CMS Will Work With Stakeholders to Amend Meaningful Use Criteria

The Centers for Medicare and Medicaid Services (CMS) is vowing to engage with stakeholders to update and improve “meaningful use” criteria for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs this year.

In a January 26 blog on the CMS website, Patrick Conway, M.D., CMS deputy administrator for innovation, said changes under consideration include reducing the program’s complexity and shortening the EHR reporting period in 2015 from a full year to just 90 days.

“These intended changes would help to reduce the reporting burden on providers, while supporting the long-term goals of the program.

“The new rule, expected this spring, would be intended to be responsive to provider concerns about software implementation, information exchange readiness, and other related concerns in 2015,” Conway wrote. “It would also be intended to propose changes reflective of developments in the industry and progress toward program goals achieved since the program began in 2011.”

Specifically, Conway said the administration proposes to do the following:

“To clarify, we are working on multiple tracks right now to realign the program to reflect the progress toward program goals and be responsive to stakeholder input,” he said.

Conway added that the proposals are separate from the forthcoming Stage 3 proposed rule expected to be released sometime this month. CMS intends to limit the scope of the Stage 3 proposed rule to the requirements and criteria for meaningful use in 2017 and subsequent years.

The announcement comes in response to concerns expressed by the AMA and other medical organizations, including APA.

“The AMA welcomes the Centers for Medicare and Medicaid Services’ announcement of plans to address some of the issues we have raised with the Meaningful Use program through rulemaking aimed at requirements for meeting Meaningful Use in 2015,” AMA President Steven Sack, M.D., said in a statement.

“We are eager to see the proposed rule as we have been working with CMS and the Office of the National Coordinator for Health IT (ONC) offering solutions to improve the incentive program for quite some time.

“We hope the new rule will be issued expediently to provide the flexibility needed to allow more physicians to successfully participate in the Meaningful Use program and better align Meaningful Use with other quality reporting programs such as the Physician Quality Reporting System (PQRS) and the Value-Based Modifier (VBM). …”

In general, a physician will be considered a meaningful EHR user during an EHR reporting period in a payment year if he or she uses certified EHR technology to capture, exchange, and report specific quality measures.

APA has addressed confidentiality concerns as well as concerns about a dearth of quality measures relevant to meaningful use by psychiatrists.

In a December 30, 2014, letter to CMS in response to the 2015 Medicare fee schedule released that month, APA CEO and Medical Director Saul Levin, M.D., M.P.A., said many psychiatrists are trying to comply with the PQRS system but are shut out or are automatically triggering the measure applicability verification process because they cannot find enough relevant measures to include in their reporting.

“CMS must ensure a sufficient number of appropriate measures are available for all physicians regardless of specialty,” wrote Levin.

“APA has analyzed the available measures and finds that only 10 of the measures that could possibly be reported by psychiatrists can be reported via the claims-based process for 2015. In 2014, there were four specific psychiatric-focused measures available for claims-based reporting. In 2015, these four measures may be reported only through an EHR. Psychiatry generally has a low adoption rate for EHR technology due to the confidentiality and stigmatization around mental health. Consequently, psychiatric physicians may be unable to meet the PQRS reporting requirements and be subject to the downward adjustment that has repercussions for other programs as well.”

In comments to Psychiatric News, Steve Daviss, M.D., chair of the APA Committee on Mental Health Information Technology, especially emphasized the confidentiality concerns around electronic health records as they currently exist. He said EHRs generally lack the capability of properly handling HIPAA-defined “psychotherapy” notes that carry a greater degree of privacy protections than other parts of the electronic records.

“Because of the stigma and sensitivity of mental health- and addiction-related information, psychiatrists need EHRs that can maintain the privacy protections built into HIPAA,” he said.

He added that another reason that psychiatry has such a low EHR adoption rate is that psychiatrists are concerned about the general lack of “granular control” that patients have over who has access to more sensitive portions of their records, which are sometimes shared across health information exchanges (HIEs). Most HIEs require all-or-nothing consent for practitioners to access their records, he said.

“Patients should be able to enjoy the care coordination benefits provided by EHRs and HIEs while maintaining control over who can access more sensitive parts of their records. Unfortunately, having these protections in place is not a meaningful use requirement within electronic medical records.” ■

A complete list of PQRS measures for all reporting mechanisms can be accessed here. A summary of the key provisions in the 2015 Medicare Physician Fee Schedule Final Rule, including information on the PQRS reporting system, is available on APA’s website.