July 19, 2016
As we discussed last week, CMS new proposed rules to amend Meaningful Use / MIPS will ease some of the requirements for meeting Meaningful Use / MIPS stage 2 in 2016. Significant changes were also proposed to the stage 3 requirements for 2017-2018, several of which reduce participation thresholds that have been widely controversial. Many providers are likely to welcome these proposed modifications, which we have summarized as follows:
Patient Access Measure: This measure requires hospitals to provide patients’ electronic access to clinically relevant information about their care in a timely fashion. As originally proposed in stage 3, this would require hospitals to make information available for view, download, and transmit, and also to provide access via application programming interface (API). In the proposed rule, CMS would lower the threshold from 80 percent of patients to 50 percent.
Inadequate API technology was cited as a reason that this measure may be difficult to meet by hospitals. This logic doesn’t entirely make sense, because the primary barrier to meeting the API measure will be the development of the technology by certified electronic health record technology (CEHRT) vendors. Once the technology is available, hospitals should be able to make the API interface fully available to 50% or 80% of patients with nearly the same effort.
Patient Education Measure: This measure, which requires hospitals to use their CEHRT to identify and provide electronic, patient-specific educational material, is also significantly reduced from 35% to 10%. CMS expressed concern that not all patient users are sufficiently computer savvy to download electronic instructions, rendering them essentially unable to access their instructions.
View, Download, and Transmit (VDT) Measure: CMS has again proposed reducing the measure to only require one unique patient to view, download, or transmit his or her data during the reporting period. CMS has expressed a concern that many healthcare providers have already noted: patient participation is the limiting factor in attaining this goal. The expectation now is that as the technology matures, and hospitals find new ways to engage patients with their patient portals, patient participation will naturally increase.
Secure Messaging Measure: The requirement of providers to use secure messaging to communicate with patients, a new requirement for stage 3, is substantially reduced from 25 % to 5%. Again, CMS cited uncertainties in patient participation and not-fully mature technology as primary reasons.
Transition of Care: This measure’s threshold, which was slated to increase substantially to require 50% of patient transitions from one care provider to another to include the exchange of information in stage 3, will remain at 10%. CMS cited hospitals’ concerns that there are insufficient receiving providers available to meet the higher numbers.
Request/Accept Patient Care Record Measure: This measure balances the previous measure, by reducing the threshold from 40% to 10% of patients for which hospitals must receive and incorporate an electronic summary of care document accepting them as new patients via transition of care. The threshold originally established at 40% would be substantially reduced to 10%. Ironically, with CMS’ reduction of the threshold of sent documents to 10%, meeting this requirement may now become even more difficult than before.
Clinical Information Reconciliation Measure: CMS proposes to reduce the number of patient transitions where a reconciliation of clinical information is performed from more than 80% to 50%, citing interoperability concerns that would impair the easy incorporation of external data into the EHR.
Public Health and Clinical Data Registry Reporting Measure: CMS proposes to reduce the number of required reporting partners from four to three, citing the challenges hospitals have in many states with the lack of availability of qualified registries.
These changes are currently in the proposal stage. While it’s unlikely that CMS will backtrack to make them more difficult, we continue to recommend waiting until fall for the final Rule before significantly altering your Meaningful Use / MIPS plans. Another note of caution: while CMS’ apparent direction is to lower the bar for meeting Meaningful Use / MIPS stage 3 in 2017 and 2018, no commitment has been made to continue reductions into 2019 and beyond.
Finally, recognize that the proposed lowered thresholds for meeting Meaningful Use / MIPS has in no way affected the true goal of the program – making us all Meaningful Use / MIPSrs of our EHR technology.
If you’d like to comment on the proposed rules, you may submit electronic comments on this regulation at http://www.regulations.gov.
We’ve compiled the main elements of this two-part series into one summary in MU Proposed Changes 7-2016.