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From Health Law Daily, October 16, 2015

CMS sets Stage 3 EHR incentive program date for January 2018

By Bryant Storm, J.D.

CMS issued a Final rule which specifies the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must satisfy in order to qualify for electronic health record (EHR) incentive payments and avoid payment penalties under Stage 3, the final stage, of the Medicare EHR Incentive Program. The Final rule establishes that Stage 3 of the program will be optional in 2017 and required for all participants beginning in 2018. The Final rule also changes the program’s 2015 reporting period to a 90-day reporting period that aligns with the calendar year (CY) and removes duplicative and unnecessary measures from the EHR incentive program (Final rule, 80 FR 62762, October 16, 2015).

Proposed rules. The Final rule finalizes the proposals made in two separate Proposed rules, the Medicare and Medicaid Programs; Electronic Health Record Incentive Program Stage 3 Proposed rule (80 FR 16731) (see Stage 3 of Electronic Health Record Incentive Program proposed, March 30, 2015) and the Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Modifications to Meaningful Use in 2015 through 2017 Proposed rule (80 FR 20346) (see CMS proposes 90-day EHR reporting period for 2015, April 15, 2015). CMS finalized its positions on those proposed rules after receiving and reviewing 2500 comments.

Timeline. The Final rule establishes the requirements for the EHR incentive program for 2015 through 2017, 2018, and subsequent years. The provisions of the Final rule are designed “to continue improving program efficiency, effectiveness, and flexibility by making changes to the Medicare and Medicaid EHR Incentive Programs that simplify reporting requirements and reduce program complexity.” The final rule adopts more flexible reporting periods that are intended to line up better with other programs to reduce burdens on providers. The changes include moving from fiscal year to calendar year reporting for all providers in 2015 and allowing a 90-day reporting period in 2015 for all providers, for new participants in 2016 and 2017, and for any provider moving to Stage 3 in 2017.

Stage 3. The Final rule implements a transition period for 2015 through 2017 to help providers prepare for the long term goals of Stage 3. The transition period will allow providers to take part in an optional Stage 3 reporting year in 2017. Additionally, in order to give providers more time, the Final rule pushes the compliance date for Stage 3 out 27 months, until January 1, 2018. The pushed back date came in response to comments that the earlier 2017 date was “not a realistic start date.” The additional time is intended to allow developers to enhance technology, support providers in their switch to more interoperable infrastructure, and address the barriers in health information transmission between patients and providers. When participation is mandatory in 2018, providers will be required to use EHR technology certified to the 2015 Edition.

Measures. Several program measures are consolidated under the Final rule to reduce duplication and unnecessary complexity. For the EHR incentive program in 2015 through 2017, the major provisions include “10 objectives for EPs including one public health reporting objective, down from 18 total objectives in prior stages” in the case of CAHs, for 2015 through 2017 major provisions include 9 objectives or measures, “including one public health reporting objective, down from 20 total objectives in prior stages.” For 2017 and subsequent years, Stage 3 measures are relying more heavily on interoperability, with more than 60 percent of the proposed measures requiring interoperability. The Stage 3 emphasis on interoperable EHRs is up from 33 percent in Stage 2.

MACRA. After the publication of the Proposed rules, Congress enacted the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10), which alters the trajectory of the EHR incentive program with a provision to sunset the meaningful use payment adjustment for EPs at the end of CY 2018. The law also stablished the Merit-based Incentive Payment System (MIPS), which will consolidate certain aspects of a number of quality measurement and federal incentive programs, including the EHR program, into one efficient framework. CMS is also announcing a 60-day comment period to facilitate additional feedback regarding the impact that MACRA and MIPS will have on Stage 3.

Reactions. Rick Pollack, President and CEO of the American Hospital Association (AHA) called the Final rule “a mixed bag for hospitals and health systems.” Pollack celebrated the 90-day reporting period for 2015 but noted that the January 1, 2018 compliance date for Stage 3 was “deeply disappointing.” The AHA urged CMS to delay the implementation of the final stage of the EHR incentive program because “more than 60 percent of hospitals and about 90 percent of physicians have yet to attest to Stage 2” and “the Stage 3 rule is too much too soon.” The chairman of the Senate health committee, Rep. Lamar Alexander (R-Texas) said that by rushing to implement Stage 3, the administration “is doing a disservice to more than 500,000 doctors, thousands of hospitals, and millions of patients.” The American Medical Association released a statement praising the leniency of the rule and the inclusion of things like the hardship exemption, which can be awarded on a case-by-case basis to physicians who are unable to attest in 2015.

Companies: American Hospital Association; American Medical Association

MainStory: TopStory EHRNews AgencyNews ComplianceNews CMSNews ReimbursementNews IPPSNews CoPNews CAHNews HITNews HIPAANews MedicaidPaymentNews PaymentNews QualityNews

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