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Regulatory Update

Is Meaningful Use Over?

Published on 6/6/2018
Is Meaningful Use over? 

This question comes up a lot. We’ve got a simple answer: No, it’s not – but the name is.

The EHR Incentive Program, commonly known as Meaningful Use (MU), has been considered over or has “died” many times, but it is still around. The latest “death” of the MU program is rooted in recent rule making by CMS: In the Inpatient Prospective Payment System (IPPS) proposed rule for 2019 federal fiscal year, CMS changed the name of the EHR Incentive Program/MU to the Promoting Interoperability (PI) program, applicable to both Medicare and Medicaid. That name change is tied to a shift in the program away from incentives for EHR use and a refocusing of the program on interoperability. 

Not only is the idea of required EHR use not dead, but it is changing and potentially expanding. CMS outlined several other proposals regarding objectives and measures that could have a significant impact on the Medicare PI program if they are finalized. These proposals would only apply to hospital and Critical Access Hospitals (CAHs) that are attesting using the Medicare attestation portal through QualityNet. These proposals create a division between the Medicare PI program, the Eligible Hospital/CAH Medicaid PI program and the EP Medicaid PI Program. Larger organizations will need to view PI as, at a minimum, a Medicare and Medicaid PI program. 

Proposed program changes in 2019 and 2020

CMS is proposing to update its scoring methodology for the Medicare PI program and to move away from the current all-or-nothing approach, in which if a hospital fails to hit any of the required percentage thresholds, they will fail the entire program for that program year. However, hospitals and CAHs will need to attest to four objectives (five if you count the requirement to do security risk review as required by the protect patient health information objective) and receive a minimum of at least one in the numerator of all mandatory measures (of which there are six in 2019 and eight in 2020). The only two measures that are voluntary are two-new e-prescribe measures related to opioid use, and those are only voluntary in 2019 and become mandatory in 2020. So, there is still a component to the Medicare PI program that is all-or-nothing and which requires hospitals and CAHs to implement new certified functionality as it becomes required. 

In the IPPS proposed rule, CMS is proposing to eliminate six measures, four of which were Stage 3-only measures that hospitals were never required to meet prior to now. The measures proposed for elimination are: patient education, patient engagement (View, Download, or Transmit (VDT) 2), secure messaging, patient-generated health data, request/accept summary of care and clinical reconciliation. 

CMS is also proposing to add three new measures to the Medicare PI program for the 2019 and 2020 program years. One of those measures – Support Electronic Referral Loops by Receiving and Incorporating Health Information – is a consolidation of two eliminated measures: request/accept summary of care and clinical reconciliation. This measure is essentially the numerator from the request/accept summary of care measure, and the new numerator is the numerator from the clinical reconciliation measure.

CMS is proposing two new measures to be added under the e-prescribe objective, both of which are related to the opioid epidemic. The two new measures are: Query PDMP (Prescription Drug Monitoring Program) and Verify Opioid Treatment Agreement. Both measures would also require the ability to perform Electronic Prescribing of Controlled Substances (EPCS), as they are both limited to Schedule II opioids. Both new measures would be optional in 2019, but mandatory in the 2020 program year. These measures are therefore effectively creating a national requirement for hospitals and CAHs attesting to Medicare PI to have EPCS functionality in use no later than October 2, 2020. 

These proposals would only apply to the Medicare PI program; a proposal for a 90-day reporting period in 2019 and 2020 applies to Medicare and Medicaid PI and includes Eligible Professionals (EPs). Hospitals attesting to the state Medicaid program through the state’s attestation portal only would still be held to the objectives, measures and thresholds originally outlined by the Stage 3 final rule in November 2015. 

Proposed functionality changes in 2019 and 2020

The new e-prescribe measures will not only require EPCS, but will also require use of a state Prescription Drug Monitoring Program (PDMP), a medication history query for the patient and query and incorporation of an opioid treatment agreement between the patient and one of their providers. CMS additionally updated the Transition of Care measure by renaming it Support Electronic Referral Loops by Sending Health Information and by suggesting that hospitals and CAHs could use the HL7 Consolidated Clinical Document Architecture (C-CDA) template that best fits the transition and referral situation. There are 11 templates available; in the HL7 2.1 Implementation Guide, CMS points to only a few that are currently requirements of 2015 Edition certification. 

These template updates, as well as the new functionality updates, point to new and updated 2015 edition Certified EHR Technology (CEHRT) requirements, which would need to be outlined by the Office of the National Coordinator (ONC). ONC has a certification proposed rule that was slated to be released in the spring of 2018, but appears to have been pushed back to September. This would place a final rule in the late December to January 2019 timeframe, and allow health IT (HIT) vendors very little time to make updates required for CEHRT and the new PI measures. HIT vendors would need to ensure they comply with the certification criteria to allow hospitals, CAHs and other providers to use their system for PI attestation. 

Other PI measurement considerations 

In addition to the IPPS proposed rule updating and renaming the PI program, CMS has a call for measures for hospitals and CAHs in the Medicare PI program. This call for measures is the equivalent of a Request for Information (RFI) in that CMS is asking for the public to provide feedback on potential additional future measures for the Medicare PI program. These measures could be optional in 2020 and potentially mandatory in 2021. The commenters need to outline how the measures are related to interoperability or patient safety, what the measure would use as a denominator and numerator, and if the measure would require additional certified functionality, then what that functionality would be. 

This is the first annual call for measures, so we will likely see a new call for measures and potentially new measures on an annual basis moving forward. The annual call for measures, the renaming and refocusing of the PI program and the changes in the IPPS proposed rule to allow for performance based scoring all point to the PI (MU) program not only not being dead, but becoming more of a routinely monitored and updated program that is very much alive. 

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