The healthcare industry is hard at work reviewing recent significant regulatory developments from the U.S. Department of Health & Human Services. We can be certain that elements of these proposals will change when the final versions come out, but nonetheless, there are some big ideas to process in each of them.
We’re in the midst of a 60-day public comment period. Here’s a summary of the big three proposed rules from Centers of Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC):
1. CMS: Definitions of Meaningful Use – Changes to Stage 3
We anticipate CMS will finalize this rule in August or September. It focuses heavily on interoperability, laying the groundwork for a focus on quality and outcomes-based payment models.
It proposes an option in 2017 of moving to Stage 2 or 3, and all participants would move to stage 3 in 2018. Effectively, CMS would abolish stages at that point. All reporting periods also would become one calendar year.
CMS eliminated several measures in an attempt to make Meaningful Use simpler. While it says you only have to attain eight objectives, in reality these are eight categories including a total of 21 measures. But several redundant or “topped-off” measures – things that people are now doing consistently – no longer require reporting.
The proposed rule also continues to consolidate Clinical Quality Measures (CQMs) into a single set for all its incentive programs. Ultimately participants will need to submit these electronically.
2. ONC: Definitions of certifications – Facilitate interoperability
This proposed rule’s main purpose is to improve accessibility and exchange of data with a single certification program that serves several types of programs.
Software certification would no longer be exclusively tied to Meaningful Use under the proposals. This means that certified systems would need to be able to provide functionality that is not only about what Meaningful Use participants are measured on but also that which is helpful to other advanced payment models, such as ACOs.
One change is the announcement that on-site field audits are likely coming. The ONC intends to randomly survey (an ambitious) 10% of all installations. It’s unclear exactly what such an audit would look like, but it would test the software, not your workflows.
We expect this rule to be final in late summer. Participants don’t need to focus on the details within this rule, but there is more work for software vendors here, and any unrealistic timing from the regulators could impact developers’ ability to execute efficiently.
3. CMS: Meaningful Use modification rules for 2015-17
This is a rule that everyone is eager to see finalized because it affects 2015. CMS has suggested it will finalize the rule in July, which is an aggressive timeframe.
There are a couple of changes to the reporting periods. 2015 becomes a 90-day floating reporting period, no matter what stage or year you’re in. Eligible hospitals would also move to a calendar year, which would give them three extra months this year.
Other proposed changes came as more of a surprise. The work wouldn’t change; the measures would stay the same or get easier. However, the rule would restructure the reporting of measures – something for us to take care of. Luckily, however, there would be no changes to certification, meaning no need for a new system or any upgrades.
CMS proposes not allowing attestation for 2015 activity until January 2016. If you started in 2014 or 2015, you will get some exceptions in a “special” Stage 2, for 2015 only (several exclusions apply).
5 tips for regulatory success
In processing these three proposed rules, it’s good to understand what steps providers could take even as the government reviews and finalizes the rules. Smart providers know that preparation is key to success when it comes to regulatory compliance. A few specific action items include:
1. Respond to public comment. It’s in your best interest to do so. As someone who reviews these rules regularly, I’ve seen that your comments mean a great deal to the government – in fact, we’ve been told explicitly that your comments are the most important ones they receive. The public comment period for the first two proposed rules will close May 29, the third rule on June 15.
2. Treat 2015 as a full year. While you may only need to report on 90 days, don’t stop demonstrating your success. If you stop trying to achieve these goals, only to return to them later, it’s like jumping off a moving bus and trying to jump back on. And the reality is the modification rule is only proposed, so you should act as if it’s not changing until it’s finished.
3. Be vigilant with patient engagement. These are the thorniest of measures in many ways. It takes time to build success here, and the thresholds if adopted as proposed will be high in 2018. It’s not something you can do just by installing software, but rather it takes a long, dedicated effort. Get started, and never let up on the effort.
4. Watch out for workflows involving paper. It’s a good idea to wean your organization completely off of paper-based processes. Remember that giving paper to patients and documenting electronically after the fact will not count.
5. Stay tuned for more information. Clients can access more information on ClientConnect, including a full webinar presentation on this topic.
What’s your reaction to these proposed rules? Share your thoughts in the comments below.