization, I am afraid AI is so far off its radar screen that if you said AI to somebody at CMS they might consider you were talking about Allen Iverson,” said Brennan.
CMS is the greatest single U.S. health payer, generating enormous amounts of data. Although, as Brennan pointed out, it is primarily claims data, with the agency “missing nearly all of the clinical and genomic data.” Even so, he believes AI and machine learning technology could give CMS the capabilities to utilize data in new and creative ways and to generate actionable insights, he said.
Over the next 5 years, Brennan asserts that one of the key issues related to whether or not artificial intelligence and machine learning technology gain traction with huge public payers is “translating it into something tangible that will resonate with payers and lead them to consider them about realigning financial incentives” to make better the patient outcomes and reduce healthcare costs.
On the provider side, he made the case that the single most important driver for spurring the adoption of AI and machine learning technology is the transition from fee-for-service to value-based care “because it develops incredible incentives for providers to innovate and attempt to provide better care at lower costs.” At the similar time, Brennan cautioned against the hazards of “bolting innovative solutions on to a fee-for-service chassis.”
Although, these medical breakthroughs are being hampered by the deficiency of health data necessary to learn the complex patterns needed to positively affect patient care.
That is the consensus of healthcare stakeholders who gathered at Wednesday’s Machine Learning in Healthcare: Industry Applications conference in the Boston to discuss the technology’s promise and challenges.
Research released earlier this month by MarketsandMarkets projected that the healthcare artificial intelligence market is hoped to grow from $667.1 million in the year of 2016 to more than $7.9 billion by the year of 2022, a compound yearly growth rate of 53% over the forecast period. Machine learning technology is accelerating at a rate beyond Moore’s Law, with algorithms and models doubling in capability every 6 months.
Among the potential applications: medical imaging, drug discovery, diagnostics, precision medicine, as well as patient information and risk analysis. In fact, a study presented this week at the American Thoracic Society International Conference in Washington demonstrated that a machine-learning algorithm has the capability to recognize hospitalized patients at risk for severe sepsis and septic shock using information from electronic health records (EHRs).
In accordance to Russ Wilcox, partner of venture capital firm Pillar, machine learning technology is presently benefitting from a “trifecta” of technology trends—big data (a flood of digital information that doubles every 3 years), better hardware (optimized processors and storage) and smarter algorithms.
“90% of the world’s digital information is less than 2 years old, and (that trend) is accelerating even faster,” Wilcox told the Machine Learning conference.
Yet, in healthcare, he lamented the fact that much of the information is trapped in silos, which is stifling machine learning’s promising applications in medicine.
“So several of the other industries are way ahead of us in terms of considering about how to bring automation and digital tools to personalize our access” to data, stated John Brownstein, chief innovation officer at Boston Children’s Hospital, who summed up the issue in healthcare as being a deficiency of data accessibility and quality.
On the flip side, Brownstein pointed out that the large consumer technology companies have access to good quality information that enables automation and machine learning, resulting in a high level of personalization.
In the public sector, AI isn’t on the agenda of the Centers for Medicare and Medicare Services (CMS), even though the agency has increasingly been issuing updated healthcare data to improve transparency in the Medicare program and to provide more timely data for providers, researchers and beneficiaries, claims Niall Brennan, former chief data officer at CMS.
“While we did a ton of data work and re-centered and reengineered CMS as a more data-driven organization, I am afraid AI is so far off its radar screen that if you said AI to somebody at CMS they might consider you were talking about Allen Iverson,” said Brennan.
CMS is the greatest single U.S. health payer, generating enormous amounts of data. Although, as Brennan pointed out, it is primarily claims data, with the agency “missing nearly all of the clinical and genomic data.” Even so, he believes AI and machine learning technology could give CMS the capabilities to utilize data in new and creative ways and to generate actionable insights, he said.
Over the next 5 years, Brennan asserts that one of the key issues related to whether or not artificial intelligence and machine learning technology gain traction with huge public payers is “translating it into something tangible that will resonate with payers and lead them to consider them about realigning financial incentives” to make better the patient outcomes and reduce healthcare costs.
On the provider side, he made the case that the single most important driver for spurring the adoption of AI and machine learning technology is the transition from fee-for-service to value-based care “because it develops incredible incentives for providers to innovate and attempt to provide better care at lower costs.” At the similar time, Brennan cautioned against the hazards of “bolting innovative solutions on to a fee-for-service chassis.”
Wednesday, April 19, 2017
Study asserts Hospital Compare errs on AMI mortality amounts at certain facilities
The Hospital Compare website, operated by the CMS (Centers for Medicare and Medicaid Services), is meant to assist people learn about the quality of hospitals, but a recent study emphasizes that the statistical methodology utilized by Hospital Compare underestimates heart attack or Acute Myocardial Infarction or AMI mortality amounts for small hospitals.
“The underestimation of AMI mortality amounts at small hospitals, as seen in Hospital Compare, contradicts initially established research and consistent findings that mortality rates are generally higher at low-volume hospitals,” stated Jeffrey Silber, MD, co-author of the study, professor of pediatrics at the Children's Hospital of Philadelphia and professor of health care management at The Wharton School.
The website is intended to assist sufferers and their families make decisions about providers by giving a side-by-side comparison between facilities in their place.
The study, released in the Journal of the American Statistical Association, makes the case that Hospital Compare’s statistical methodology—the random effects logit model—really shrinks mortality rates from small hospitals to resemble the national average.
“Hospital Compare’s finding of average risk at small facilities is a mistake because the current model isn’t precisely calibrated,” stated Edward George, professor of statistics at the University of Pennsylvania’s Wharton School and co-author of the study. “It is an error that has implications for sufferers.”
CMS officials weren’t immediately available for comment about the findings of the research.
Nevertheless, previous year, the agency released a statement saying it “designed the methodology to be inclusive of as many hospitals and as several measures as possible,” which “stops the methodology from limiting star rating calculations to certain types of hospitals based on characteristic or size.” Although, at the same time, CMS noted that it’ll “continue to re-evaluate and make any needed modifications to the methodology over time.”
“As a model for AMI hospital mortality amounts, we’ve discovered the hierarchical random effect logit model used by Hospital Compare to be inadequate, compared to alternatives that model hospital effects as a functions of hospital attributes,” summarize the authors, who add that “sufferers deserve to have the most accurate information available so they can make well-informed healthcare decisions.”
“The underestimation of AMI mortality amounts at small hospitals, as seen in Hospital Compare, contradicts initially established research and consistent findings that mortality rates are generally higher at low-volume hospitals,” stated Jeffrey Silber, MD, co-author of the study, professor of pediatrics at the Children's Hospital of Philadelphia and professor of health care management at The Wharton School.
The website is intended to assist sufferers and their families make decisions about providers by giving a side-by-side comparison between facilities in their place.
The study, released in the Journal of the American Statistical Association, makes the case that Hospital Compare’s statistical methodology—the random effects logit model—really shrinks mortality rates from small hospitals to resemble the national average.
“Hospital Compare’s finding of average risk at small facilities is a mistake because the current model isn’t precisely calibrated,” stated Edward George, professor of statistics at the University of Pennsylvania’s Wharton School and co-author of the study. “It is an error that has implications for sufferers.”
CMS officials weren’t immediately available for comment about the findings of the research.
Nevertheless, previous year, the agency released a statement saying it “designed the methodology to be inclusive of as many hospitals and as several measures as possible,” which “stops the methodology from limiting star rating calculations to certain types of hospitals based on characteristic or size.” Although, at the same time, CMS noted that it’ll “continue to re-evaluate and make any needed modifications to the methodology over time.”
“As a model for AMI hospital mortality amounts, we’ve discovered the hierarchical random effect logit model used by Hospital Compare to be inadequate, compared to alternatives that model hospital effects as a functions of hospital attributes,” summarize the authors, who add that “sufferers deserve to have the most accurate information available so they can make well-informed healthcare decisions.”
Sunday, March 19, 2017
Efforts of HHS to increase patient engagement with EHRs fall short, GAO reports
Brief:
- A latest report claims that sufferers aren’t accessing and using their electronic health information, despite wide availability to do so, and calls on HHS to reassess the effectiveness of efforts to enhance patient engagement with EHRs.
- In accordance to the General Accountability Office report, just about one-third of sufferers accessed EHRs through physician practices. The amount of use among hospital patients was less than half that at 15 percent, despite 88 percent of hospitals providing access.
- HHS has injected more than $35 billion into health information technology, primarily intended to increase the adoption of EHRs among caregivers.
Description:
Much of the federal push to enhance patient engagement with EHRs has fallen to the Office of the National Coordinator for Health IT and CMS through programs such as Patient Engagement Playbook and the Medicare EHR Incentive Program. Although, neither agency has effective means of measuring the outcomes of their attempts to see if patients are really accessing and using their EHRs.
“While HHS’s investment in health IT is important, HHS lacks the capability to determine whether, or to what extent, CMS’s and ONC’s efforts are assisting HHS to achieve its goals,” the report summarizes. GAO suggested that HHS develop performance measures to assess its attempts to enhance patients’ access to longitudinal health information and use the data to achieve program goals.
Despite an industry-wide push to enhance patients’ use of their personal health data, little progress has been made — in part because of the deficiency of interest from patients, but also in part because providers haven’t actively promoted PHIs and patient portals.
In accordance to a recent West survey, 75 percent of patients with chronic conditions need their provider to check in regularly so they can be alerted if anything seems unusual, though only 30 percent report getting such feedback. Such information could be beneficial in tracking a health of patient between visits and better inform the doctor when the patient schedules their next visit.
Providers are aware of the need improve EHR access. In a survey by CDW Healthcare, 71 percent of providers said improving patient engagement is a top priority and 80 percent said they were working to make EHRs simpler for patients to access.
Tuesday, January 31, 2017
GAO calls CMS’ Medicare Advantage encounter data into query
The Centers for Medicare and Medicaid Services (CMS) has made insufficient development in validating the completeness and precision of Medicare Advantage encounter data, a crucial component for administering accurate payments for the program, in accordance to a Government Accountability Office audit.
CMS gathers Medicare Advantage encounter data, detailed data about the care and health status of Medicare Advantage enrollees, to evaluate payments. Although, despite GAO’s 2014 suggestions that CMS completely assess data quality before use, auditors discovered that the agency has yet to take critical measures to make sure the encounter data is right and complete, making the Medicare Advantage program susceptible to improper payments and wasted taxpayer dollars.
“CMS has still to undertake tasks that fully deals Medicare Advantage encounter data precision, like reviewing medical records,” states the audit report. “Moreover, few health insurance and provider trade associations GAO interviewed voiced concerns about CMS’s capability to accurately identify diagnoses utilized for risk adjustment…To the extent that CMS is making payments deployed on data that haven’t been completely validated for completeness and accuracy, the soundness of billions of dollars in Medicare expenditures sustains to be unsubstantiated.”
A CMS spokesperson refused to particularly comment on the GAO’s findings and suggestions, and instead referred to the agency’s official written responses released in the audit report. Among those responses, CMS officials pointed out that they are working with Medicare Advantage agencies to refine how the methodology used to gain diagnoses data is applied.
Additionally, the agency claimed that it has started compiling basic statistics on the volume and consistency of data submissions and preparing automated summary reports for Medicare Advantage agencies demonstrating diagnosis information used for risk adjustment.
Specifically, CMS started phasing in patient diagnosis data from Medicare Advantage encounter data in its risk adjustment process in the year of 2015 and told the GAO it intends to depend completely on those data by the year of 2020.
Because it has primarily concentrated on collecting comprehensive encounter data for risk adjustment purposes, CMS officials also informed auditors that the agency has highly deferred planning for extra uses of the data.
Nevertheless, in accordance to the GAO, few stakeholder agencies have objected to the risk adjustment transition time frame, compelling that it does not permit sufficient time for a victorious transition. Still, CMS asserts that the multiyear transition time frame is reasonable.
Provided the agency’s limited progress, auditors claimed that they continue to believe that CMS should execute GAO’s July 2014 suggestion that the agency completely develop plans for the extra uses of Medicare Advantage encounter data.
“This latest GAO research proves once again that the encounter data system isn’t ready for full implementation,” stated House Ways and Means Committee Chairman Rep. Kevin Brady (R-Texas) in a written statement. “While the system was developed to ensure right payments for the millions of seniors who depend on Medicare Advantage, it won’t work with incomplete and inaccurate data and could lead to higher premiums or decreased benefits down the road. CMS must ensure this significant system is based on the right information so taxpayer dollars are going to Medicare recipients who require them most.”
Likewise, House Energy and Commerce Committee Chairman Rep. Greg Walden (R-Ore.) claimed in a written statement that the GAO report “raises more uncertainties about the encounter data system and either it is ready to perform its duties.”
While applauding that few improvements have been made since GAO’s 2014 report, Walden noted that “key suggestions from the government watchdog have still to be implemented” and voiced his support for the “GAO’s asserting that CMS should completely assess its data quality before implementing” the Medicare Advantage encounter data system.
CMS gathers Medicare Advantage encounter data, detailed data about the care and health status of Medicare Advantage enrollees, to evaluate payments. Although, despite GAO’s 2014 suggestions that CMS completely assess data quality before use, auditors discovered that the agency has yet to take critical measures to make sure the encounter data is right and complete, making the Medicare Advantage program susceptible to improper payments and wasted taxpayer dollars.
“CMS has still to undertake tasks that fully deals Medicare Advantage encounter data precision, like reviewing medical records,” states the audit report. “Moreover, few health insurance and provider trade associations GAO interviewed voiced concerns about CMS’s capability to accurately identify diagnoses utilized for risk adjustment…To the extent that CMS is making payments deployed on data that haven’t been completely validated for completeness and accuracy, the soundness of billions of dollars in Medicare expenditures sustains to be unsubstantiated.”
A CMS spokesperson refused to particularly comment on the GAO’s findings and suggestions, and instead referred to the agency’s official written responses released in the audit report. Among those responses, CMS officials pointed out that they are working with Medicare Advantage agencies to refine how the methodology used to gain diagnoses data is applied.
Additionally, the agency claimed that it has started compiling basic statistics on the volume and consistency of data submissions and preparing automated summary reports for Medicare Advantage agencies demonstrating diagnosis information used for risk adjustment.
Specifically, CMS started phasing in patient diagnosis data from Medicare Advantage encounter data in its risk adjustment process in the year of 2015 and told the GAO it intends to depend completely on those data by the year of 2020.
Because it has primarily concentrated on collecting comprehensive encounter data for risk adjustment purposes, CMS officials also informed auditors that the agency has highly deferred planning for extra uses of the data.
Nevertheless, in accordance to the GAO, few stakeholder agencies have objected to the risk adjustment transition time frame, compelling that it does not permit sufficient time for a victorious transition. Still, CMS asserts that the multiyear transition time frame is reasonable.
Provided the agency’s limited progress, auditors claimed that they continue to believe that CMS should execute GAO’s July 2014 suggestion that the agency completely develop plans for the extra uses of Medicare Advantage encounter data.
“This latest GAO research proves once again that the encounter data system isn’t ready for full implementation,” stated House Ways and Means Committee Chairman Rep. Kevin Brady (R-Texas) in a written statement. “While the system was developed to ensure right payments for the millions of seniors who depend on Medicare Advantage, it won’t work with incomplete and inaccurate data and could lead to higher premiums or decreased benefits down the road. CMS must ensure this significant system is based on the right information so taxpayer dollars are going to Medicare recipients who require them most.”
Likewise, House Energy and Commerce Committee Chairman Rep. Greg Walden (R-Ore.) claimed in a written statement that the GAO report “raises more uncertainties about the encounter data system and either it is ready to perform its duties.”
While applauding that few improvements have been made since GAO’s 2014 report, Walden noted that “key suggestions from the government watchdog have still to be implemented” and voiced his support for the “GAO’s asserting that CMS should completely assess its data quality before implementing” the Medicare Advantage encounter data system.
Sunday, January 29, 2017
Health Information Technology (HIT) Permits Payers to Share Data
The Centers for Medicare & Medicaid Services (CMS) strive to develop programs meant to bring “better care, smarter spending, and healthier people.” CMS joined hands with healthcare payers across 7 regions to make better primary care through the Comprehensive Primary Care initiative (CPC), in accordance to The CMS Blog. Through the utilization of health information technology (HIT) and multi-insurer payment reform, the program was established to support primary care practices in advancing the quality of care.
Payers across 3 regions involving Ohio, Colorado, and Oklahoma and CMS partnered to establish reports with private patient information to give quality information straightly to primary care offices. Payers worked closely with primary care practices while CMS constantly transformed the format and wording of the reports.
Utilizing health information technology (HIT) and sharing significant patient data has become a major aspect of making better patient care inside and outside of primary care physician offices. By ensuring primary care doctors have access to a sufferer’s overall medical information outside of their office, physicians will be capable to reach out to their sufferers and offer services before a patient seeks more expensive emergency care.
Prior to the Comprehensive Primary Care initiative, primary care doctors mostly had numerous reports from different healthcare payers with several quality measures and formats. Such diverse reports made it more complex for providers to target what data mattered and how they could act on the given information.
Although, CMS programs like the Comprehensive Primary Care initiative give aggregated data reports, which provide doctors with a stronger understanding of their patient populations and enable them to recognize gaps in care. Physicians can then concentrate on areas where population health management could be improved.
“This was a much anticipated solution to the complications posed by not having access to consistent claims information, and a continuous desire to make better our approach to meeting CPC Milestones [program requirements],” stated Dr. Austin Bailey, Medical Director of University of Colorado Health (UCHealth).
“Our practices will sustain to leverage the utilization of aggregated claims data using Stratus [the tool for practices in Colorado] to recognize the cost patterns of high risk patients — for instance, among our sufferers with diabetes, is the greatest cost linked with specialists, emergency department utilization, or medications? Having this data across several payers makes it more relevant and assists to build our confidence in choosing the suitable interventions, recognizing trends, and effectively assigning care management resources,” Bailey summarized.
The Comprehensive Primary Care Plus program is a modern version of the former initiative and began operating on the day of January 1, 2017. More than fifty private healthcare payers have partnered with state Medicaid agencies and CMS across fourteen regions to participate in the Comprehensive Primary Care Plus program.
CMS is searching to continue working with payers to expand the execution of aggregated data reports and health information technology to share medical information that enables physicians to recognize gaps in care. Private and public healthcare payers are motivated to work with primary care physicians and the sufferer population to deliver medical data meant to make better the quality of care.
The sharing or exchange of information through health information technology enables doctors to reinforce care coordination, fill in gaps in care, and concentrate on increasing preventive care use, stated Dan Paoletti, CEO of Ohio Health Information Partnership at CliniSync.
In the previous days, hospitals, clinics, and payers had a fragmented system of healthcare delivery with inadequate communication and coordination. Since then, health information technology and the sharing of data enabled payers and providers to make better the coordination and the use of preventive care.
“Having access to data actually goes back to handling coordination of care,” Paoletti stated. “One of the most significant things related to that is preventative care because, finally, this is about trying to keep people healthy. That is how we are going to handle risk by making that pool of healthy individuals bigger and decreasing overall costs of care through that.”
“It actually is critical to get the data where it requires being in case to fill in the gaps that exist today,” Paoletti added. “That is what we are attempting to do and that is where we are headed on a larger scale.”
Furthermore, the results from health information exchange indicate that duplicative testing is decreased and wasteful spending is also decreased, stated Paoletti.
“I consider what will result [from health information exchange] will be a reduction in spending both because ultimately, it’ll increase preventive care but also realistically we’ll have a reduction in tests and duplicative services because the data will be available,” Paoletti contended.
Private and public payers are advancing their work with primary care doctors to share patient information more rapidly to fill in gaps in care and make better coordination.
Payers across 3 regions involving Ohio, Colorado, and Oklahoma and CMS partnered to establish reports with private patient information to give quality information straightly to primary care offices. Payers worked closely with primary care practices while CMS constantly transformed the format and wording of the reports.
Utilizing health information technology (HIT) and sharing significant patient data has become a major aspect of making better patient care inside and outside of primary care physician offices. By ensuring primary care doctors have access to a sufferer’s overall medical information outside of their office, physicians will be capable to reach out to their sufferers and offer services before a patient seeks more expensive emergency care.
Prior to the Comprehensive Primary Care initiative, primary care doctors mostly had numerous reports from different healthcare payers with several quality measures and formats. Such diverse reports made it more complex for providers to target what data mattered and how they could act on the given information.
Although, CMS programs like the Comprehensive Primary Care initiative give aggregated data reports, which provide doctors with a stronger understanding of their patient populations and enable them to recognize gaps in care. Physicians can then concentrate on areas where population health management could be improved.
“This was a much anticipated solution to the complications posed by not having access to consistent claims information, and a continuous desire to make better our approach to meeting CPC Milestones [program requirements],” stated Dr. Austin Bailey, Medical Director of University of Colorado Health (UCHealth).
“Our practices will sustain to leverage the utilization of aggregated claims data using Stratus [the tool for practices in Colorado] to recognize the cost patterns of high risk patients — for instance, among our sufferers with diabetes, is the greatest cost linked with specialists, emergency department utilization, or medications? Having this data across several payers makes it more relevant and assists to build our confidence in choosing the suitable interventions, recognizing trends, and effectively assigning care management resources,” Bailey summarized.
The Comprehensive Primary Care Plus program is a modern version of the former initiative and began operating on the day of January 1, 2017. More than fifty private healthcare payers have partnered with state Medicaid agencies and CMS across fourteen regions to participate in the Comprehensive Primary Care Plus program.
CMS is searching to continue working with payers to expand the execution of aggregated data reports and health information technology to share medical information that enables physicians to recognize gaps in care. Private and public healthcare payers are motivated to work with primary care physicians and the sufferer population to deliver medical data meant to make better the quality of care.
The sharing or exchange of information through health information technology enables doctors to reinforce care coordination, fill in gaps in care, and concentrate on increasing preventive care use, stated Dan Paoletti, CEO of Ohio Health Information Partnership at CliniSync.
In the previous days, hospitals, clinics, and payers had a fragmented system of healthcare delivery with inadequate communication and coordination. Since then, health information technology and the sharing of data enabled payers and providers to make better the coordination and the use of preventive care.
“Having access to data actually goes back to handling coordination of care,” Paoletti stated. “One of the most significant things related to that is preventative care because, finally, this is about trying to keep people healthy. That is how we are going to handle risk by making that pool of healthy individuals bigger and decreasing overall costs of care through that.”
“It actually is critical to get the data where it requires being in case to fill in the gaps that exist today,” Paoletti added. “That is what we are attempting to do and that is where we are headed on a larger scale.”
Furthermore, the results from health information exchange indicate that duplicative testing is decreased and wasteful spending is also decreased, stated Paoletti.
“I consider what will result [from health information exchange] will be a reduction in spending both because ultimately, it’ll increase preventive care but also realistically we’ll have a reduction in tests and duplicative services because the data will be available,” Paoletti contended.
Private and public payers are advancing their work with primary care doctors to share patient information more rapidly to fill in gaps in care and make better coordination.
Friday, January 27, 2017
DMC's Michigan Pioneer Merges with CMS Next Generation ACO Model
Detroit Medical Center (DMC) is glad to declare it has been opted to participate in the year of 2017 Centers for Medicare and Medicaid Services’ (CMS’s) Next Generation ACO Model (Accountable Care Organization Model), a transformative step sponsored by the CMS Innovation Center. As a Next Generation ACO Model, DMC’s Michigan Pioneer ACO will sustain to join CMS to give Medicare beneficiaries with higher-quality care at lower charges.
The declaration is an outcome of a rigorous and competitive selection process that started in the year of 2015 with the national release of a request for Letters of Intent (LOI) from CMS. Building on the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model gives a new chance in accountable care that sets predictable financial targets, enables providers and beneficiaries greater opportunities for coordination with the target to attain the largest quality standards of care and make better health outcomes. The Model will permit the ACO greater flexibility in offering benefit enhancements and payment models involving faster access to skilled nursing facilities and other services.
"We are happy to build on the national victory of the Michigan Pioneer ACO," stated Dr. Anthony Tedeschi, chief executive officer of the Detroit Medical Center. "Our focus has always been our commitment to make better the health outcomes for our sufferers while increasing the efficiency of healthcare to provide the best possible model."
The Michigan Pioneer ACO is believed to be one of the original 32 Pioneer ACOs participating in the 5 year Model that began in the year of 2012, and is one of 9 still successfully participating. In fact, the Michigan Pioneer ACO was ranked the most successful Pioneer ACO of nation in the year of 2014 for financial benchmark savings improvements and has consistently increased its quality and efficiency every year. Since inception in the year of 2012, the Michigan Pioneer ACO has decreased Medicare spending for the health care services by $41 million, resulting in net savings to the Medicare program of $20 million.
"Shifting to the Next Generation ACO Model gives for larger collaboration between our sufferers and providers, closing the gaps in care while enhancing the quality of services," claimed Roger Wiseman, senior vice president of Population Health at the Detroit Medical Center. "We look forward to working with our almost 18,000 Medicare beneficiaries served in the Michigan Pioneer ACO to increase the benefits and further decrease charges."
The Next Generation ACO Model gives important services for all stages of healthcare involving chronic disease programs, preventative care reminders, transportation assistance following hospitalization, transitional care call follow-ups, appointment assistance and the support of the high quality specialists on staff at DMC
The declaration is an outcome of a rigorous and competitive selection process that started in the year of 2015 with the national release of a request for Letters of Intent (LOI) from CMS. Building on the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model gives a new chance in accountable care that sets predictable financial targets, enables providers and beneficiaries greater opportunities for coordination with the target to attain the largest quality standards of care and make better health outcomes. The Model will permit the ACO greater flexibility in offering benefit enhancements and payment models involving faster access to skilled nursing facilities and other services.
"We are happy to build on the national victory of the Michigan Pioneer ACO," stated Dr. Anthony Tedeschi, chief executive officer of the Detroit Medical Center. "Our focus has always been our commitment to make better the health outcomes for our sufferers while increasing the efficiency of healthcare to provide the best possible model."
The Michigan Pioneer ACO is believed to be one of the original 32 Pioneer ACOs participating in the 5 year Model that began in the year of 2012, and is one of 9 still successfully participating. In fact, the Michigan Pioneer ACO was ranked the most successful Pioneer ACO of nation in the year of 2014 for financial benchmark savings improvements and has consistently increased its quality and efficiency every year. Since inception in the year of 2012, the Michigan Pioneer ACO has decreased Medicare spending for the health care services by $41 million, resulting in net savings to the Medicare program of $20 million.
"Shifting to the Next Generation ACO Model gives for larger collaboration between our sufferers and providers, closing the gaps in care while enhancing the quality of services," claimed Roger Wiseman, senior vice president of Population Health at the Detroit Medical Center. "We look forward to working with our almost 18,000 Medicare beneficiaries served in the Michigan Pioneer ACO to increase the benefits and further decrease charges."
The Next Generation ACO Model gives important services for all stages of healthcare involving chronic disease programs, preventative care reminders, transportation assistance following hospitalization, transitional care call follow-ups, appointment assistance and the support of the high quality specialists on staff at DMC
Tuesday, January 24, 2017
Texas ACO Produces $14M in Savings, Acquires Perfect Quality Score
Rio Grande Valley Health Alliance, LLC (RGVHA), a Texas ACO (accountable care organization) based in the region of McAllen, Texas, is acquiring important cost savings and quality improvements spearheaded by area primary care physicians who’ve joined hands with population health technology provider Lightbeam Health Solutions.
The Texas ACO contains 18 primary care physician practices working with the Centers for Medicare & Medicaid Services (CMS) to give coordinated care to Medicare sufferers in the Rio Grande Valley of South Texas. Since it started operating as an ACO in the year of 2013, RGVHA has saved more than $28 million – almost $14 million in the year of 2015 alone – by better stratifying and serving its population with tools from Lightbeam.
“Lightbeam’s value to our ACO goes beyond population health software because we benefit merely as much from Lightbeam’s information and best practices for orchestrating proactive and efficient work by physicians and care management teams. Lightbeam assists us stay a step ahead of our populations’ health requirements, which lets us deliver both quality and cost savings that we are very proud of,” stated Victoria Farias, assistant administrator at Rio Grande Valley Health Alliance, LLC. “We sustain collaborating with Lightbeam to recognize and deal new ways of cost-effectively providing high-quality care, especially for those patients with the most acute and chronic conditions.”
In the latest ACO Financial Report from CMS profiling results from the 2015 Medicare Shared Savings Program (MSSP), RGVHA was also one of mere four ACOs in the nationwide program to acquire a perfect 100% quality score. These outcomes were because of the ACO working with a scorecard system based on Lightbeam quality measures that also targeted non-compliant patients so care teams could more proactively handle those individuals’ care.
“We are proud to join hands with Rio Grande Valley Health Alliance to find ways to decrease healthcare charges while identifying sufferers whose lives can be improved simply through heightened healthcare education and more proactive care coordination,” claimed Pat Cline, CEO of Lightbeam. “The Lightbeam platform assists ACOs such as Rio Grande risk-stratify their populations to a granular level and our tools deliver that reliable information to care teams that use it to move more rapidly and decisively to close care gaps, increase patient engagement and decrease cost. We consider that Rio Grande is an outstanding blueprint for other ACOs looking to deliver similar savings and quality scores.”
Key points of the victory of RGVHA Texas ACO involve:
A significant next step for the ACO is deploying the Lightbeam Cohort Builder to assist RGVHA further identify high-risk sufferers who can enroll in several evidence-based care programs to make better patient outcomes and lower costs. Cohort analysis assists ACOs and providers by offering clear guidance and prioritizing where care management and other attempts should be focused.
The Texas ACO contains 18 primary care physician practices working with the Centers for Medicare & Medicaid Services (CMS) to give coordinated care to Medicare sufferers in the Rio Grande Valley of South Texas. Since it started operating as an ACO in the year of 2013, RGVHA has saved more than $28 million – almost $14 million in the year of 2015 alone – by better stratifying and serving its population with tools from Lightbeam.
“Lightbeam’s value to our ACO goes beyond population health software because we benefit merely as much from Lightbeam’s information and best practices for orchestrating proactive and efficient work by physicians and care management teams. Lightbeam assists us stay a step ahead of our populations’ health requirements, which lets us deliver both quality and cost savings that we are very proud of,” stated Victoria Farias, assistant administrator at Rio Grande Valley Health Alliance, LLC. “We sustain collaborating with Lightbeam to recognize and deal new ways of cost-effectively providing high-quality care, especially for those patients with the most acute and chronic conditions.”
In the latest ACO Financial Report from CMS profiling results from the 2015 Medicare Shared Savings Program (MSSP), RGVHA was also one of mere four ACOs in the nationwide program to acquire a perfect 100% quality score. These outcomes were because of the ACO working with a scorecard system based on Lightbeam quality measures that also targeted non-compliant patients so care teams could more proactively handle those individuals’ care.
“We are proud to join hands with Rio Grande Valley Health Alliance to find ways to decrease healthcare charges while identifying sufferers whose lives can be improved simply through heightened healthcare education and more proactive care coordination,” claimed Pat Cline, CEO of Lightbeam. “The Lightbeam platform assists ACOs such as Rio Grande risk-stratify their populations to a granular level and our tools deliver that reliable information to care teams that use it to move more rapidly and decisively to close care gaps, increase patient engagement and decrease cost. We consider that Rio Grande is an outstanding blueprint for other ACOs looking to deliver similar savings and quality scores.”
Key points of the victory of RGVHA Texas ACO involve:
- Reducing home health spending by 41%
- Viewing sufferers’ underlying data, comparing it to CMS home health criteria, and recognizing patients who qualify for alternative avenues of care
- Decreasing emergency room visits and associated hospitalizations by 10%
- Improving care coordination across the health system and connecting area providers to better handle several patient populations
A significant next step for the ACO is deploying the Lightbeam Cohort Builder to assist RGVHA further identify high-risk sufferers who can enroll in several evidence-based care programs to make better patient outcomes and lower costs. Cohort analysis assists ACOs and providers by offering clear guidance and prioritizing where care management and other attempts should be focused.
Monday, January 2, 2017
CHIME Calls for Modifications to the standards of Meaningful Use Requirements
Providers express interest in reducing stressful and restrictive regulatory Meaningful Use requirements.
In the reaction to allegedly overzealous requirements for Medicare meaningful use, Medicaid meaningful use, and meaningful use measures under MIPS, the College of Healthcare Information Management Executives (CHIME) has released comments advocating for increased flexibility in meaningful use requirements.
The current meaningful use requirements or standards reportedly hinder optimization of information technology systems to make better patient care.
In its suggestions, CHIME called for a 90-day reporting period in the years of 2016 and 2017 for meaningful use requirements providers rather than the previously mandated full-year period as well as fewer requirements and lower thresholds for Medicare hospitals.
A ninety-day reporting period will enable providers to familiarize themselves with latest electronic health record (EHR) installations and technology.
Less stringent regulatory requirements will also enable providers to develop new technologies more freely and efficiently.
In the comments, CHIME emphasized “the complexity of overall reporting requirements Medicare providers and clinicians must meet is degrading their capability to optimize use of technology and has put them in a continual state of churn directed at meeting government requirements.”
A policy claiming a complete year of electronic clinical quality reporting (eCQMs) beginning in 2017 was a requirement CHIME deemed unsupportable, along with misaligned reporting periods for several programs that change in different years.
CHIME also took issue with the 3 sets of requirements CMS recognized as mandatory and suggested a single set of requirements to expedite efficient data exchange and aide private sector initiatives targeted at improving patient identification at a national level.
In accordance to the letter, Medicaid providers are hoped to meet Modified Stage 2 Requirements/Meaningful Use Stage 3, the changes executed in the Hospital Outpatient Prospective Payment System (OPPS) final rule, and the ACI performance category of MIPS modeled after meaningful use.
CHIME claimed these 3 distinct sets of requirements could be consolidated into one streamlined set, stating “we suggest CMS (Centers for Medicare & Medicaid Services) decrease the variability among the reporting programs and better synchronize the reporting requirements” as the present regulations might overwhelm providers.
In terms of reporting periods, CHIME asserts “reporting periods will be out of sync for Meaningful Use providers and MIPS clinicians” provided that meaningful use providers have a 90-day reporting period for the years of 2016 and 2017 while MIPS has a 90-day reporting period for 2017 and 2018, confusing several providers.
In light of recent complaints, CHIME recommended that CMS synchronize the reporting periods and change the 90-day reporting period from a 2-year stipulation to a permanent one.
Vendor readiness has also been flagged as problematic after members demonstrated they don’t anticipate getting their Version 2015 Certified EHR technology (CEHRT) before the year of 2018.
This delay could impact other CMS programs and put certain smaller providers at threat of missing a whole reporting year. Since CMS has made CEHRT compulsory for several programs, involving the Comprehensive Primary Care Plus (CPC+), CHIME suggested assessing whether vendors will have the capability to deliver essential products to providers in time to meet Stage 3 requirements in 2017 or 2018.
“CHIME again emphasizes CMS postpone requiring the use of Stage 3 / Stage 3-like measures until no earlier than the year of 2019,” the letter read, noting the disparate timelines.
CHIME also sees problems regarding interoperability in the coming years, maintaining they have “continuously advocated for the requirement for making better the state of interoperability.”
Stage 3 requirements in 2017 operate under a higher grade of interoperability than presently available.
CHIME also recommended a way to meet regulatory requirements and also improve interoperability.
“We suggest CMS work with ONC to make sure that a single set of standards are adopted to facilitate more seamless data exchange and provide support to private sector initiatives concentrated on improving patient identification at a national level.”
In the reaction to allegedly overzealous requirements for Medicare meaningful use, Medicaid meaningful use, and meaningful use measures under MIPS, the College of Healthcare Information Management Executives (CHIME) has released comments advocating for increased flexibility in meaningful use requirements.
The current meaningful use requirements or standards reportedly hinder optimization of information technology systems to make better patient care.
In its suggestions, CHIME called for a 90-day reporting period in the years of 2016 and 2017 for meaningful use requirements providers rather than the previously mandated full-year period as well as fewer requirements and lower thresholds for Medicare hospitals.
A ninety-day reporting period will enable providers to familiarize themselves with latest electronic health record (EHR) installations and technology.
Less stringent regulatory requirements will also enable providers to develop new technologies more freely and efficiently.
In the comments, CHIME emphasized “the complexity of overall reporting requirements Medicare providers and clinicians must meet is degrading their capability to optimize use of technology and has put them in a continual state of churn directed at meeting government requirements.”
A policy claiming a complete year of electronic clinical quality reporting (eCQMs) beginning in 2017 was a requirement CHIME deemed unsupportable, along with misaligned reporting periods for several programs that change in different years.
CHIME also took issue with the 3 sets of requirements CMS recognized as mandatory and suggested a single set of requirements to expedite efficient data exchange and aide private sector initiatives targeted at improving patient identification at a national level.
In accordance to the letter, Medicaid providers are hoped to meet Modified Stage 2 Requirements/Meaningful Use Stage 3, the changes executed in the Hospital Outpatient Prospective Payment System (OPPS) final rule, and the ACI performance category of MIPS modeled after meaningful use.
CHIME claimed these 3 distinct sets of requirements could be consolidated into one streamlined set, stating “we suggest CMS (Centers for Medicare & Medicaid Services) decrease the variability among the reporting programs and better synchronize the reporting requirements” as the present regulations might overwhelm providers.
In terms of reporting periods, CHIME asserts “reporting periods will be out of sync for Meaningful Use providers and MIPS clinicians” provided that meaningful use providers have a 90-day reporting period for the years of 2016 and 2017 while MIPS has a 90-day reporting period for 2017 and 2018, confusing several providers.
In light of recent complaints, CHIME recommended that CMS synchronize the reporting periods and change the 90-day reporting period from a 2-year stipulation to a permanent one.
Vendor readiness has also been flagged as problematic after members demonstrated they don’t anticipate getting their Version 2015 Certified EHR technology (CEHRT) before the year of 2018.
This delay could impact other CMS programs and put certain smaller providers at threat of missing a whole reporting year. Since CMS has made CEHRT compulsory for several programs, involving the Comprehensive Primary Care Plus (CPC+), CHIME suggested assessing whether vendors will have the capability to deliver essential products to providers in time to meet Stage 3 requirements in 2017 or 2018.
“CHIME again emphasizes CMS postpone requiring the use of Stage 3 / Stage 3-like measures until no earlier than the year of 2019,” the letter read, noting the disparate timelines.
CHIME also sees problems regarding interoperability in the coming years, maintaining they have “continuously advocated for the requirement for making better the state of interoperability.”
Stage 3 requirements in 2017 operate under a higher grade of interoperability than presently available.
CHIME also recommended a way to meet regulatory requirements and also improve interoperability.
“We suggest CMS work with ONC to make sure that a single set of standards are adopted to facilitate more seamless data exchange and provide support to private sector initiatives concentrated on improving patient identification at a national level.”
Sunday, December 25, 2016
Next Year: Meaningful Use Penalty to struck 171,000 Clinicians
171,000 physicians, nurse practitioners, and other clinicians will take a 3 percent pay cut next year from Medicare for failing to indicate that they met the requirements of government for meaningful use of an electronic health record (EHR) system in the year of 2015, the Centers for Medicare & Medicaid Services (CMS) has declared. Meaningful Use Penalty will hit 171,000 clinicians next year.
A government liaison for a huge medical association blames Centers for Medicare and Medicaid Services (CMS) for setting up clinicians to fail in the controversial EHR incentive program. Although, there is hope that the incoming administration of President-elect Donald Trump may undo the damage.
The snafu, stated Robert Tennant, director of HIT policy for the Medical Group Management Association (MGMA), goes back to the day of October 6, 2015, when CMS released its final Stage 2 rules for acquiring meaningful use that year and ignoring a meaningful use penalty in 2017. The organization said clinicians needed to meet the requirements only during a ninety-day stretch of 2015 year. Although, there were fewer than ninety days left in the year of 2015 by October 6.
Fearful of widespread penalties, Congress approved a bill in the year of December 2015 that permitted CMS to depart from its usual policy of granting meaningful use hardship exemptions on a case-by-case basis and grant 1 for a whole category of physicians who were beset by “extreme and uncontrollable circumstances”.
Several physicians apparently did not take advantage of this escape hatch, provided the multitude confronting a meaningful use penalty next year, MGMA's Robert Tennant claimed.
Inquired if CMS was responsible for several physicians flunking meaningful use in the year of 2015 by releasing its final regulations so late that year, Tennant replied, "Absolutely." CMS didn’t respond to a request for a comment on the matter as of 5 PM CST today.
After Trump takes office next month, MGMA might inquire the US Department of Health & Human Services (HHS) to waive the penalty, Tennant stated. "It’ll be a tough sell," he claimed. "My guess is, the Trump administration will have greatest fish to fry in healthcare."
The choice of Trump to head HHS is Rep. Tom Price, MD (R-GA), a fierce critic of government regulation in healthcare. "We might have a more sympathetic ear should Dr Price be confirmed as HHS secretary," Tennant claimed.
One flaw to a waiver of the next year's meaningful use penalty, he pointed out, would be the requirement to reprocess potentially millions of Medicare claims paid for services rendered beginning on the day of January 1 at the reduced rate.
The number of clinicians confronting a meaningful use pay cut in the year of 2017 is down from 209,000 penalized in the year of 2016, and 256,000 in 2015. The previous year for a penalty — and the EHR meaningful use program itself — is 2018. Although, elements of meaningful use will live on in the latest reimbursement system developed by the Medicare Access and CHIP Reauthorization Act (MACRA).
A government liaison for a huge medical association blames Centers for Medicare and Medicaid Services (CMS) for setting up clinicians to fail in the controversial EHR incentive program. Although, there is hope that the incoming administration of President-elect Donald Trump may undo the damage.
The snafu, stated Robert Tennant, director of HIT policy for the Medical Group Management Association (MGMA), goes back to the day of October 6, 2015, when CMS released its final Stage 2 rules for acquiring meaningful use that year and ignoring a meaningful use penalty in 2017. The organization said clinicians needed to meet the requirements only during a ninety-day stretch of 2015 year. Although, there were fewer than ninety days left in the year of 2015 by October 6.
Fearful of widespread penalties, Congress approved a bill in the year of December 2015 that permitted CMS to depart from its usual policy of granting meaningful use hardship exemptions on a case-by-case basis and grant 1 for a whole category of physicians who were beset by “extreme and uncontrollable circumstances”.
Several physicians apparently did not take advantage of this escape hatch, provided the multitude confronting a meaningful use penalty next year, MGMA's Robert Tennant claimed.
Inquired if CMS was responsible for several physicians flunking meaningful use in the year of 2015 by releasing its final regulations so late that year, Tennant replied, "Absolutely." CMS didn’t respond to a request for a comment on the matter as of 5 PM CST today.
After Trump takes office next month, MGMA might inquire the US Department of Health & Human Services (HHS) to waive the penalty, Tennant stated. "It’ll be a tough sell," he claimed. "My guess is, the Trump administration will have greatest fish to fry in healthcare."
The choice of Trump to head HHS is Rep. Tom Price, MD (R-GA), a fierce critic of government regulation in healthcare. "We might have a more sympathetic ear should Dr Price be confirmed as HHS secretary," Tennant claimed.
One flaw to a waiver of the next year's meaningful use penalty, he pointed out, would be the requirement to reprocess potentially millions of Medicare claims paid for services rendered beginning on the day of January 1 at the reduced rate.
The number of clinicians confronting a meaningful use pay cut in the year of 2017 is down from 209,000 penalized in the year of 2016, and 256,000 in 2015. The previous year for a penalty — and the EHR meaningful use program itself — is 2018. Although, elements of meaningful use will live on in the latest reimbursement system developed by the Medicare Access and CHIP Reauthorization Act (MACRA).
Sunday, December 18, 2016
CMS Analyzes Meaningful Use Reporting Requirements of 2016
Those attesting to meaningful use in the year of 2016 should take note of modifications in secure direct messaging and public health reporting requirements. CMS is reminding the eligible providers over the 2016 meaningful use reporting requirements for the EHR Incentive Programs, involving added flexibilities. CMS has reviewed the Meaningful Use Reporting Requirements of 2016
In a public statement, the organization analyzed the modifications and changes for secure electronic messaging reporting requirements. For this reporting period, eligible professionals (EPs) must send or receive a secure electronic message from nearly 1 unique patient utilizing the certified EHR technology (CEHRT).
CMS has also made certain changes to public health reporting requirements, easing the requirements under this measure. In the 2016 reporting period, eligible professionals must attest to two measures, while eligible hospitals and critical access hospitals must attest to 3 measures. They might also claim alternative exclusions.
In accordance to CMS, it has executed these flexibilities over time to help providers who are scheduled to be in an earlier stage of the programs, impacted by a significant hardship, or executing or upgrading their CEHRT.
Attestation for the 2016 reporting period starts on the day of January 1, 2017, and lasts until the day of February 28, 2017.
Thursday, November 10, 2016
CMS Announces $66.1 million Funds for Zika prevention and treatment
The Centers for Medicare and Medicaid Services (CMS) on the day of Wednesday declared $66.1 million funds for Zika prevention and treatment to combat Zika virus.
Puerto Rico will get $60.6 million due to its high incidence of regional Zika cases, CMS stated.
Other regions that are eligible for the funds involve American Samoa, Florida and the U.S. Virgin Islands. They are eligible because they have active or regional Zika virus transmissions that have been assured by the Centers for Disease Control and Prevention.
Health departments eligible to apply for funding involve territories, states, tribes or tribal agencies.
Applicants must indicate that their capability to rapidly and efficiently expand existing Zika response attempts and further determine the most effective use and dissemination of funds in their respective jurisdictions.
The money is to support Zika prevention and treatment services for health conditions regarded to the Zika virus, CMS claimed.
Funds will be available for healthcare services regarded to the family planning, screening, diagnostic testing, and counseling, medical care, case management and treatment, and making better provider capacity and capability.
Funds to Puerto Rico will go to resources to assist stop transmission of the virus and to give diagnostic, screening and treatment for pregnant ladies, newborns and others, CMS stated.
Congress approved the funds in the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and the Zika Response and Preparedness Act.
Zika virus is spread by the bite of an infected mosquito. The virus can be passed from a pregnant lady to her fetus, causing extreme birth defects.
"This proposed funding will increase attempts to give access to important healthcare services for people, in specific pregnant women and kids, living in areas with local active Zika transmission," stated Vikki Wachino, deputy administrator, CMS. "Giving instant help to regions impacted by Zika is critical. Powerful coordination by health departments is important to deal the Zika prevention and treatment needs of people at threat from Zika."
Wednesday, November 2, 2016
CMS rule Finalizes Changes in meaningful use reporting
CMS will just need doctors and hospitals to track meaningful use reporting data for ninety continuous days this year and next under a policy finalized on the day of Tuesday. For 2 years, at least, the move will settle the debate over the hotly contested need. Hospital and doctor groups — along with sympathetic members of the Congress — had made a complain that a year-long reporting period was too complicated and would compel providers to abandon the meaningful use program, putting it at danger. The American Hospital Association claimed that it was “glad” and “motivated” by the rule of Tuesday.
More meaningful use reporting changes in the rule:
— Removal of clinical decision support and computerized provider entry measures in the year of 2017 and subsequent years for hospitals.
— Establishment of a 1-time hardship exemption from 2018 penalties for doctors who are new to the program in the year of 2017 and transitioning to new Merit-Based Incentive Payment System of MACRA.
— CMS will sustain to work on incorporating electronic clinical quality measures into quality reporting program of Medicare for hospitals, despite commenters who stated that this would duplicate meaningful use reporting.
Modifications in requirements to Stage 3, which is optional in the year of 2017 and required in the year of 2018:
— Decreasing the percentage of sufferers whom hospitals must securely message from 25% to 5%.
— Dropping to a single patient the number of patients who must view, download and transmit their records.
— Dropping from 40% to 10% the number of electronic patient records that hospitals must get, and the summary of care documents they must incorporate.
The changes do not apply to hospitals merely attesting to Medicaid meaningful use.
The AHA was dissatisfied CMS kept a 2018 start for Stage 3, stated Ashley Thompson, the group’s senior vice president of public policy. Also, the need that hospitals make application program interfaces — APIs — available to third-party app developers is “concerning” provided the security threats and the absence of standards, she claimed.
For Further information, please visit these links mentioned below:
Find the final rule here. CMS’s release here. The AHA’s full statement here.
Monday, October 10, 2016
Reviewing Meaningful Use to Accelerate Success?
A research team recommends policymakers for reviewing meaningful use or transition from Stage 1 Meaningful Use to Stage 2 that facilitate a successful transition to MIPS.
To make sure the consistent clinical quality when transitioning from Stage 2 Meaningful Use to Advancing Care Information under MIPS, policymakers should consider reviewing meaningful use and the initial transition from Stage 1 to Stage 2 Meaningful use.
In a latest study published in the Journal of the American Medical Informatics Association, researchers did merely that — assessing and reviewing the consistency of clinical quality as healthcare agencies progressed through the first 2 phases of meaningful use.
The research team evaluated a longitudinal research at hospitals affiliated with Brigham and Women’s Hospital between the month of September and November 2012 and October and December 2014. These were the timeframes during which the network attested to Stage 1 and Stage 2 Meaningful Use, respectively.
During these time periods, the researchers looked at the 7 clinical quality measures that sustained consistent between the 2 stages of the program: influenza immunization, hypertension control, and counseling, tobacco use assessment, diabetes control, senior weight screening follow-up, Chlamydia screening, and adult weight screening and follow-up.
From one program stage to the next, the researchers observed betterment in hypertension control (35 to 40%), influenza immunization (63 to 68%), tobacco use assessment and counseling (86 to 96%), and diabetes control (93 to 96%).
Senior weight screening worsened from 54% in Stage 1 Meaningful Use to 49% in Stage 2 Meaningful Use. Adult weight and Chlamydia screening sustained to be consistent.
“While our research doesn’t make a causal link between the transition to MU2 and quality, it recommends that few of the elements, like electronic reporting of clinical quality measures at stricter thresholds, secure messaging, and information exchange, might have a positive impact on quality,” the researchers concluded.
While the Advancing Care Information performance category does involve several differences from meaningful use, it yet consists some of the same elements. This might be depicted in reviewing meaningful use and transition from Stage 1 to Stage 2 Meaningful Use.
“Several elements of MU2 are preserved in the proposed rule, like mandated reporting of institution-selected quality measures at stricter thresholds, secure messaging, and information exchange,” the researchers elaborated. “Hence, the affect of reviewing meaningful use and transitioning from MU1 to MU2 has significant implications for the latest policy, specifically for agencies that will be transitioning directly from MU1 to the latest program.”
Given these outcomes, the researchers recommend the following steps for the development and progress of MACRA implementation.
First, CMS should make sure that the MACRA measures are rooted in evidence that shows they will make better the outcomes. For instance, the CMS proposal to remove clinical decision support might not be effective because there is little evidence to recommend that clinical decision support limits care quality. In accordance to the researchers, most evidence proves that clinical decision support really improves quality.
However, scant evidence supports the efficiency of secure direct messaging between patient and provider. The researchers recommend CMS look at measures to make sure that they are not inquiring eligible clinicians to report measures that aren’t proven to empower care quality. Rather, CMS should conduct research to evaluate how effective this measure is.
Second, the researchers recommend CMS continue setting a high bar for providers. The heightened expectations providers were subject to in Stage 2 Meaningful Use compared to Stage 1 might have been a driving factor behind the increased care quality. Should providers be held to a lower or more stagnant standard, they may not continuously improve quality.
Third, CMS should review how providers utilize certified EHR technology for clinical quality measures reporting.
Fourth, CMS should make certain that providers can track their Advancing Care Information progress through their own EHRs. In accordance to the researchers, several providers were capable to do this during either stage of meaningful use and found it useful for their successful program attestation. Such abilities could likewise be beneficial under MACRA.
Monday, October 3, 2016
Small contributors Might struggle as ICD-10 grace period ends up
With the Saturday enabling the 1-year anniversary of the execution of ICD-10 codes, healthcare agencies must now concentrate on some latest needs that went into effect on the day of October 1. Small contributors might struggle as ICD-10 grace period ends up.
While the transformation from ICD-9 version codes universally is believed to be an unqualified victory, the ICD-10 grace period has finished, and the Centers for Medicare and Medicaid Services (CMS) no longer will be embracing unspecified codes on Medicare fee-for-service claims. The year of coding flexibilities that CMS agreed to previous year in he collaboration with the American Medical Association (AMA) has expired and won’t be expanded.
Although, as the agency noticed in guidance released in the month of August, the end of the ICD-10 grace period should not be a huge deal for contributors, as several commercial health insurers didn’t provide contributors any coding flexibility, needing them to use particular ICD-10 codes. Besides, CMS claimed, healthcare agencies “should already be coding to the largest level of specificity” and “should code claims to the degree of specificity reinforced by the encounter and the medical documentation.”
Moreover, Sue Bowman, senior director of coding policy and agreement at the American Health Information Management Association (AHIMA), asserts that the grace period merely implemented to Medicare fee-for-service claims from physician or other practitioner claims billed under the Medicare Fee-for-Service Part B physician fee schedule.
The grace period “didn’t apply to hospitals, so it does not impact anything hospitals are doing going forward on the day of October 1, and even from the physician standpoint it was restricted in its affect because it merely applied to post-payment reviews,” claims Bowman, who adds that “most persons have been having to do the largest degree of code specificity over the last year anyhow, regardless of the flexibility.”
Beginning on the day of October 1, CMS review contractors will “utilize coding specificity as the reason for an audit for a refusal of a reviewed claim” and they will “notify contributors of coding problems they identify during review and of steps required to correct those problems,” the agency claims.
On the other hand, Debi Primeau, president of revenue cycle consultancy Primeau Consulting Group, considers that the end of the ICD-10 grace period is “not a huge deal for acute-care hospitals, which have implemented retrospective and/or concurrent audits,” but it “might be a bid matter for smaller physician groups and individual practices.”
Primeau compels that physician groups and practices “haven’t actually been aggressively auditing to recognize either their physicians are utilizing unspecified codes.” She also mentions the fact that several practices don’t have coding experts but are rather utilizing drop-down boxes in their EHR systems to select codes.
“If they’re in hurry and do not actually understand codes, these practices might be choosing unspecified codes, and because several of these agencies haven’t yet performed coding audits, they really do not know if there is an issue or not,” adds Primeau, who largely suggests coding and documentation audits. “What we are discussing about is recognizing opportunities where you can concentrate on denial prevention versus denial management.”
Overall, Bowman claims she does not hope adverse consequences as an outcome of the end of the ICD-10 grace period. Nevertheless, Mary Beth Haugen, CEO of Haugen Consulting Group, is not as optimistic.
Primeau’s worry going forward is health insurers—not merely Medicare but commercial payers, who might start to adjust medical policies deployed on the latest specificity provided by ICD-10. “They have been gathering data for a year, and now is their chance to go back and recognize where some of these unspecified codes have been utilized and to begin denying claims,” she adds. “There are many commercial payers out there, and they have been data mining. They have seen bills that have been submitted for the previous year, know what is going on, and who is and isn’t submitting unspecified codes.”
For its part, AHIMA is motivating healthcare agencies to sustain to monitor their documentation and work to make better it when essential, Bowman claims.
Furthermore, she points out that CMS has lifted the partial code freeze, and as an outcome, thousands of latest ICD-10 diagnosis and procedure codes have been added for fiscal year 2017, which start on the day of October 1.
CMS claims in its guidance that the yearly update to codes is not a new procedure, as “codes were daily updated on an annual basis until a freeze was developed to help providers and health policies to prepare for ICD-10.”
Thursday, September 29, 2016
Learn More about Public Health Reporting in 2016
Review the Public Health Reporting Requirements for Providers in 2016
National Health IT Week is September 26-30, 2016. CMS is sharing guidance throughout the week to help providers and industry members participate successfully in ongoing CMS health IT initiatives. Stay tuned all week for the latest news and updates from CMS.
To participate successfully in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in 2016, providers must be in active engagement with a public health agency. Eligible professionals (EPs) and eligible hospitals and critical access hospitals (CAHs) must submit electronic public health data using certified EHR technology (CEHRT), except where prohibited and in accordance with applicable law and practice.
2016 Public Health Reporting Requirements
The public health reporting objective for 2016 includes three measures for EPs, and four measures for eligible hospitals and CAHs. EPs must attest to any combination of two measures, and eligible hospitals and CAHs must attest to any combination of three measures.
- Measure 1: Immunization Registry Reporting
- Measure 2: Syndromic Surveillance Reporting
- Measure 3: Specialized Registry Reporting
- Measure 4: Electronic Reportable Laboratory (ELR) Results Reporting (eligible hospitals and CAHs only)
Please note: providers may report to more than one specialized registry and may count specialized registry reporting more than once to meet the required number of measures for the objective.
Exclusions and Alternate Exclusions in 2016
There are multiple exclusions for each of the public health reporting measures in 2016. For a complete list, see the Public Health Reporting specification sheets for EPs and eligible hospitals and CAHs.
Providers may claim an alternate exclusion for the Public Health Reporting measure(s) that might require the acquisition of additional technologies they did not previously have or did not intend to include in their activities for meaningful use.
Providers may claim an alternate exclusion for:
- Measure 2 - Syndromic Surveillance Reporting (EPs)
- Measure 3 - Specialized Registry Reporting (EPs and eligible hospitals and CAHs)
Centralized Repository
CMS is developing a centralized repository for public health agency and clinical data registry reporting to assist providers in finding entities that accept electronic public health data. Registries can now declare their readiness to receive electronic data by completing the Centralized Repository for Public Health Agencies and Clinical Data Registry Reporting Input Form.
Wednesday, September 28, 2016
Review 2016 CQM Requirements for Eligible Professionals and Hospitals
National Health IT Week is September 26-30, 2016. CMS is sharing guidance throughout the week to help providers and industry members participate successfully in ongoing CMS health IT initiatives. Stay tuned all week for the latest news and updates from CMS.
To participate successfully in the Medicare & Medicaid EHR Incentive Programs, eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must submit clinical quality measures (CQMs).
2016 CQM Requirements for Eligible Professionals (EPs)
EPs must report 9 out of a possible 64 measures. At least 3 of those must cover the National Quality Strategy domains, which include:
- Patient and Family Engagement
- Patient Safety
- Care Coordination
- Population/Public Health
- Efficient Use of Healthcare Resources
- Clinical Process/Effectiveness
EPs have several options for reporting their CQMs:
- Medicare EHR Incentive Program Reporting Options:
- Option 1: Attest to CQMs through the EHR Registration & Attestation System
- Option 2: eReport to CQMs through the Physician Quality Reporting System (PQRS) Portal
- Options that align with Other Quality Programs:
- Option 3: Report individual CQMs through the PQRS Portal
- Option 4: Report group CQMs through the PQRS Portal
- Option 5: Report group CQMs through Pioneer ACO participation or Comprehensive Primary Care Initiative participation
- Medicaid EHR Incentive Program Reporting Options:
- Option 6: Attest to CQMs through their State Medicaid Portal
2016 CQM Requirements for Dually Eligible Hospitals and Critical Access Hospitals (CAHs)
Dually Eligible hospitals and CAHs participating in the EHR Incentive Programs have two options for reporting CQMs:
- Option 1: Attest to 16 of 29 possible CQMs through the EHR Registration & Attestation System
- Option 2: eReport 4 CQMs through Hospital Inpatient Quality Reporting (IQR) through QualityNet Secure Portal
Note: The CQM reporting options for EPs and hospitals in 2016 are the same as the options that were available in 2015. Medicaid-only hospitals report their CQMs via their state's portal.
Friday, September 9, 2016
CMS to provide providers MACRA flexibility in the year of 2017
The Centers for Medicare and Medicaid Services (CSM) on the day of Thursday declared that it will provide providers various options to comply with the latest quality payment program being enforced under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA flexibility in the year of 2017) .
In a day of September 8 blog, CMS Acting Administrator Andy Slavitt claimed that physicians could “select their pace of participation” for the 1st performance period of the quality payment program that starts on the day of January 1.
“During the year of 2017, eligible physicians and other clinicians will have several options for participation,” wrote Slavitt. “Selecting one of these choices would make sure that you don’t get a negative payment adjustment in the year of 2019. These options and other supporting details will be explained completely in the final rule,” which he said is expected by the day of November 1.
In accordance to Slavitt, these are the 4 options available to providers MACRA flexibility in the year of 2017:
Option 1: Test the quality payment program. With this choice, as long as contributors submit some data to the quality payment program, involving data from after the day of January 1, 2017, they will ignore a negative payment adjustment. This 1st option is made to make certain that provider systems are working and that they are prepared for broader participation in the years of 2018 and 2019.
Option 2: Participate for part of the calendar year. Contributors might select to submit quality payment program information for a decreased number of days. This means their first performance period could start later than the day of Jan. 1, 2017, and their practice could yet qualify for a minor positive payment adjustment. For instance, if they submit data for part of the calendar year for quality measures, how their practice utilizes technology and what improvement activities their practice is undertaking, they could qualify for a minor positive payment adjustment. Contributors could select from the list of quality measures and improvement activities present under the quality payment program.
Option 3: Participate for the full calendar year. Practices that are ready to go on the day of Jan. 1, 2017, might choose to submit quality payment program data for a full calendar year. This means their 1st performance period would start on the day of Jan. 1, 2017. For instance, if they submit information for the whole year on quality measures, how their practice utilizes technology and what improvement activities their practice is undertaking, they could qualify for a modest positive payment adjustment.
Option 4: Participate in an advanced alternative payment model in the year of 2017.Rather of reporting quality information and other data, the law permits providers to participate in the quality payment program by merging an advanced alternative payment model, like Medicare Shared Savings Track 2 or 3 in 2017. If providers get enough of their Medicare payments or see enough of their Medicare sufferers through the advanced alternative payment model in the year of 2017, then they would qualify for a 5% incentive payment in 2019.
“Although you choose to participate in the year of MACRA flexibility in the year of 2017, we’ll have resources present to help you and walk you through what requires to be done,” Slavitt wrote. “And although you select to participate, your feedback will be invaluable to building this program for the long term to achieve results that matter to your sufferers.”
Responses to the CMS declaration from industry groups and lawmakers were very positive. The American Medical Association applauded the agency’s flexibility.
“By accepting this thoughtful and MACRA flexibility in the year of 2017, the Administration is motivating a victorious transition to the new law by offering physicians options for participating in MACRA,” stated AMA President Andrew Gurman, MD, in a written statement. “This approach better depicts the diversity of medical practices throughout the country.”
Gurman further added that the flexibility “will help give physicians a fair shot in the 1st year of MACRA implementation.”
Similarly, the American Hospital Association claimed that it approved of the CMS actions.
“We are glad that CMS has reacted to feedback inquiring for greater flexibility in meeting MACRA’s aggressive timeline and reporting needs,” stated Ashley Thompson, AHA senior vice president for public policy analysis and development. “We look forward to considering the details of these choices when CMS releases a final rule.”
Rep. Michael Burgess, MD (R-Texas), chairman of the House Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade, claimed that he was glad to hear that CMS was going to be flexible in transitioning to the latest payment reporting needs.
Burgess stated the “declaration from CMS regarding the agency’s dedication in the implementation of MACRA flexibility in the year of 2017 is proof of the benefits of keeping Congress engaged in policy implementation,” adding that “just as this policy was carefully crafted with the input of everyone impacted by the payment policies, the implementation procedure should be conducted in the similar way.”
He stated that he is “committed to leading the charge for continued congressional oversight of MACRA implementation to make sure the simplified, streamlined requirements that permit for entire doctors to succeed.”
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