By Michael Burger, Practice Lead, EHRs and EDI

Heads up, electronic health record (EHR) vendors. Medicare has proposed big changes for fiscal year 2019. Many will affect how EHRS will be used by a multitude of providers for Meaningful Use, MIPS/MACRA and reporting clinical quality measures. Details were announced in a newly released proposed rule from the Centers for Medicare and Medicaid Services (CMS). Comments are due June 25.

Specifically, the new proposed rule will create or revise existing requirements for:

• Quality reporting by such Medicare providers as acute care hospitals, PPS-exempt cancer hospitals, and long-term care hospitals
• Eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid EHR Incentive Program. It’s now referred to as the “Promoting Interoperability Program.” The name was changed because “…the former name, Medicare and Medicaid EHR Incentive Programs, does not adequately reflect the current status of the programs, as the incentive payments under Medicare generally have ended….”

What’s in the new rule? As with all things CMS, the new proposed rule is complex. The bulk of the rule relates to changes for Medicare payments to hospitals. There are a number of provisions that are of note to ambulatory and hospital EHRs. These will:

• Eliminate meaningful use as a term. While the term is gone, the concept lives on. Providers will still need to meet various metrics related to the use of EHRs to incentivize their Medicare payments or keep them from being reduced. According to the regulation text, this will involve “scoring and measurement policies to move beyond the three stages of meaningful use to a new phase of EHR measurement with an increased focus on interoperability and improving patient access to health information.“
• Require providers to use the 2015 Edition of certified electronic health record technology (CHERT) in 2019. This includes use of patient-facing application program interfaces (APIs), and particularly those that will enable patients to consolidate health data from multiple sources. It complements the new government-wide initiative called MyHealthEData. The initiative is expected to promote patient access to their entire electronic medical record and enable sharing of their personal health data among providers, caregivers and others.
• Change the metrics on how use of CHERT is demonstrated. This will no longer be measured on a pass/fail basis; instead, use will be scored on a 100-point scale. Scores over 50 will help providers to qualify for incentive payments and avoid Medicare payment reductions.
• Make changes to some requirements, including:
  • Adding two new metrics for electronic prescribing: the ability to query prescription drug monitoring programs (PDMPs) and verify opioid treatment agreements. These two measures will not be required in 2019; optional use by hospitals will add bonus points to their usage score in 2019. CMS is expecting to require them in 2020.
  • Requiring providers to report to fewer registries, although syndromic surveillance programs are now on the list.
  • Encouraging use of the CCDA’s shorter version referral note under a modified version of the Send a Summary of Care metric, which will now be called Supporting Electronic Referral Loops by Sending Health Information.

• Eliminate a significant number of measures acute care hospitals currently must report on and remove duplicative measures across the five-hospital quality and value-based purchasing programs. This would result in the removal of a total of 19 measures from the programs and would de-duplicate another 21 measures. These measures include those that are topped-out — meaning the overwhelming majority of providers are performing well on them — redundant measures, and measures that are excessively burdensome to report. This is expected to reduce more than two million burden hours for hospital providers impacted by the proposed rule, saving them $75 million. Details are summarized in a CMS fact sheet.

What’s the impact? The biggest impact is on vendors serving hospitals, which have the biggest number of changes to absorb. Ambulatory EHR vendors have some changes relating to a few measures. That said, the new proposed rule continues what EHR vendors have been doing already. Many EHR vendors are certified or working to be certified under the 2015 CHERT criteria, so they will be readily available to be used in 2019. Legislation and federal programs have been pushing APIs for some time, especially for patient engagement. Vendors have responded to meet these requirements and we expect to see continued, accelerated growth in that segment of the market. The new opioid-related requirements reflect policy changes at the federal level and activities in the states, which are requiring integration of PDMP data into EHRs and reporting on opioid treatment agreements.

All in all, vendors should see this proposed rule as a harbinger for 2020. Keeping abreast of the proposed changes, and commenting as appropriate before the June 25 deadline, will ensure that they have the opportunity to plan ahead and move methodically to the new requirements in anticipation of the next round of mandates.

Additional questions? Contact me at michael.burger@pocp.com.