Proposed Quality Payment Program rule gets mixed comments from groups

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While healthcare stakeholder groups are generally encouraged by the Centers for Medicare and Medicaid Services’ proposed rule to simplify reporting requirements under the new Quality Payment Program, some continue to be concerned about burdensome health IT regulations.

Provider and HIT associations submitted mixed comments to CMS on proposed updates for the second and future years of the QPP, which were due to the agency by August 21.

Also See: MACRA Quality Payment Program‘s first performance period gets underway

In November 2016, CMS published a final rule to implement the QPP, established under the Medicare Access and CHIP Reauthorization Act (MACRA), designed to reward providers for value and improved health outcomes. As part of the program, clinicians have two tracks to choose from—the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternate Payment Models (APMs).

Although the agency began implementing the program through rulemaking for 2017, CMS in June proposed a 2018 Updates to the Quality Payment Program rule.

In response, the American Hospital Association said in an August 18 letter to CMS that it supports many of the agency’s proposed policy changes that “relieve regulatory burden and foster greater collaboration across the healthcare system, including the facility-based measurement in the MIPS and the gradual, flexible increase in reporting requirements.”

However, at the same time, AHA urged CMS to “better align the Meaningful Use requirements of electronic health records for hospitals with those of clinicians, enhance its approaches to risk adjustment, and provide additional opportunities for clinicians to earn incentives for collaborating with hospitals to enhance the quality and efficiency of care through advanced APMs.”

In its letter, the AHA called out HIT requirements included in the advancing care information (ACI) component of the QPP program. The objectives in the ACI performance category of MIPS emphasize measures that support clinical effectiveness, information security and patient safety, patient engagement, as well as health information exchange.

“The AHA appreciates the proposals for additional flexibility to meet the ACI performance category of the MIPS, including a 90-day reporting period in 2018 and 2019, and the continuation of modified stage 2 Meaningful Use requirements through 2018,” states AHA’s letter. “At the same time, we urge CMS to align the requirements for eligible clinicians in the ACI performance category with the requirements for eligible hospitals and critical access hospitals in the Medicare and Medicaid EHR Incentive Programs.”

The American Medical Association in its August 21 letter to the agency supports CMS’s proposal within the ACI category to extend certified electronic health record technology (CEHRT) flexibility for performance year 2018 and the proposed hardship exemption for small practices.

Under MIPS, the ACI performance category score defines a meaningful electronic health record user as a MIPS eligible clinician who possesses certified EHR technology, uses the functionality of CEHRT, and reports on applicable objectives and measures.

However, AMA recommended “improvements to the ACI category, including adding flexibility within the base score, reducing information blocking attestation requirements, and creating a pathway for physicians to achieve ACI credit by using CEHRT to participate in a Qualified Clinical Data Registry (QCDR).”

In its August 21 letter to CMS, Health IT Now—a coalition of patient groups, provider organizations, employers and payers—lamented about the lack of an eligible measure applicability (EMA) process for qualified clinical data registries (QCDRs) or EHR reporters and warns that this disparity may unfairly disadvantage providers under the MIPS program.

As a result, HITN wrote to the agency that QCDRs can “advance improvements in quality and patient outcomes by providing actionable feedback to participating providers related to their performance on key quality metrics in real-time” and encouraged it to award 50 percent of the Quality Category score to active engagement in a QCDR.

CMS’s proposed rule seeks to help clinicians successfully participate in QPP by continuing to allow the use of 2014 Edition CEHRT, while encouraging the use of 2015 Edition CEHRT.

The American Medical Group Association in its August 21 letter said it does not object to CMS proposing to allow eligible clinicians to use either 2014 or 2015 Edition CEHRT in performance year 2018. Nonetheless, AMGA pointed out to the agency that many of its members have invested in 2015 CEHRT.

“This leads us to welcome the proposal to grant a one-time 10 percent bonus for exclusive use of 2015 CEHRT in 2018,” states AMGA’s letter. “Among other advantages, the 2015 Edition software will offer greater interoperability, improved privacy and security, improved data exporting, and application programming interface capabilities that will substantially improve the user experience.”

In its August 21 letter to CMS, the American Medical Informatics Association enthusiastically supported the use of CEHRT in the QPP.

“With the sunset of Meaningful Use for Medicare, we view MIPS and APM requirements as a primary mechanism to incentivize continued investment and use of Certified EHR Technology among ambulatory providers,” states AMIA’s letter to the agency. “It is important that CMS continue to view CEHRT as a means to encourage adoption and maintenance of modern information and communication technology in care delivery, and focus on making the use of such systems easier for clinicians. Without CEHRT, there is a higher likelihood that systems will not interoperate because there is very little else compelling the market to standardize around medical vocabularies, content templates, or transport mechanisms.”

Specifically, AMIA said that it views proposals that encourage the adoption of CEHRT—such as the bonus score available to MIPS eligible clinicians who use the 2015 Edition—as important. And, while the letter said the group understands the hesitancy of CMS to require upgrades to the 2015 Edition for all MIPS eligible clinicians in 2018, it asked the agency to clearly state its intentions to require 2015 Edition CEHRT in 2019 for QPP participation.

“This will signal to industry that they must continue investments in CEHRT, and prepare clinicians for a nationwide upgrade to 2015 Edition products to better support interoperability across the care continuum,” according to AMIA.

However, Health IT Now said it is concerned that CMS—working with the National Coordinator for Health IT—is “missing an opportunity” by merely delaying the requirement for eligible providers to report using the 2015 Edition.

“While we support the delay as it is important to reduce provider burden in the program, we believe that CMS, in coordination with ONC, should not simply delay for the sake of delay—rather, use this time to revisit certification requirements and ensure that every requirement is critical to providers’ success and reduces provider and vendor burdens under the QPP,” stated HITN.

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