Last week, CMS released a new set of proposed rules to modify Meaningful Use / MIPS. As most of you will not relish putting in hours of midnight oil to review this 764-page document, following is our contribution to the cause: a hopefully readable and worthwhile summary. The proposed rule is important: it alters both MU Stage 2 and Stage 3 requirements, and includes changes to several programs, including the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems, Quality Reporting Programs, and the Value Based Purchasing Program.

Read on and enjoy!

Proposed Changes for Meaningful Use / MIPS Stage 2

CMS’ new proposed rule makes changes to requirements for Meaningful Use / MIPS Stage 2, which impacts hospitals in 2016 and 2017, and which are the subject of this article. In addition, there are changes proposed for the Meaningful Use / MIPS Stage 3 goals, which we will cover in a separate post next week. For returning hospital participants in the Medicare incentive program, four substantial changes have been proposed for Stage 2. The proposed rules will:

• For 2016 only, establish a 90-day measurement period.
• For 2017 only, reduce the threshold of the View, Download, and Transmit (VDT) objective to require “at least 1 patient.” This is already the established requirement for 2016.
• For 2017 and beyond, eliminate the Clinical Decision Support (CDS) goals.   These requirements called for demonstrating 5 ways clinical decision support was used, and required drug-drug interaction and drug-allergy checking.
• For 2017 and beyond, eliminate the Computerized Provider Order Entry (CPOE) requirements, which called for CPOE of lab, radiology, and medication orders.

The Impact of Proposed Changes to Stage 2

A focused set of hospitals will see significant benefits from the proposed changes, but most hospital participants will experience little impact:

• The impact of the 90-day measurement period will be greatest on the small subset of hospitals changing EHRs during 2016.   These hospitals will now have the opportunity to use a 90-day period on either side of their transition date for Meaningful Use / MIPS purposes instead of having to combine data from the pre- and post-transition systems into one attestation.
• The reduction of the VDT measure to require only a single patient could be substantial for a significant subset of hospitals struggling to meet that goal, and essentially provides another year for these hospitals to reshape their patient portal program.
• The elimination of the CDS and CPOE goals should have minimal impact, as these  are being eliminated because they already have widespread acceptance. CMS refers to this condition as “topped-out.”

Hospitals should also be aware that the 90-day reporting period change will not allow them to receive their 2016 Medicare incentive program money more quickly. We must wait while the proposed rules remain open for comment for 60 days, and then for the 60 to 90 days CMS will need to process the comments and prepare a final rule for publication. At that point, CMS will generate a task order to modify its portal to accept attestations under the new guidelines — an effort likely to take another 60 to 90 days. Ultimately the rule-making process will push the ability to attest to Meaningful Use / MIPS well into the first quarter of 2017.

A Major Question Remains

CMS indicates that the proposals to eliminate the CDS and CPOE objectives and reduce the VDT thresholds apply to hospitals participating in the Medicare program, but do not impact the Medicaid program. In many cases, hospitals are still actively participating in both programs.   It remains unclear how this disparity of measures would work, particularly in states that rely primarily on federally collected data for their attestations.

What to Do

Remember that this discussion is about a proposed rule.   It doesn’t have the force of law until it’s been finalized. While it’s true that CMS rarely backtracks on proposed changes to make them more difficult, we recommend staying the course until the rule is finalized in the fall. Hospital Meaningful Use / MIPS teams should, however, review the proposed rule to see how it impacts their attestation efforts and consider submitting comments to CMS, using the procedure outlined in the proposed rule.

If you are in a specific situation that might be impacted by the changed rule, such as implementing a new EHR, by all means devote some time considering how the changes may affect your plans for 2016 — and perhaps positively.  For example, we are working with three hospitals that are currently replacing EHRs, for whom a change to an October 2 start date for a 90-day measurement period will make collecting 2016 Meaningful Use / MIPS dollars a possibility.

Stay tuned for next week’s post where we will analyze CMS’ proposed changes to Meaningful Use / MIPS Stage 3.