HHS Watchdog Sees Room for Improvement in Meaningful Use Oversight
A report from the HHS Office of Inspective General finds the Centers for Medicare and Medicaid Services does not verify the accuracy of providers self-reported compliance with electronic health records meaningful use requirements prior to issuing incentive payments.
A report from the HHS Office of Inspective General finds the Centers for Medicare and Medicaid Services does not verify the accuracy of providers’ self-reported compliance with electronic health records meaningful use requirements prior to issuing incentive payments.
CMS has paid nearly $8 billion under the EHR Incentive Program during 2011 and 2012, and is not required under law to verify accuracy of the information. However, verifying information prior to payment would strengthen the agency’s oversight of the meaningful use program and reduce the need to identify and recover erroneous payments that are made, OIG notes in a new report, “Early Assessment Finds that CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program.”
Further, OIG concludes that the meaningful use audits that CMS will conduct “may not conclusively verify the accuracy of professionals’ and hospitals’ self-reported meaningful use information.” CMS plans to use EHR reports to verify accuracy “where possible,” and obtain supporting documents from providers to verify measures not covered by the reports, OIG says. However, EHR reports are not always accurate and reports and documentation must be sufficient enough to “cover all aspects of each meaningful use measure,” the agency adds.
The Office of Inspector General acknowledges several barriers that CMS faces in verifying the veracity of meaningful use attestations:
“CMS has identified internal data sources for 25 meaningful use measures but does not use the data to verify the accuracy of self-reported information because they do not match measure definitions. For example, CMS cannot verify self-reported denominators using Medicare claims data because these data only cover the portions of the denominators associated with Medicare patients. To verify self-reported denominators, CMS would also need information about the non-Medicare patients.
“CMS identified external data sources for six measures, but either did not have access to them or choose not to use them to verify self-reported information at the time of our data collection. For one measure, CMS staff reported that the cost of obtaining e-prescribing data from a private company, as well as the logistical difficulty of establishing real-time access, prevented CMS from using that source. For five measures, CMS identified public health data sources, such as State immunization registries, for potential use. CMS staff reported that CMS would attempt to gain access to these State data sources, but at the time of our data collection did not yet have access.
“For 19 meaningful use measures, CMS did not identify any data sources it could use to verify the accuracy of self-reported information. CMS staff noted that these measures involve information that is not currently collected by any entity.”
HHS Office of Inspector General recommendations in the report include:
* CMS should obtain and review supporting documentation from selected “high risk” providers prior to payment to verify accuracy of self-reported information. CMS could use risk analyses it plans to use to select post-payment audit targets to identify and review these high-risk providers before they are paid. CMS did not concur with the recommendation, contending that meaningful use is an attestation-based program and prepayment reviews would impose an increased up-front burden on providers. Timing constrains on pre-payment reviews beyond the first year of participation also could delay incentive payments.
* CMS should issue guidance on the types of documentation it expects providers to maintain to support compliance. CMS concurred with this recommendation and said it is developing an FAQ document.
* The Office of the National Coordinator for Health Information Technology should require EHRs to produce reports for Yes/No meaningful use measures. ONC concurred with the recommendation.
* ONC should require EHR certification entities to test EHR reports for accuracy. ONC concurred with the recommendation.
The HHS Office of Inspector General’s full report is available here.
CMS has paid nearly $8 billion under the EHR Incentive Program during 2011 and 2012, and is not required under law to verify accuracy of the information. However, verifying information prior to payment would strengthen the agency’s oversight of the meaningful use program and reduce the need to identify and recover erroneous payments that are made, OIG notes in a new report, “Early Assessment Finds that CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program.”
Further, OIG concludes that the meaningful use audits that CMS will conduct “may not conclusively verify the accuracy of professionals’ and hospitals’ self-reported meaningful use information.” CMS plans to use EHR reports to verify accuracy “where possible,” and obtain supporting documents from providers to verify measures not covered by the reports, OIG says. However, EHR reports are not always accurate and reports and documentation must be sufficient enough to “cover all aspects of each meaningful use measure,” the agency adds.
The Office of Inspector General acknowledges several barriers that CMS faces in verifying the veracity of meaningful use attestations:
“CMS has identified internal data sources for 25 meaningful use measures but does not use the data to verify the accuracy of self-reported information because they do not match measure definitions. For example, CMS cannot verify self-reported denominators using Medicare claims data because these data only cover the portions of the denominators associated with Medicare patients. To verify self-reported denominators, CMS would also need information about the non-Medicare patients.
“CMS identified external data sources for six measures, but either did not have access to them or choose not to use them to verify self-reported information at the time of our data collection. For one measure, CMS staff reported that the cost of obtaining e-prescribing data from a private company, as well as the logistical difficulty of establishing real-time access, prevented CMS from using that source. For five measures, CMS identified public health data sources, such as State immunization registries, for potential use. CMS staff reported that CMS would attempt to gain access to these State data sources, but at the time of our data collection did not yet have access.
“For 19 meaningful use measures, CMS did not identify any data sources it could use to verify the accuracy of self-reported information. CMS staff noted that these measures involve information that is not currently collected by any entity.”
HHS Office of Inspector General recommendations in the report include:
* CMS should obtain and review supporting documentation from selected “high risk” providers prior to payment to verify accuracy of self-reported information. CMS could use risk analyses it plans to use to select post-payment audit targets to identify and review these high-risk providers before they are paid. CMS did not concur with the recommendation, contending that meaningful use is an attestation-based program and prepayment reviews would impose an increased up-front burden on providers. Timing constrains on pre-payment reviews beyond the first year of participation also could delay incentive payments.
* CMS should issue guidance on the types of documentation it expects providers to maintain to support compliance. CMS concurred with this recommendation and said it is developing an FAQ document.
* The Office of the National Coordinator for Health Information Technology should require EHRs to produce reports for Yes/No meaningful use measures. ONC concurred with the recommendation.
* ONC should require EHR certification entities to test EHR reports for accuracy. ONC concurred with the recommendation.
The HHS Office of Inspector General’s full report is available here.
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