Inside CHIME: Progress Seen on CMS Policy Tied to Certified EHRs

Inside CHIME - header

6.22.17 by Mari Savickis
VP of Federal Affairs, CHIME

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule on updates to the Quality Payment Program (QPP), which encapsulates the Medicare Incentive-based Payment Program (MIPS) and Advanced Payment Models established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

CMS largely heeded our advice and has proposed an extended transition period under the MACRA programs, building on the progress made by providers 2017. This includes a proposal to allow physicians to use 2014 Edition CEHRT in 2018. It does not address the 2015 CEHRT timelines for hospitals.

The release came a week after the CHIME Board of Trustees submitted a letter to CMS that strongly urged the agency to delay use of 2015 edition certified electronic heath records (CEHRT). We were concerned that requiring providers to use 2015 Edition CEHRT and to begin meeting Meaningful Use Stage 3 measures starting Jan. 1, 2018, would put providers at risk of substantial financial penalties.

In the letter, we challenged CMS on the use of estimates based on earlier years’ data. CMS estimated more than 85 percent of hospitals and 74 percent of eligible professionals would be ready for 2015 Edition CEHRT by the end of 2017. CMS relied on the Office of the National Coordinator’s (ONC) retrospective data on the move from the 2011 Edition to the 2014 Edition; 90 percent of products were certified by the end of 2014 and CMS expects a similar level of readiness for the 2015 Edition.

The 2015 Edition CEHRT contains a greater level of development and complexity for vendors, though. At last review, ONC’s Certified Health IT Product List found only 71 products are certified for the 2015 Edition. This still represents less than 1 percent of the overall products certified for 2014. Looking back to July 2016, 4,250 of 4,474 hospitals participating in the EHR Incentive Program were using 2014 CEHRT. Ten EHR vendors supplied 2014 CEHRT to 98 percent of hospitals. Of these ten vendors, two make up just under 50 percent of all hospital-certified products and both vendors still have not received certification from ONC.

Comprehensive Primary Care Plus, the Medicare Shared Savings Program and MIPS had required the use of 2015 Edition CEHRT beginning in 2018. This interlocking set of requirements meant that providers were in jeopardy of failing not only Meaningful Use but several other programs that required this new version of CEHRT. We made these recommendations to CMS:

  • Permit both the use of 2014 and 2015 CEHRT in 2018;
  • Allow providers to continue meeting Meaningful Use Stage 3 and Stage 3-like measures at least another year through 2018;
  • Provide adequate vendor development lead time and provider implementation time before requiring a new version of CEHRT;
  • Align reporting requirements around the current version (2014 Edition CEHRT) rather than continuing to mandate use of 2015 Edition CEHRT in 2018 for other CMS programs tied to the use of the CEHRT; and
  • Conduct a systematic review in conjunction with ONC on how to capitalize on the provisions in the 21st Century Cures Act to improve interoperability of CEHRT before mandating the use of 2015 Edition CEHRT.

The board’s letter also cautioned CMS that the quest for interoperability will not be solved by use of 2015 CEHRT or requiring use of Stage 3 and Stage 3-like measures, and provided recommendations along with feedback on ways to reduce the regulatory burden on the provider community.

We will continue to work with CMS to articulate our members’ concerns and provide guidance on possible solutions, and our review of the MACRA QPP/MIPS proposed rule is underway. Stay tuned for additional resources concerning the MACRA Program in coming weeks. We will also be forming a workgroup to aid in the drafting of CHIME’s comments, please email [email protected] if you are interested in participating.

More Inside CHIME Volume 2, No. 13: