If trying to follow regulatory programs has you feeling like a 20-year-old trying to catch Pokémon, join the club! However, for those just trying to see patients and run a practice, it is extremely difficult not only to find the time to understand all the programs, but also to add the additional reporting burdens and resources these programs require. To make matters more complicated, once you think you’ve finally got it, the rules change. Therefore, in this ever-changing regulatory world, I’ll try my best to level-set with you on the current state of what we know today.
Another 90-day reporting period for Meaningful Use (MU)?
Earlier this month, CMS released a proposed ruling entitled “Hospital Outpatient Prospective Payment Changes for 2016” that requests the 2016 MU reporting period be changed from a full calendar year back to a 90-day reporting period.
CMS also proposed that certain providers who have not attested to MU in 2016, but do intend on participating in MIPS in 2017, will have the opportunity to file for a hardship exemption in order to avoid a 2018 negative payment adjustment.
In addition, a group of GOP senators led by Senator John Thune (R-SD), introduced the EHR Regulatory Relief Act to reduce reporting periods not only for the EHR Incentive Programs but also the Merit-based Incentive Payment System (MIPS).
The EHR Regulatory Relief Act adds legislative weight behind CMS’ request for a 90-day reporting period in 2016. It also requests that a 90-day reporting period be repeated in 2017 during the first year of MIPS. Furthermore, it details an end to the pass-fail methodology of MU in 2018 and beyond (although the legislation makes no mention of MU becoming the advancing care information performance category under MIPS where the pass-fail methodology would be removed).
It seems like a no-brainer that with all the uncertainty surrounding 2017, that both proposals will pass. The only small hiccup could come from any financial implications of a shorter reporting period. If this bill means less revenue from physician penalties and Congress is a budget-neutral environment, then Congress will need to find the money from somewhere else.
A MACRA delay as well?
To make matters more interesting—due to the overwhelming industry feedback on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) proposed rule—CMS has given hints that MACRA will be delayed.
During a U.S. Senate Committee on Finance hearing earlier this month, CMS Acting Administrator Andy Slavitt left open the possibility that the epic shift in payment reform could be pushed back from the intended start date of Jan. 1, 2017.
Slavitt also suggested that CMS remains open to multiple approaches in the MACRA implementation, such as alternative start dates, shorter reporting periods, a “trial” period of MACRA without initial consequences, reducing the need for reporting in certain areas (via automatic data feeds from registries), and redefining how rural and small practices will participate. He even alluded to an interim final rule before a final rule so that every physician in the country can feel like “they are set up for success”.
What should I do now?
Although there is a lot of uncertainty in the air, focus can be given to what we know to be true today:
1. Prepare for PQRS.
The PQRS program is still a separate program in play; it behaves exactly as it has been defined in the 2016 Medicare Physician Fee Schedule. If you are a nephrologist (and not affiliated with an ACO), I’m going to add in a shameless plug to take a look at the Acumen PQRS Registry. The CKD measures group is still available to report on for the 2016 reporting period.
2. Read your QRURs.
Another separate program still in play in 2016 is the value-based payment modifier. A provider’s performance in this program is geared solely on claims data—so there is no reporting requirement. Therefore, in order to know how well you or your practice is doing, you must take a look at your QRUR.
QRURs provide information about the resources used and the quality of care furnished to a group’s or solo practitioner’s Medicare FFS beneficiaries. Your group can use your QRURs to see how your tax identification number (TIN) compares with other TINs caring for Medicare beneficiaries. TINs affiliated with an ESCO or ACO will not be affected by the VM program this year. An annual QRUR for the 2015 reporting year will be available at some point in September.
3. Prepare to report MU.
It is extremely likely that CMS will go back to another 90-day reporting period. However, you should always be prepared to report for the entire year. Final comments to the proposed change are due in September which means we won’t see a final decision until late fall/early winter. So, in the meantime, take a close look at the modified stage 2 measures and make sure you can pass an audit.
If the Advancing Care Information portion of MIPS stays nearly the same, you will want to identify measures you do really well in and focus on reporting those specific measures in the future. For those providers who take a hardship, it is very likely that the hardship options will remain intact. However, you should also consider reading up on how taking an MU hardship may affect your MIPS score in the future.
4. Keep a close eye on MACRA.
CMS should release some form of a ruling in November of this year. When that rule is released, it will only give clinicians 2 short months to prepare for whatever will be instated on January 1. Make sure you sign up for CMS email updates on MACRA, and of course subscribe to this blog!
No matter how the MU reporting period or how the MACRA final rule shakes out, it is written into law that payment adjustments will continue to occur in 2018 and that value-based payments will begin in 2019. How will your practice prepare during this time of uncertainty?
Diana Strubler, Policy and Standards Senior Manager, joined Acumen in 2010 as an EHR trainer then quickly moved into the role of certification and health IT standards subject matter expert. She has successfully led Acumen through three certifications while also guiding our company and customers through the world of Meaningful Use, ICD-10 and PQRS.