Following the release of its proposed new rules designed to improve the interoperability of electronic health information, members of leadership from the Centers for Medicare & Medicaid Services (CMS) hosted a call to provide additional detail about the proposed rule, and to answer questions from the media. The following includes the key takeaways from the officials hosting the call.
Seema Verma
Seema Verma, Administrator, CMS
CMS shares a commitment with patients to obtain and share their health data.
The proposed rules ensure patients have access to their records in digital format.
We are “unleashing” data for research and innovation while tackling what might be the greatest healthcare challenge in our history, including the potential upcoming healthcare cost crisis that could destroy the US economy.
MyHealthEData unleashes innovation and focuses on results.
CMS is doubling down by requiring health plans to release claims data. All health plans in Medicare, Medicaid and that have plans within the federal exchange must allow for information be shared so patients can take their records with them when they move on.
Through these efforts, more than 125 million patients will have access to health information and be able to take information with them.
We are putting an end to information blocking and will publically identify doctors, hospitals and others who engage in information blocking.
Patient data doesn’t belong to doctor, but to the patient.
We’re putting the patient at the center of healthcare data. The time of keeping patients in the dark to trap them in systems so that they can never leave are over.
We are empowering patients to understand their healthcare information.
This rule allows patients to aggregate their data in one place through APIs/apps – putting the data in one place to help them understand it. They can organize the information, create care reminders, take data for the next provider when they go to a new provider.
This allows for aggregation of data in one place; physicians no long need to duplicate tests, for example.
Patients can donate their data for research, if they so desire, possibly opening up new wave of innovation of development.
Don Rucker
Don Rucker, MD, National Coordinator for Health Information Technology (ONC)
Through this rule, ONC has put the technical underpinnings asked for in the 21st Century Cures Act.
Provisions have been made for security and privacy for patients.
Information blocking has not be enforceable until now.
Interoperability is technically there, but pricing strategies were not effective, but this proposed rule changes that.
This strikes a role for transparency – and helps lead toward providing information about what patients are buying and they are getting for a certain cost.
Getting transparency in pricing is very complicated, primarily because of decades of previous regulation.
Eric D. Hargan
Eric Hargan, deputy secretary, HHS Office of the Secretary
These proposals contain a number of historic measures designed so that individual patients can securely access their health records.
We believe empowering patients with this access will build an ecosystem that improves individual care and provides access to healthcare.
This also should reduce the burden on providers.
We can’t built a vale-based healthcare system with these rules.
Following the release today of the finalized modified rules for the current stage of meaningful use, CHIME released the following statement, summarizing the position of many in healthcare. Overall, the organization supports the modifications, including the adopted 90-day reporting period:
We are pleased that the Centers for Medicare & Medicaid Services today finalized modifications to the current stages of the Meaningful Use program and agreed to extend the comment period on Stage 3. CHIME and its 1,700-plus members agree with CMS that it is time to focus the meaningful use program on adoption of information technology systems that improve both the quality and safety of patient care.
The 752-page rule grants flexibility for providers who are doing their best to not only meet the intent of the federal program, but also ensure the adoption of health information technology that improves patient care.
Importantly, the rule adopts a 90-day reporting period for the current stages of the program, down from 365 days. CHIME has long called for a 90-day reporting period and applauds CMS for adopting this new standard. While several members are positioned to take advantage of this shorter period, others will be challenged to meet it since there are fewer than 90 days remaining in the year. We urge CMS to implement a hardship exemption for those unable to meet this timeframe.
CHIME also applauds the agency for modifying requirements surrounding patient access to electronic records. The rule stipulates that for 2015 and 2016, one patient discharged from a hospital view, download or transmit their electronic record.
With regard to Stage 3, the extra comment period will enable providers, CMS and other stakeholders to ensure that the next stage of Meaningful Use advances interoperability and takes into account new payment models being advanced by Medicare.
Also today, the Office of the National Coordinator for Health Information Technology finalized a rule on certification of electronic health records. CHIME supports key provisions in the rule that should lead to greater transparency regarding vendor products; improved testing and surveillance of health IT, and an improved focus on user-centered design.
We are reviewing the regulations and will have more detailed comments in the coming days.
The 2013 report found that there was an increase in participation from eligible professionals and in reporting clinical quality information for both PQRS and the e-prescribing Incentive Program, reflecting both increased use of electronic prescribing as well as increased tracking and reporting of important quality information. The report also indicates progress in CMS’ efforts to improve quality measurements, and to encourage building a national electronic health information infrastructure in the United States.
Report highlights include:
Participation in the PQRS program increased by 47 percent from 2012 to 2013.
In 2013, 641,654 eligible professionals participated either as individuals or as part of PQRS group practices, through at least one reporting mechanism, a 47 percent increase from the 435,931 who participated in 2012. Approximately 51 percent of the 1.25 million professionals who were eligible to participate in 2013 participated in PQRS. The 2013 PQRS incentive payments totaled $214,551,741.
469,755 eligible professionals were subject to a 2015 PQRS negative payment adjustment. Based on 2013 PQRS reporting, 469,755 eligible professionals are subject to a reduction of 1.5 percent of their 2015 Part B Medicare Physician Fee Schedule allowed charges. Of those professionals subject to the adjustment, 98 percent did not attempt to participate in PQRS. In addition, 43 percent of the professionals subject to the payment adjustment treat 25 or fewer Medicare beneficiaries a year.
The Centers for Medicare & Medicaid Services (CMS) for the first time introduced star ratings on Hospital Compare, the agency’s public information website, to make it easier for consumers to choose a hospital and understand the quality of care they deliver. According to the organization, “This announcement builds on a larger effort across HHS to build a healthcare system that delivers better care, spends healthcare dollars more wisely, and results in healthier people.”
The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:
How well nurses and doctors communicated with patients
How responsive hospital staff were to patient needs
How clean and quiet hospital environments were
How well patients were prepared for post-hospital settings
“The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality,” said Dr. Patrick Conway, acting principal deputy administrator for CMS and deputy administrator for Innovation and Quality. “These star ratings also encourage hospitals and clinicians to strive to continuously improve the patient experience and quality of care delivered to all patients.”
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
The recent flurry of upsets in college football has caused pundits and fans of the sport to do a mid-season recalibration of their projections for their respective teams. Many of the pre-season favorites — selected just seven or eight weeks ago — are no longer in the running for the national championship, others are plugging along pretty much in line with expectations, and a number of “Cinderella” teams have emerged. All teams, no matter how well they have done thus far, will need to make adjustments in the second half of the season.
In like manner, with recent developments and disclosures about CMS’ Pioneer ACO Model, it’s time to do a kind of mid-season recalibration and speculate a bit about needed adjustments to the program.
In August and September, four hospital systems — Sharp HealthCare, a five-hospital system in San Diego, Calif.; Franciscan Alliance in central Indiana; Genesys PHO in Flint, Mich.; and Renaissance Health Network in Pennsylvania — dropped out of the Pioneer ACO Program. With those departures and nine that were previously announced, the number of Pioneers has dropped by 41 percent, from 32 original participants to 19. It should be noted, however, that the majority of the ACOs that have left the program have transferred to the less challenging Medicare Shared Savings Program (MSSP).
On August 6, CMS posted 879 pages of public comments received in response to the CMS Innovation Center’s December 2013 request for information that solicited input on the Pioneer ACO Model as well as new ACO models.
On October 8, CMS released detailed quality and financial data by ACO for the first two years of the Pioneer Program. With regard to quality performance, average quality scores for the Pioneers improved by 19 percent year-to-year, with improved performance on 28 of 33 measures (85 percent) between the first and second year.
Financially, in year one of the program, 13 of the Pioneers (41 percent) met or beat their expenditure benchmarks, qualifying for shared savings and garnering an average of $5.9 million, with the amounts received ranging widely. One Pioneer had to pay CMS a shared loss of $2.6 million, and the remaining 18 ACOs either did not earn shared savings or did not owe CMS money because of losses.
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
On April 30, 2014, the Centers for Medicare & Medicaid Services issued its proposed rule for the Inpatient Prospective Payment System (IPPS), which pays about 3,400 acute care hospitals, and the Long-term Care Hospital Prospective Payment System (LTCH PPS), which pays about 435 LTCHs.
The issuance of this proposed rule is a significant event, as it discloses CMS’s intent regarding the average change (increase or decrease) to the IPPS reimbursement rate, what one might call an “annual inflation adjustment.”
While CMS projects that the payment rate update to general acute care hospitals will be 1.3 percent in FY 2015—which on the face of it doesn’t look too bad—it’s important to understand how CMS arrived at that figure, what is the projected overall impact on hospital payments because of other regulatory changes, and how the proposed update compares with the recommendation of the nonpartisan Medicare Payment Advisory Commission (MedPAC).
How did CMS arrive at the 1.3 percent update (adjustment)?
CMS started with a proposed annual market basket update (inflation projection) from research firm IHS of 2.7 percent. That starting point was then reduced, per the Affordable Care Act, by a multi-factor productivity adjustment of 0.4 percent and a specified reduction to the market basket update of 0.2 percent, yielding 2.1 percent. Then CMS reduced it by a documentation and coding recoupment adjustment (basically to correct for past, unintended documentation and coding over payments) of 0.8 percent, resulting in a net update of 1.3 percent.
The Centers for Medicare & Medicaid Services (CMS) today released the 2012 Physician Quality Reporting System and Electronic Prescribing (eRx) Experience Report, showing a significant increase in participation in two key programs that allow eligible professionals to earn incentive payments through voluntary participation.
“Our physician and other clinician quality programs reached new records this year with over 430,000 professionals participating in the Physician Quality Reporting System and over 340,000 e-prescribing,” said Patrick Conway, M.D. deputy Administrator for innovation and quality and chief medical officer at CMS. “Clinicians are actively measuring and reporting on quality, and CMS is in the beginning stages of adding this information to the Physician Compare website, which can be viewed by patients. Measuring, transparently sharing, and improving quality performance is key to a better health system.”
The Physician Quality Reporting System (PQRS) has been using incentive payments, and will begin to use payment adjustments in 2015, to encourage eligible health care professionals to report on designated quality measures. The Electronic Prescribing (eRx) Incentive Program used a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals.
Hospitals and other healthcare organizations in the midst of the complex meaningful use attestation process often see the attestation itself as the end of the process. It is not. Today, 20 percent of hospitals are being selected for a meaningful use audit after attestation. That’s why it’s important that, while preparing for attestation, hospitals also get prepared to be audited.
Iatric Systems help to longtime customer Memorial Healthcare in their attestation process — and successfully passing their recent audit — as well as our work with other customers, has revealed how important this preparation can be. Not passing an audit results in having to pay back 100 percent of any incentive money already received.
Much of the decisions made and records kept during the process of attestation affect the outcome of an audit, as does careful attention to the details. One hospital being audited had accidently transposed a single number. This simple mistake meant many hours of extra effort to find the error and then straighten it out with the independent auditing agency.
What follows are the components currently included in an audit request to eligible hospitals from the Centers for Medicare and Medicaid Services (CMS):
Part I – General Information:
As proof of use of a Certified Electronic Health Record Technology system, provide a copy of your licensing agreement with the vendor or invoice. Please ensure that the licensing agreement or invoices identify the vendor, product name and product version number of the Certified Electronic Health Record Technology system utilized during your attestation period. If the version number is not present on the invoice/contract, please supply a letter from your vendor attesting to the version number used during your attestation period.
Provide documentation to support the method (Observation Services or All ED Visits) chosen to report Emergency Department (ED) admissions designating how patients admitted to the ED where included in the denominator of certain meaningful use core and menu measures (i.e. an explanation of how the ED admissions were calculated and a summary of ED admissions).
The Centers for Medicare & Medicaid Services (CMS) today released the 2012 Physician Quality Reporting System and Electronic Prescribing (eRx) Experience Report, showing a significant increase in participation in two key programs that allow eligible professionals to earn incentive payments through voluntary participation.