Meaningful Use: Is It Really Going Away or Just Hiding?

What About Penalties?

5. Is it true that there won't be any MU penalty for 2015 performance?

Yes, if you submit an exemption application to CMS by July 1, 2016. Physicians have an opportunity to avoid paying MU penalties for 2015 performance, owing to CMS' tardiness in issuing a new rule last year. But this exemption, affecting 2017 payments, is not automatic. It must be applied for.

The chance to avoid a penalty in 2017 is welcome news, because MU penalties have been steadily rising each year. They started in 2015at a rate of 1% of a physician's Medicare reimbursements, based on 2013 performance. Then they rose to a 2% rate in 2016, based on 2014 performance, and are slated to reach 3% in 2017, for 2015 performance.

However, in the 2015 performance year, CMS was late in releasing a new regulation. The regulation, which covered changes in stage 2 of MU, replaced the old 12-month reporting period with a new 90-day period. However, the release date, in first week of October, meant there was less than 90 days left in the calendar year to measure 2015 performance.

Physicians who had been awaiting the new rule before they started to measure performance would have been in a jam—there simply weren't enough days left in the year to meet the requirement. Congress reacted to this bureaucratic Catch-22 by passing the Patient Access and Medicare Protection Act^[5] in late December. The act said that doctors and other providers could apply for a hardship exemption from MU penalties; this exemption is usually used when the EHR vendor makes a mistake.

The AMA is advising all physicians, even those not affected by the delay, to file for the CMS hardship exemption. "The AMA is encouraging ALL physicians subject to the 2015 Medicare MU program to apply for the hardship," the organization stated in a release.^[6] "CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations."

The exemption is good news for tens of thousands of physicians who expected to pay penalties. CMS reported^[7] that nearly 257,000 physicians and other eligible professionals had to pay penalties in 2015 for 2013 performance.

Physicians can cite the CMS snafu when applying, and the usual documentation requirements will be waived, says Elizabeth Holland, senior technical advisor in the Division of Health Information Technology at CMS. In addition, she says, groups of providers can file a single application, and the deadline was recently extended from March 15 to July 1.

A CMS FAQ^[8] explains the application process. Anyone "for whom the timing of the rule caused a significant hardship" should fill out the application, it says. Also, if physicians file for an exemption but are expecting a payment rather than a penalty—which could happen if they are part of groups that files—don't have to worry about losing those payments. CMS says qualifying for the exemption does not waive your right to payment.

The open-ended exemption is a one-time deal, only for payments in 2017. But Holland says that in the future, some of the changes that streamline the application process might be preserved, such as allowing physicians to apply in groups.

6. What will the new MU look like?

CMS has already divulged some objectives, although exactly how the revamped MU program will operate will be described later this year.

There's some good news. CMS aims to encourage interoperability and "to minimize provider burden by collecting data that are part of the existing clinical workflow," according to the agency's Draft Quality Measure Development Plan,^[9] a document released in December. The plan also stated that MU rules should be "based as much as possible on existing provider workflows and inherently created as a by-product of providing clinical care."

Other changes that are on the horizon: The program should be "rewarding providers for the outcomes [that] technology helps them achieve with their patients," and it should give providers "the flexibility to customize health IT to their individual practice needs," according to a January 2016 blog post by Slavitt and Dr DeSalvo.

If MU can be aligned with outcomes, "It won't be important whether you used your technology to improve outcomes," says Probst, the Intermountain CIO. "The important thing will be that outcomes were improved." This greater emphasis on outcomes could reduce the reporting burden on physicians, he adds.

The CMS officials' January blog post also said that MU should emphasize interoperability, which so far MU has failed to create for many EHR systems. They said CMS should push for "federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care." 

CMS has already begun its push for interoperability. In March, the government announced that EHR vendors representing 90% of systems in use had pledged to a three-step plan to promote interoperability.

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Leigh Page. Meaningful Use: Is It Really Going Away or Just Hiding? - Medscape - Apr 20, 2016.