On Tuesday October 6, 2015 CMS released the final rule for this year. The final rule for this year also discusses Meaningful Use in years 2016 and 2017. In addition, the final rule for Meaningful Use Stage 3, which becomes mandatory in 2018, was released.
The purpose of this update is to discuss what is required to meet the Meaningful Use requirements for this year (2015).
Please pay careful attention to the directions in this blog in order to understand what you must do to gain any remaining bonus payments – and avoid the payment adjustments being imposed in 2017 based on this year’s performance.
- CMS released the final rule after the first day of the last measurement period for this year and this level of tardiness is unprecedented.
- CMS does not share with EHR vendors the details of the final rule before it is published.
- EHR vendors can’t build functionality in advance of the rule because they don’t know what functionality is required.
- Most providers cannot meet all measures in advance of the final rule because they don’t know have a full understanding of the required measures.
The measurement period for this year is any 90-day period. Based on the way the rule is crafted we anticipate that most providers will need to attest to the final 90-day period.
CMS won’t open the attestation portal until Jan 4th 2016, but providers will have until the last day of February to report.
Review the Measures:
We suggest that you review the measures from this PDF document on the CMS website.
There are 2 obvious red flags:
Red Flag #1 – Only applies to Stage 2 Providers
Objective: Health Information Exchange (previously this objective was: Summary of Care)
Measure: The EP that transitions or refers their patient to another setting of care or provider of care
(1) uses CEHRT to create a summary of care record (CCDA); and
(2) electronically transmits such summary to a receiving provider for more than 10 percent of transitions of care and referrals.
Part 2 of the Health Information Exchange measure is the requirement that is the Red Flag.
What this measure is really asking the provider to do is to:
Part 1, create a CCDA (summary of care document) at the time the provider is referring a patient for a consult or any transition of care. Once the CCDA document is created Part 2 of the measure requires that the CCDA is transmitted electronically via Direct Secure Messaging to the receiving party.
The reason why using Direct Secure Messaging to transmit CCDA summary of care documents at a transition of care is considered a Red Flag is because some providers in your referral network may not have a Direct Secure Address. Over the past year we have seen greater adoption of Direct by more and more EHRs, remember MediTouch was live on Direct since June of 2013. There never has been an easier time to comply, but compliance is dependent on adoption by your referral network.
WHAT YOU SHOULD DO:
Make sure that enough of the providers that you transition care to have Direct Secure Messaging enabled. Having more providers that you transition care to contributing to your denominator for this measure will make meeting the 10% threshold for the numerator achievable.
About the Exclusion for the Health Information Exchange Measure:
There is exclusion for this measure: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.
If you are a physician that makes less than 100 “referrals or transitions” in the measurement period you can attest to this exclusion. It is far easier to meet this “less than 100 times” threshold in 2015 because the measurement period is just 90 days. Next year the measurement period will be a full year but the exclusion number will remain at 100.
None of the Providers I Transition Care to Have Direct Secure Messaging:
If you believe that none of the providers in your referral network have Direct Messaging you can claim a hardship exemption sometime in 2016. Our advice is to always try to comply and attest successfully. It will be up to you to prove that your referral network did not support the 10% threshold should CMS choose to audit your practice. The MediTouch team will not be able to provide documentation of this fact so please document carefully if you choose to claim a hardship exemption for this measure.
Red Flag #2
Measure 1 – Immunization Registry Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit immunization data.
Measure 2–Syndromic Surveillance Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit syndromic surveillance data.
Measure 3–Specialized Registry Reporting – The EP, eligible hospital, or CAH is in active engagement to submit data to a specialized registry.
STAGE 2 PROVIDERS ARE REQUIRED TO REPORT TWO OF THE THREE MEASURES.
STAGE 1 PROVIDERS ARE REQUIRED TO REPORT ONE OF THE THREE MEASURES IN 2015 AND TWO OF THE THREE MEASURES IN 2016 AND 2017.
DEFINITION OF ACTIVE ENGAGEMENT:
Proposed Active Engagement Option 1–Completed Registration to Submit Data: The EP, eligible hospital or CAH registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP, eligible hospital, or CAH is awaiting an invitation from the PHA or CDR to begin testing and validation. This option allows providers to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process. Providers that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.
Proposed Active Engagement Option 2 – Testing and Validation: The EP, eligible hospital, or CAH is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.
Proposed Active Engagement Option 3 – Production: The EP, eligible hospital, or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.
Many Providers May Be Able to Claim an Exclusion for One or More Measures:
Read about the Public Health Exclusions at the CMS web page captioned above.
The rule works in a round robin fashion; if you meet the exclusion criteria from one Public Health Measure you must report the other one or two depending on your stage. If you meet the exclusion criteria for two measures you must report the remaining one and if you meet the exclusion criteria for all three measures you need not report any.
READ THIS PART CAREFULLY:
Historically CMS was requiring active ongoing submission of data, now the Public Health Measures simply required “active engagement” within 60 days from the start of the measurement period. This means that if you can’t be excluded from the measure you must actively engage. Assuming you are a Stage 2 Provider that can’t use the exclusion criteria for more than 1 measure you must report that you are actively engaged for the other 2 measures. Today most providers are not actively engaged with two Public Health Registries. Some may be actively engaged with one, usually an Immunization Registry, but very few are engaged with two registries. If you are a Stage 2 provider you must be actively engaged with two registries.
NO PROVIDER SHOULD FAIL MEANINGFUL USE BECAUSE OF THE PUBLIC HEALTH MEASURES.
WHAT YOU SHOULD DO:
If you do not meet the definition of active engagement with two Public Health Registries today you still have time to meet the definition of active engagement. You must actively engage within 60 days of the start of the last reporting period, which began on October 3rd 2015.
*REMEMBER: ACTIVE ENGAGEMENT CAN BE AS SIMPLE AS COMPLETING REGISTRATION TO SUBMIT DATA AND RECEIVING AND SAVING THE ACKNOWLEDGMENT OF YOUR REGISTRATION.
Public Health Measure Next Steps:
- It is impossible for EHR vendors to connect to every Public Health Agency in every jurisdiction in the country.
- Most Local or even Statewide Public Health Agencies are not ready to connect to EHR vendors.
- Some Public Health Agencies do not support one or more of the registry types included in the Meaningful Use Public Health Objective.
- There are several national Specialty Registries that may satisfy the needs for most providers.
- Our team is confident that our MediTouch providers can meet Meaningful Use for 2015.
- Stage 1 providers should have a very simple path to success.
- Stage 2 providers need to understand the Red Flags discussed in this blog.
- Ask your vendor for their upgrade plan for Meaningful Use 2015, they should be providing your practice with a new Meaningful Use report card that documents numerator and denominator values and reflects the layout of the new objective set.
- Follow your progress for all measures that have numerators and denominators – don’t wait till the end of your measurement period to “catch up”.
- Plan on attesting early in January, don’t wait till the last day of February, but good news, next year is a leap year so you’ll have one extra day!
- Watch for further communications relating to Meaningful Use 2015, there will be several more.