What is the Incentive Program again?
The Centers for Medicare & Medicaid Services (“CMS”) began
its meaningful use incentive program with Stage 1 nearly four years ago in
2011. By 2017, Stage 3 is projected to
be fully implemented. Recently, in March
2015, the Department of Health and Human Services (HHS) released
the Notice of Proposed Rulemaking (NPRM) identifying the criteria for Stage 3. Like its preceding stages, Stage 3
will mandate eligible professionals, eligible hospitals, and critical access
hospitals to meet certain criteria in order to receive Medicare and Medicaid
incentive payments and avoid penalties.
To qualify for incentive payments, eligible providers
must demonstrate meaningful use for each year they participate in the
program. Eligible providers that do not
demonstrate meaningful use will incur a penalty—a “payment adjustment.” The adjustment reduces reimbursement by “1%
and increases each year that an eligible professional does not demonstrate
meaningful use, to a maximum of 5%.”
What’s going on with Stage 3?
Stage 3
takes the role of improving outcomes that align with the goals of the previous
stages. Stage 1 focused on capturing and sharing data, and Stage 2 focused on
advancing the clinical processes. One recommended
outcome that has been identified is to increase patient engagement. Three measures of engagement have been
recommended, and providers must report all three measures, but only have to meet
the standards of two.
The first measure comes from the Office of the National
Coordinator (“ONC”) which recommends increasing the rates at which patients “view,
download, and transmit their personal health data” from 5%, laid out in Stage 2,
to 25%. The second recommended measure
would require that at least 35% of patients seen by eligible providers, at
discharge or check-out, receive a “secure message” from the provider’s
electronic health record’s (“EHR”) messaging function. The third measure would require at least 15%
of patients to participate in contributing to their personal EHR by gathering and
entering health related data into their EHR.
Concerns
Although these measures are intended to improve patient
outcomes, there are concerns relating to the recommended measures. First, interacting with patients through electronic
messaging provides the patient with little context and uses technical jargon
the patient may not understand. Second, many
providers face challenges in meeting the 5% Stage 2 requirement in having their
patients view their online EHR. Lastly,
besides facing these challenges moving into Stage 3, HHS is trying
to address the ongoing issues since the EHR inception, which include:
“the burden of reporting to multiple quality reporting programs, the number of EHR
Program requirements, the timing of EHR meaningful use reporting periods, and
the numerous stages of participation.”
Conclusion
With the inception of the electronic health record and the
increasing demands placed on providers, HHS states that the overall goal
for Stage 3 is to support “broader efforts to increase simplicity
and flexibility in the program while driving interoperability and a focus on
patient outcomes in the meaningful use program.” Time will tell whether eligible providers
will be able to keep up with the evolving EHR and the demands of the ongoing
incentive program.
Lauren E. Masching is pursuing her law degree and
health law certificate at DePaul University College of Law in Chicago,
Class of 2017. Lauren completed her undergraduate degree at
the University of Iowa and has a Bachelor of Science in
Nursing. She is an active member of the Jaharis Health Law
Institute as Co-Vice Chair of Outreach and Recruitment. She is interested
in pursuing a career in either Administrative Health Law or working
in-house after graduation.