House Calls for Suspension of EHR Incentive Payments under HITECH Act

Hands on keyboard in circleOn Thursday, October 4, 2012, in a letter to Secretary Sebelius of the United States Department of Health & Human Services (HHS), the United States House GOP called on HHS to suspend incentive payments for the adoption and implementation of electronic health records (EHRs) otherwise authorized under the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act).  The GOP also asked HHS to delay the imposition of penalties on providers who choose not to use EHRs in their practice (such penalties that pursuant to the HITECH Act provisions are to take the form of reductions in Medicare reimbursements in 2015).  Continue reading

Final Rule on ACOs encourages EHR adoption but eliminates “meaningful use” requirement

The Centers for Medicare and Medicaid Services (CMS) announced today, October 20, 2011, that the use of certified electronic health records (EHRs) will be the highest-weighted quality measure for an Accountable Care Organization (ACO) under the new Medicare Shared Savings Program.

ACOs are designed to encourage primary care doctors, specialists, hospitals, and other health care providers to coordinate their care. The CMS Final Rule on ACOs bases the amount of shared savings that an ACO may receive for its performance on four domains of quality: 1) quality standards on patient experience; 2) care coordination and patient safety; 3) preventive health; and 4) at-risk populations.  To earn shared savings the first performance year, providers must report across all four domains of quality, which include a total of 33 quality measures.  Providers will begin to share in savings based on how well they perform on 23 of the 33 quality measures in the second performance year and on 32 of the 33 measures in the third performance year. 

Measure 20 of the 33 quality measures requires ACOs to report the percentage of primary care providers (PCPs) who successfully qualify for an EHR Incentive Program payment.  CMS expanded the scope of PCPs who can be counted in this measure by eliminating the requirement that the PCP be a “meaningful EHR user” as defined in 42 C.F.R. § 495.4 of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.  CMS stated that it “decided to . . . expand [measure 20] to include any PCP who successfully qualifies for an EHR Incentive Program incentive rather than only including those deemed meaningful users.”

Continue reading

CMS Proposed Rule on Accountable Care Organizations is linked to Meaningful Use Measures

What do the Physician Quality Reporting Incentives Program (PQRI) and Hospital Inpatient Value Based Purchasing (VBP) Program have in common with the recently released proposed regulation for establishing an Accountable Care Organization (ACO)? Answer: The meaningful use measures established by the Centers for Medicare and Medicare Services (CMS) for qualifying for incentives under the Health Information  Technology for Economic and Clinical Health Act of 2009 (HITECH).  Of course! 

On April 7, 2011, CMS published the Proposed Rule on Medicare Shared Savings Program: Accountable Care Organizations in the Federal Register. The Proposed Rule sets forth the requirements that an ACO must meet in order to qualify for the cost savings that will be available to qualifying providers.  Among the requirements, CMS incorporates the EHR meaningful use incentives, stating:

[T]he ACO should have a process in place (or clear path to develop such a process) to electronically exchange summary of care information when patients transition to another provider or setting of care, both within and outside the ACO, consistent with meaningful use requirements under the EHR Incentive program.

Now Medicare providers have another reason to get on board sooner rather than later with the implementation of a certified electronic health record (EHR). 

Stay tuned to the HITECH Law Blog for a post that will have a more in-depth review of how the ACO requirements may impact providers in regard to the implementation and use of certified EHRs, including a review of the overlapping measures for PQRI, Hospital VBP Programs, HITECH EHR incentives and ACOs.  In the meantime, to read more about the HITECH meaningful use measures utilized in the CMS Hospital VPB Program, see the article, “Certified EHRs Expected to Transmit Data for Medicare’s New Hospital Inpatient Value-Based Purchasing Program,” posted to the HITECH Law Blog on February 8, 2011.

Certified EHRs Expected to Transmit Data for Medicare’s New Hospital Inpatient Value-Based Purchasing Program

On January 13, 2011, the Centers for Medicare and Medicaid Services (CMS) released its Proposed Rule on the Medicare Hospital Inpatient Value-Based Purchasing (VBP) Program. The VPB Program is being established per the directive of the Patient Protection and Affordable Access to Care Act of 2010 (PPACA). CMS is to begin making incentive payments under the VBP Program for discharges on or after October 1, 2012.

Seven years before PPACA required CMS to establish the VBP Incentive Program, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) gave CMS authority to establish the Hospital Inpatient Quality Reporting (IQR) Program. The clinical quality measures that CMS has adopted for the IQR Program will feed into the measures for the VBP Program.

The IQR Program measures were generally based on recommendations from the National Quality Forum (NQF), a voluntary consensus standard-setting organization with a diverse representation of consumer, purchaser, provider, academic, clinical, and other health care stakeholder organizations. The IQR measures began as a set of 10 quality indicators that have since expanded to 45 clinical quality measures for the FY 2011 IQR program payment determination. The FY 2011 IQR hospital measures focus on four topics: 1) Acute Myocardial Infarction (AMI); 2) Heart Failure (HF); 3) Pneumonia (PN); and 4) Surgical Care Improvement Project (SCIP).

So how does this relate to the Health Information Technology for Economic and Clinical Health Act (HITECH Act) and a hospital’s “meaningful use” of a “certified EHR“? Ahhh, there is a method to the madness. As the CMS VBP Proposed Rule points out, the Hospital IQR program and the Hospital VBP Program have “important areas of overlap and synergy with regard to the reporting of quality measures under the HITECH Act.”

CMS notes in the Proposed Rule that the certification standards for EHRs under the HITECH Act are directed at enabling EHR submission of quality measures. CMS is striving “to align the [VPB] measures with the adoption of meaningful use standards for health information technology (HIT), so the collection of performance information is part of care delivery.” As a result, CMS anticipates that hospitals will use their certified EHRs for the reporting of clinical quality measures under both the Hospital IQR program and the subsequent Hospital VBP Program.

The proposed initial measures for the FY 2013 Hospital VBP Program include 18 measures. Of these 18 measures, 17 measures will focus on the four clinical process of care topics set forth for the 2011 IQR Program (AMI, HF, PN, and SCIP), and will add Healthcare-Associated Infections (HAI). The 18th measure will include a measure from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) that will fall under a patient experience of care domain.

The proposed performance period is to begin July 1, 2011 and will continue through March 31, 2012 for the FY 2013 payment determination. This is already less than five months away! Another reason for Eligible Hospitals under the HITECH Act to focus on implementation of a certified EHR. Did I hear someone ask how the VBP incentive payments will be funded? Answer: By a reduction of the Fiscal Year 2013 base operating DRG payments for each discharge of 1%. “What one hand giveth, the other hand taketh away.” (Unknown)

For more information about the IQR Program, visit QualityNet.  For additional details about the VBP Program, see the Proposed Rule.  CMS will accept comments on the VBP Proposed Rule until March 8, 2011.  CMS expects to issue a final rule in 2012.

Health Care Reform & HITECH Update for Employers: Webinar

The health care reform law is massive, and it will take time for employers to develop appropriate plans for compliance. The first transformative step in health care reform actually started with the American Recovery and Reinvestment Act of 2009 (ARRA), which included the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The HITECH Act set the course for implementing a nationwide network of electronic health records (EHRs). One of the main goals of the HITECH Act is to ensure privacy and security.  Why might this be important to a business that is not a health care provider?  To find out, join the Kentucky Chamber’s webinar, Health Care Reform Update for Employers, on December 16, 2010, from 3:00 to 4:00 pm (EST). The first part of the webinar will focus on the employer and its HR department, looking at the new laws and discussing what decisions an employer must consider in light of these new laws. Jason Lee, Esq., a member of the Tax, Business & Personal Planning Service Team at Wyatt, Tarrant & Combs, LLP, will lead this discussion, which also will include an overview of tax credits and penalties, as well the changes in effect now and those coming in the future, for employers. The second part of the webinar will focus on the changes that occurred last year with the passage of the HITECH Act.   Kathie McDonald-McClure, Esq., Editor of the HITECH Law Blog and a partner with Wyatt, Tarrant & Combs, LLP, will lead this discussion. She will highlight certain provisions of the HITECH Act’s new privacy and security provisions that will have an immediate and direct impact on certain businesses, including those that do not directly provide any health care. For more information, and to sign up, click here.