fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

MACRA Proposed Rule Lacks Meaningful Use Flexibility for Hospitals

April 29, 2016 | FAH Policy Blog Team

Category: FAH News, HIT, Legislation

The Medicare Access and Chip Reauthorization Act of 2015 (MACRA) proposed rule recently released by CMS will have a significant impact on America’s entire health care system, including the Electronic Health Record (EHR) Meaningful Use (MU) program. Under EHR MU, hospitals face demanding requirements that could make providing care to patients more difficult. 

The proposed rule would implement the requirements of MACRA to establish a new system by which physicians and other health care professionals would be paid by Medicare under the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) framework.

MIPS participants must meet quality, resource use, clinical improvement, and EHR use requirements.

FAH is a strong supporter of the fact that interoperable certified EHR technology can be a conduit for having the right information in the right place at the right time, resulting in better care for patients. However, under the EHR MU program, burdensome provisions for hospitals could undermine these objectives.

CMS’s proposed rule would provide regulatory relief to eligible physicians under the MU program, by offering them greater simplification and flexibility using the “Advancing Care Information” criteria, which is the new name for EHR use for physicians.

Unfortunately, the rule fails to give hospitals the same relief.

Hospitals must meet compliance thresholds with an “all or nothing” approach for MU criteria, which is too demanding and unnecessary. 

They also have to comply with requirements that were previously menu options under MU Stage 2 and will be mandatory effective January 2017. For instance, FAH believes that CMS should keep the e-prescribing requirement for hospital discharges as a menu option until MU Stage 3 takes effect.  E-prescribing systems are very complex, which require providers to contract with appropriate third party vendors to process the script, verify insurance coverage, and process and transmit prescriptions. Failure to meet CMS’ thresholds on these mandatory measures will result in penalties.

The new rule provides no guidance to hospitals on reporting, yet relief is needed.  For example, hospitals were allowed to report on a 90-day period for 2015. This should continue for 2016 and future years, if appropriate, including the first year of MU Stage 3.

FAH thinks CMS should drop from MU Stage 3 requirements hospital measures that do not make sense in the hospital setting. These measures are geared towards community physicians and could interfere with patient care, and adversely impact patient safety.  Such measures include sending secure messages to patients, and incorporating external data (e.g., data provided by the patient) into the medical record.

Also, rather than require percentage thresholds for coordination of care/patient engagement measures, providers should simply attest that certain functionalities are available.  Compliance here is heavily dependent on patient behavior, over which providers have little or no control. 

In addition, requiring that encounter data be made available to patients through a patient portal, or API, is grossly premature because the technology required for providers to satisfy this type of measure is not yet available. These types of measures should be dropped as well. 

The Federation looks forward to working with the CMS to make changes that ensure that hospitals and other providers can achieve true and meaningful interoperability.