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CMS Meaningful Use Relaxation Rule What does it mean?
Introductions Lindsey Lanning Cindi Kincade Healthcare Informatics Vice President, Coordinator Consulting Solutions
Preview of the CMS Proposed MU Relaxation Rule
Agenda This session will cover: • Proposed Modifications to Meaningful Use in 2015-2017 • Clinical Quality Measures • Proposed Rule for Meaningful Use Stage 3 • Proposed 2015 EHR Certification Criteria
Meaningful Use Stage Breakdown
Modifications to Meaningful Use in 2015-2017
CMS Proposed MU Relaxation Rule On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting.
Modifications to Meaningful Use Changes reporting period in 2015 to a 90-day period aligned with the calendar year Modifies patient action measures in Stage 2 objectives related to patient engagement Removes reporting requirements on redundant, duplicative, or topped out measures, therefore reducing the overall number of objectives.
Purpose of Modifications These modifications will allow providers to refocus on the advanced use objectives and measures. These advanced measures are at the core of IT supported health care which drives toward improving the way electronic health information is shared among providers and with their patients, enhancing the ability to measure quality and set improvement goals, and ultimately improving the way health care is delivered and experienced.
Changes to Participation Timeline 2015 Attest to modified version of Stage 2 with accommodations for Stage 1 providers 2016 Attest to modified version of State 2 2017 Attest to either modified version of Stage 2 or full version of Stage 3 2018 Attest to full version of Stage 3
Proposed Participation Changes • Meaningful Use Stage 3 was originally slated to begin in 2017 for providers that had completed Stage 2; now 2017 is a flex year. This means that providers who would have progressed from Stage 2 to Stage 3 in 2017 now have the option to stay in Stage 2 an additional year. Only providers who use an EHR certified to the 2015 ONC standards will be allowed to attest to Stage 3. • Every provider will be Meaningful Use Stage 3 in 2018 even if 2018 is the provider’s first reporting year – In order to simplify the Meaningful Use program, all providers will be in the same stage at that point. This will allow group practices to focus on a single set of measures for all providers.
Proposed Participation Changes This means Stage 1 of Meaningful Use is essentially gone with additional exemptions for those scheduled to meet Stage 1. Stage 2 and 3 would be the only MU stages available for attestation.
Proposed Reporting Period Changes • In 2015 and 2016, new meaningful use participants would be allowed to attest for any 90-day period within the calendar year; For 2015 only, all eligible providers would be allowed to attest for any 90-day period within the calendar year regardless of their previous participation; For 2016, all eligible professionals, eligible hospitals and critical access hospitals who are first-time attesters would be allowed to attest for any 90-day period within the calendar year, while returning participants would use a full calendar year reporting period; and • For 2017, all providers, regardless of their previous participation, would use a full calendar year reporting period as proposed in the Stage 3 proposed rule .
Alignment with MU Stage 3 • Reduce burden by creating a single set of sustainable objectives. • Enable providers to focus on objectives that support advance use of health IT such as health information exchange, public health reporting, and quality measures reporting.
Core and Menu Concept Change • Because of the restructuring of measures, the concept of core and menu will be discontinued in favor of choices within certain objectives. • The new reporting structure is outlined here:
Removed MU Objectives CMS has identified the following objectives as either redundant, duplicative, or topped out and will no longer require attestation on them. • Record Demographics • Patient Reminders • Record Vital Signs • Electronic Notes • Record Smoking Status • Imaging Results • Clinical Summaries • Family Health History • Structured Lab Results • Summary of Care • Patient List Measure 1 – Any Method Measure 3 – Test CMS states that many of these redundant, duplicative, or topped out objectives and measures may be valuable to providers and patients – They encourage providers to continue to conduct these activities if it suits their practice and patient population.
Changes to MU Objectives Changes made to objectives listed below will be effective for EHR reporting for EP’s beginning in 2015. • Patient Access Objectives • Public Health Objectives
Changes to Patient Access Objectives • The proposed threshold changed that more than 5% of patients must view, download, or transmit health information to just ‘1’ patient needing to do so. • The proposed threshold changed a secure message must be sent using electronic messaging of CEHRT by more than 5% of patients to just having secure messaging fully enabled.
Changes to Public Health Objectives • Stage 2 provider is required to ‘successfully engage’ in any combination of 2 public health measures, unless through exclusions less than 2 options remain. • Stage 1 provider is required to ‘successfully engage’ in 1 public health measure, unless all exclusions are met. • This consolidates all public health reporting objectives into one objective with measure options following the same structure of Stage 3 Public Health Reporting.
What will 2015 look like? This proposed rule has a 2-month comment period and therefore we expect the final rule around Aug-Sept. After the final rule is published, EHR vendors will need to update their Meaningful Use Report Cards and the measurement period options in their software. While there may be a few 90-day reporting options available, we expect another year where most providers will be reporting on the last quarter of the year.
Clinical Quality Measures (CQMs) Still Required to be a Meaningful User
CQM Basics • CQMs are tools that help measure and track the quality of health care services provided. • These measures use data associated with providers’ ability to deliver high -quality care or relate to long term goals for quality health care. • To participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and receive an incentive payment, providers are required to submit CQM data from certified EHR technology.
CQM Basics • For 2015 -EPs will need to report 9 (of 64 possible) measures. • These 9 measures must cover at least 3 of the 6 National Quality Strategy domains: 1. Patient and Family Engagement 2. Patient Safety 3. Care Coordination 4. Population/Public Health 5. Efficient Use of Healthcare Resources 6. Clinical Process/Effectiveness
Proposed Rules for MU Stage 3 Broken down by Notable Objectives
Meaningful Use Stage 3 goals • Increased data interoperability; • Advanced use of EHR technology to improve patient engagement and coordination of care; • Improve program efficiency, effectiveness, and flexibility by aligning the EHR Incentive Program with other CMS quality reporting programs.
Meaningful Use Stage 3 Criteria Focus • Improving quality, safety, and efficiency, leading to improved health outcomes • Decision support for national high- priority conditions • Patient access to self-management tools • Access to comprehensive patient data through patient-centered HIE • Improving population health
Stage 3 Objectives Retained Stage 2 objectives with modifications include: • Protecting electronic heath information • E-prescribing • Clinical decision support • Computerized physician order entry (CPOE) Objectives with expanded scope include: • Patient access to health information • Coordination of Care • Health information exchange • Public health reporting
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