CMS Finalizes Promoting Interoperability

CMS Finalizes Promoting Interoperability

Promoting Interoperability

On August 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released a 2,693-page FY 2019 Medicare IPPS and LTCH Final Rule, detailing changes to the Promoting Interoperability (PI) Program, formerly known as the EHR Incentive Program or Meaningful Use.

Under the final rule, several key changes were made to the PI Program:

  1. Use of 2015 Edition of CEHRT is required beginning in calendar year (CY) 2019 for eligible hospitals and Critical Access Hospitals (CAHs)
  2. Certain measures that did not emphasize the electronic exchange of health information or interoperability will be removed beginning in CY 2020
  3. In effort to allow eligible hospitals and CAHs to place more focus on the patients, a new performance-based scoring methodology will be set for the Medicare PI Program and will be based on a smaller set of objectives
  4. CMS or State Medicaid agency participants who are new or returning to the program may report – at a minimum – for any consecutive 90-day period in CYs 2019 and 2020
  5. Eligible hospitals and CAHs must select at least four electronic quality measures (eCQMs) from a set of 16 for eCQM reporting
  6. The rule also finalizes two new optional e-Prescribe measures focused on opiods

Beyond Promoting Interoperability – Quality Program Changes in the Final Rule

Beyond the PI Program the final rule also impacts the Hospital Inpatient Quality Reporting (IQR) Program, updating the measure sets. As with PI, CMS removed certain IQR measures to create a less-burdensome reporting environment, enabling providers to focus more on their patients. Moving forward, CMS plans to reduce and remove measures that focus on process rather than the patient. In all, eighteen measures were removed and twenty-one were de-duplicated from the IQR program to better streamline measures across the other four hospital quality programs. Other hospital-centric programs can expect changes from the final rule:

  • The Hospital Value-based Purchasing (VBP) Program saw the removal of four de-duplicate measures.
  • Participants of the Hospital-Acquired Conditions (HAC) Reduction Program received a new scoring methodology, which will equally weigh all measures.
  • Hospital Readmissions Reduction Program (HRRP) measures will remain unchanged, however CMS specifies the methodology for calculating aggregate payments for excess readmissions for FY 2019 and finalizes several definitions such as dual-eligible patients. Applicable periods for the FY 2019-2021 program years are also established in the final rule.
  • Beginning in CY 2019, four measures that are “topped-out” will be removed from the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program. CMS also adopts one new claim-based Outcome measure for CY 2019.
  • The final rule also removed measures from the Long Term Care Hospital Quality Reporting Program (LTCH QRP) that are duplicative of other measures in the program or have significant operational challenges.

All in all, the Fiscal Year (FY) 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (CMS-1694-F) removed a handful of burdensome and duplicative measures to make it easier for providers to focus more on their patients and less on reporting. The final rule reflects CMS’ continued push towards interoperability, increased flexibility, greater price transparency, but above all, a patient-centered healthcare system. Author: Alex Taylor, Marketing Manager of Health Insights

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