CMS proposed rule on EHRs seeks to reduce provider burden

The Centers for Medicare and Medicaid Services on Tuesday followed through on its promise to institute an overhaul of the Meaningful Use program designed to reduce the burdens on providers in terms of time and cost, while also increasing the programs’ focus on interoperability.

The policy changes to the Meaningful Use program—which has been renamed the “Promoting Interoperability” program—were released in a proposed rule for the 2019 Inpatient Prospective Payment Systems (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System, which includes an updated scoring methodology for eligible hospitals and critical access hospitals that would start in 2019, as well as the use of 90-day electronic health record reporting periods in 2019 and 2020.

Further, the proposed rule includes the requirement for providers to use the 2015 Edition certified EHR technology in 2019 to qualify for incentive payments and avoid reductions to Medicare payments. In particular, application programming interfaces (APIs) are part of the 2015 Edition of Health IT Certification Criteria, which requires certified EHRs to demonstrate the ability to provide a patient-facing app access to the Common Clinical Data Set via an API.

“With the upgrade to 2015 Edition technology, there is now an opportunity for providers to provide patients with their electronic data through an application programming interface,” Kate Goodrich, MD, chief medical officer and director of the CMS Center for Clinical Standards and Quality, said Tuesday. “The way the payment consequence works is that we will be scoring each of the measures that the hospitals send in data on, including the patient access to their health information measure. Hospitals must reach a total of a 40 percent score in order to avoid the downward payment adjustment.”

Also See: CMS issues proposed rule to revamp Meaningful Use

In announcing the proposed rule, CMS Administrator Seema Verma said the aim is to remove unnecessary, redundant and process-driven quality measures from a number of reporting and pay-for-performance programs.

“We are removing a total of 19 measures and are de-duplicating another 21 measures while keeping the focus where it should be—on reducing harm and creating better health outcomes for patients,” said Verma. “In total, the burden reduction in this proposed rule will save providers $75 million and eliminate well over 2 million administrative hours for hospital providers over the next two years.”

The College of Healthcare Information Management Executives has long called for reducing the burdens of the Meaningful Use program’s requirements on providers. Not surprisingly, CHIME’s response to the proposed rule was positive and supportive.

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

At last month’s HIMSS18 conference in Las Vegas, CMS announced the launch of the MyHealthEData initiative to put patients in control of their own health data. As part of that effort, the agency said it intended to prioritize the use of quality measures and improvement activities in value-based care and quality programs that lead to interoperability.

However, Earle said that CHIME urges “caution as CMS moves ahead with changes to ensure that they facilitate quality care and lead to measurable improvements.” And, while the group is “still digesting the changes to the scoring methodology” in the proposed rule, he added that “CMS has exercised the flexibility given to them by Congress last year, which permits them to remove the ‘pass/fail’ policy—something CHIME has long requested be removed.”