CMS Cuts Meaningful Use Reporting Period to 90 Days

Ken Terry

November 03, 2016

As expected, the Centers for Medicare & Medicaid Services (CMS) reduced the reporting period for physicians in the meaningful use electronic health record (EHR) incentive program from a full year to 90 days in 2016 as part of the just-released final rule for CMS's outpatient prospective payment system.

The final rule also shortens the reporting period to 90 days in 2017 for all returning participants. This change will mainly benefit hospitals because most physicians will be subject to the Merit-Based Incentive System (MIPS) next year and will no longer have to meet the meaningful use requirements.

CMS also finalized a one-time hardship exception for eligible professionals who are new participants in the meaningful use program and are transitioning to MIPS next year. These participants will be able to report once in 2017 to satisfy both the meaningful use criteria and the Advancing Care Information section of MIPS. By doing so, they will avoid a negative payment adjustment in 2018.

According to the 2015 final rule on physician payments, physicians have until February 28, 2017, to attest to meaningful use for 2016. The new final rule does not change this date, except for physicians and hospitals that have not previously demonstrated meaningful use. Those providers have until October 1, 2017, to meet the modified stage 2 criteria in the program and avoid penalties in 2018.

Hardship Exceptions

The final rule doesn't say anything about hardship exceptions for physicians who did not participate in meaningful use this year because they did not know whether the reporting period would be a full year. If such doctors want to start measuring their performance now, there isn't time left this year to report for 90 days.

When the same thing happened in 2015, Congress required CMS to grant mass hardship exceptions to physicians who hadn't attested to meaningful use. CMS complied with that edict early this year, so doctors who didn't attest in 2015 and requested the hardship exceptions won't see a cut in their Medicare payment rates in 2017. Now, with the same scenario unfolding, the question arises whether CMS will again offer blanket exemptions to nonattesting doctors.

In a news release, the American Medical Association (AMA) praised the finalization of the 90-day reporting period without mentioning hardship exceptions. That omission suggests that the AMA doesn't think the late release of the final rule will negatively affect physicians.

The American College of Physicians (ACP) also lauded CMS's decision to finalize the 90-day reporting period. "Last year Congress authorized CMS to issue wide ranging hardship exemptions due to significant changes to the 2015 reporting requirements and its late-in-the-year publication date," Shari Erickson, vice president of governmental affairs and medical practice for the ACP, said in an emailed statement to Medscape Medical News. "We continue to encourage CMS to issue final rules that impact reporting timelines earlier in the calendar year so that there is a clear expectation and timeline for both physicians and the government."

Steven Waldren, MD, director, alliance for eHealth innovation, at the American Academy of Family Physicians (AAFP), told Medscape Medical News that the AAFP sees no reason for mass exceptions to meaningful use this year. In the 2015 final rule on physician payments, he noted, CMS not only changed the reporting period to 90 days but also adjusted the patient engagement measures.

In addition, he noted, doctors had to use 2014 edition EHRs to show meaningful use in 2015, and not all vendors had recertified their products by the time CMS issued its final rule. In contrast, physicians didn't have to use the next iteration of certified EHRs in 2016; that won't be required under MIPS until 2018. So the need for EHR vendors to rewrite their software is not the issue that it was in 2015.

Finally, Dr Waldren noted, CMS has done "a better job of telegraphing what would be in this final rule [than they did last year], posting on blogs and so forth." As a result, physicians could be fairly sure, before the issuance of the final rule, that there would be a 90-day reporting period this year.

"We told our members that the official regulation was a calendar year, but if they weren't able to do a calendar year, they should work toward doing it for a 90-day period, and that we were confident it would be in the final rule," he said.

The AAFP is also glad that CMS has adopted a 90-day reporting period for MIPS's Advancing Care Information category in 2017 and 2018. "We think that's needed," Dr Waldren said.

MIPS will supersede meaningful use and will also measure physician performance on quality and clinical practice improvement activities, with cost to be added later. Most physicians are expected to move into MIPS next year, at least to a token extent. Under the MIPS rules, they can just meet one quality or one clinical practice improvement measure, report fully for 90 days, or report for 12 months in 2017. Their other option is to join an advanced Alternative Payment Model, such as certain accountable care organizations and patient-centered medical homes.

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