Physician groups and other stakeholders continue to respond to CMS' release of the Merit-Based Incentive Payment System and Alternative Payment Models proposed rule and some have launched education and outreach efforts to help physicians prepare for the coming change.
Physician groups and other stakeholders continue to respond to CMS' release of the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM) proposed rule. Some stakeholders released statements offering direct feedback on the proposed rule and outlining how they believe the new payment systems should be structured. Others launched education and outreach efforts to help physicians prepare for the coming change.
The American Hospital Association (AHA) suggested four changes to MIPS it believes will help physicians. MIPS will measure performance across four broad categories, with scores in each category contributing a set percentage to the overall score. The quality category of MIPS will replace the current Physician Quality Reporting System (PQRS) and the quality component of the Value-Based Payment Modifier Program. The AHA believes CMS should ensure that, in the final rule, MIPS measures physicians fairly and encourages providers across the healthcare delivery system to work closely together. The AHA's recommeded changes include:
An increased focus on national priority areas in required reporting
Risk-adjusted measures that accommodate physicians who care for complex patients
Alignment of physician and hospital EHR Incentive Program changes
Permitting physicians associated with hospitals to use their hospital's quality and performance reporting in MIPS
With the implementation of MIPS, CMS has an opportunity to reduce the volume of measures physicians currently report under PQRS and the Value-Based Payment Modifier Program, the AHA said. The more than 200 individual measures physicians must report for 2017 create a heavy administrative burden. In addition, current measures do not always align with national goals or collect data of concrete value. Although CMS has made significant strides toward eliminating redundant reporting in the proposed rule and reduced PQRS reporting measures, the AHA believes the agency should further streamline and coordinate reporting.
The American Academy of Family Physicians (AAFP) rolled out MACRA education and continues to offer comments on MIPS. The AAFP launched a MACRA outreach and education website May 6. The website includes important dates, acronyms, and a review of how value-based payment models affect physicians. The website will be updated regularly, the AAFP says.
The AAFP successfully advocated to have patient-centered medical homes (PCMH) qualify as an APM in the proposed rule. In an April 22 letter, sent only days before the release of the proposed rule, the AAFP urged CMS to class PCMHs as APMs. Although the proposed rule does state that PCMHs qualify as APMs, it's not clear if they qualify as advanced APMs. PCMHs would need to qualify as advanced APMs to be exempt from MIPS.
The American Medical Association (AMA) expressed support for the proposed rule, saying it believes CMS listened to physicians' concerns. The AMA also released MACRA and MIPS resources for physicians. The resources currently include tips on preparing for MIPS, key points of the new payment models, and other information on value-based care models.
Although some progress has been seen, a lack of health IT vendor transparency and cooperation have been named as barriers to interoperability in the ONC’s annual report.
A version of this article originally appeared on HCPro.com
The Office of the National Coordinator of Health IT has published its annual report to Congress detailing the ups and downs of health IT in 2015 and plans for 2016. The report summarizes actions taken by various government agencies to advance health IT, such as the Department of Health and Human Services’ Federal Health IT Strategic Plan, the ONC’s Interoperability Roadmap, and CMS’s EHR Incentive Programs, and touches on the pivotal role private-sector industry plays in realizing the goals outlined in the report.
The report identifies three critical areas that the ONC and all departments of HHS will focus on for 2016:
Interoperability
The security and usability of health IT
Simplifying health IT incentive program requirements and creating clear links between participation and positive outcomes
Some progress was made in the area of interoperability, according to the report. The ONC launched a number of initiatives over the past year to promote interoperability and chip away at obstacles to its realization, including grant award programs such as the Community Health Peer Learning Program.
Roughly a quarter of hospitals reported that they engaged in all four interoperability functions (finding, sending, receiving, and using electronic health information) in the joint ONC and American Hospital Association’s 2014 Annual Survey Information Technology Supplement.
Interoperability, however, faces significant barriers. Although the report touts the overall success of the EHR incentive programs, it acknowledges that, in part due to the limited types of healthcare providers eligible to participate in the programs, there are limitations to its benefits. A study published in the March issue of Health Affairspoints out that EHR adoption among ineligible hospitals and providers, including long-term care, rehabilitation, and psychiatric hospitals, lags significantly.
This disparity means that a patient’s records don’t travel seamlessly across the healthcare system and those gaps in information can lead to poor care coordination, escalating costs, and other quality and safety issues, according to Daniel Walker, PhD, MPH, the study’s lead author. The ONC’s report draws similar conclusions about the unequal state of health IT adoption across the healthcare continuum.
The lack of health IT vendor transparency and cooperation are also named as barriers to interoperability. The report calls for the ONC to be given greater jurisdiction to require vendors to disclose detailed information about their products. The report also says that the strict non-disclosure provisions in vendor’s licensing agreements prevent users from sharing important information about a product’s usability and security. A proposed rule announced March 1 would give the ONC direct oversight of health IT certification, including the power to review and terminate certification.
Despite a number of high-profile security breaches, the privacy and security of health IT saw some support in 2015 through the 2015 Edition final rule of the ONCs Health IT Certification Program. Improvements in the 2015 Edition include new data segmentation criteria that allows providers to flag certain sensitive information, such as substance abuse and behavioral health information, for additional protection while still including it in the appropriate data stream. However, 2015 also saw large-scale breaches that affected more than a hundred million Americans.
Cybersecurity continues to be a challenge to health IT, and efforts to address it will be an on-going concern in 2016.