Health information technology experts say the tight timelines surrounding a new round of clinical quality and IT measures may result in penalties for some physicians if those measures require significant changes to electronic health records and other systems.
The CMS this week produced an 80-page plan on how it would select the quality measures used in the Merit-based Incentive Payment System, or MIPS.
The agency last week released a timeline to implement the two new payment schemes, which replace the sustainable growth-rate formula for physician reimbursements under Medicare. It plans to release the new quality measures that will start being measured on Jan. 1, 2017, by Nov. 1.
If there are big changes to the quality measures, “there is no way that this can happen in time,” said Michael Martz, chief information officer of Ohio Valley Health Services and Education Corp. in Wheeling, W.Va. “I would say they need to give us a year and two months, and not two months, to implement these new quality measures.”
Payments or penalties under MIPS will be calculated against four performance categories: quality, resource use, clinical practice improvement activities and “advancing care information.”
The quality measures plan says that “MIPS will be built upon existing quality measures,” including those in the EHR incentive payment program, but also those in the Physician Quality Reporting System and the Value-based Payment Modifier. All three will sunset at the end of 2018 prior to MIPS taking over Jan. 1, 2019.
But the plan also says that the CMS will be looking to fill “identified measure and performance gap areas” and may “expand and enhance existing measures." The number of measures will drop to six under the proposed new MIPS. There's nine in the current scheme.
A two-month window for software updates could prove problematic, “especially for the smaller practices that are running software that is not quickly upgradable or are server-based, which takes more time to upgrade,” said Robert Tennant, director of health IT policy for the Medical Group Management Association.
“From a systems standpoint, this still feels like meaningful use to me,” Martz said, referring to the regime the government has used for the past five years to judge whether providers deserve to be rewarded for using EHRs.
Because timelines for meaningful use proved too aggressive, the feds were forced several times to delay compliance dates for shifting to more stringent criteria.
According to the Office of the National Coordinator for Health Information Technology, the MACRA proposed rule says providers in 2017 may use EHRs that have been previously tested and certified.
ONC spokesman Peter Ashkenaz said he wouldn't speculate on what might happen if the CMS comes up with quality measures requiring EHR functions not covered by those certification standards.
Another new problem is that the MIPS program requires reporting of quality measures all year long, so even a short delay late this year could cause physicians to be noncompliant and subject to penalty next year.
That's why several medical groups have asked for a 90-day reporting period instead, Tennant said.
“What's even more awkward is any rule coming out late in the year of a prior administration is usually put on hold,” Tennant said. In early 2001, for example, the George W. Bush administration held for three months the HIPAA privacy rule issued in December 2000, the closing days of Bill Clinton's presidency.
“A Clinton administration or a Trump administration will want to at least have a look at the rules coming out late in the year,” Tennant said. “That makes it a challenge for the EHR vendors who have to invest in (research and development). It could impact the ability of the providers to make the change.”
The CMS should expect a lot of comments from provider groups, Tennant said. “We hope there are going to be significant modifications to the rule, which means there are potentially significant modifications by the vendors.”