CMS 'takes the teeth' out of MU in proposed rules

Included in Medicare's proposed rules for the 2017 Medicare Outpatient Prospective Payment System are significant changes to the meaningful use program, including a shortened reporting period, removal of certain measures and lowered thresholds of certain measures.

The proposed rules apply to participants in the Medicare EHR Incentive Program, not the Medicaid EHR Incentive Program. "We have chosen to limit these proposed changes to Medicare only because we are concerned that States would have to implement major process changes within a short period of time if the changes were to apply to Medicaid," said CMS in the proposed rule.

Perhaps the most significant proposed change is the 90-day reporting period across the program. Previously, returning participants (i.e. those who have previously successfully attested to meaningful use) had to attest using the full calendar year for 2016, but the proposed rule allows participants to use any continuous 90-day period. Stakeholders have long pushed for the 90-day reporting period, and these proposed rules offer them significant flexibility.   

The 90-day reporting period will allow providers and hospitals to make continuous workflow improvements throughout the year to meet meaningful use requirements. Under the calendar year reporting period, if a provider or hospital is not meeting benchmarks or thresholds in the first few months, "you're kind of behind the 8-ball," says Dan Golder, DDS, a principal at Impact Advisors.

Now, when providers notice trouble areas, they can implement changes, record their improvement and have a better likelihood of successfully attesting to the program. "Now [providers] can say, 'I'll start measuring performance in the beginning of the year, and if I'm having trouble on a certain measure, I'll do better. Maybe I'll report in October, November and December when I've had the full year to really improve my scores…and make sure quality metrics are the best they can be,'" Dr. Golder says.

The timing of the proposed rule is a little surprising, given it was released halfway through the year, and that the changes are still incumbent on the final rule being released. "But [it's] still welcome news," he says.

CMS has also proposed eliminating the clinical decision support and computerized provider order entry objectives and measures for eligible hospitals, saying they are now "topped out" and have reached widespread adoption.

The proposed rule also would reduce the threshold of several objectives and measures. Notably, CMS proposes reducing the View, Download, Transmit measure evaluating how many discharged patients view, download or transmit their health information to a third party from 5 percent of patients to just one patient. Dr. Golder says this reduction is "really profound" and in a sense almost eliminates the measure entirely.

Other thresholds CMS has proposed reducing include providing patients access to their health information and related education (reducing from more than 80 percent to more than 50 percent) and providing patients with educational materials upon discharge (reducing from more than 35 percent to more than 10 percent).

The 90-day reporting period and reduced thresholds insert significant flexibility into meaningful use and offer a sort of buffer for participants.

"Where you say you've got a 90-day [reporting period] rule and taking some of the more difficult measures to meet and reducing their thresholds, in a way it's taking the teeth out of MU…and making it easier for most everybody," Dr. Golder says, adding the proposed changes would allow most people to be successful with the program.

But vendors don't have it so easy.

"Once again, they've placed a significant burden on software developers," Dr. Golder says. "We're in the middle of the year for 2016. Everyone has software set up with thresholds already in place, and now developers have to amend the software, amend reporting to accommodate these changes. I feel bad for them."

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