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Readers Write: A Proposed Rule Peace Offering: More Regulatory Slack

May 2, 2017 Guest articles No Comments

Proposed Rule’s Peace Offering to Physicians: More Regulatory Slack
By Kerri Wing, RN


Items outlined in the proposed rule for the 2018 Inpatient Prospective Payment System (IPPS) recently released by CMS signal a growing awareness of the need for relaxed regulatory burden in healthcare. The proposed rule seeks to counter regulatory sprawl by realigning various reporting programs around common quality measures, and by actively seeking stakeholder feedback on additional opportunities for reporting program simplification.

While the bulk of the rule relates to hospital reporting programs, proposed changes for eligible professionals are also highlighted. Items in the proposal impacting physicians and EPs include:

  • Bringing the EHR Incentive Program (Meaningful Use) reporting period and clinical quality measures into alignment with the Merit-based Incentive Program (MIPS).
  • Eliminating MU penalties for EPs using de-certified EHR technology.
  • Exempting EPs who furnish “substantially all” of their services in ambulatory surgery settings from MU payment adjustments.

The Meaningful Use / MIPS Crossover

Proposed updates echo the “pick-your-pace” flexibilities extended to physicians under MACRA, which reduced clinical quality measure (CQM) and reporting period requirements for physicians on the quality payment program’s MIPS track. Under the IPPS rule, CMS is proposing to modify the MU reporting period for EPs to a continuous 90-day period during the 2017 calendar year. The rule also proposes that CQMs available to EPs under MU mirror those available under MIPS.

Streamlining that CQM cross-walk should simplify reporting for physicians and specialists participating in hospital programs. It’s nice to see CMS recognize that hospitals are part of the larger hub where data resides, and the value of migrating the industry in unison.

EHR Limitations

From a clinician perspective, the biggest challenge is having the right technology to meet CMS requirements. Providers often struggle to keep pace with reporting periods because regulations often don’t leave EHR vendors enough time to develop the regulatory requirements. The proposed rule would give providers hinged to EHR technology that has been de-certified by the ONC an opportunity to apply for penalty exemption.

Keeping up with ONC certification is a challenge that only so many EHRs can sustain, and market consolidation leaves providers with fewer options. Many providers who have invested heavily in these platforms are at the mercy of their EHR for quality reporting, but the technology is unable to maintain updates needed to keep pace with shifting requirements. The proposed penalty avoidance keeps providers from suffering twice for EHR limitations and offers providers breathing room to evaluate alternative technology solutions. (Though it’s worth noting that although MU penalties may be avoided, certified EHRs are still required for MACRA.)

ASC Exemptions

Many specialty EPs furnish the majority of their services in ambulatory surgery center settings. The proposal to exempt these EPs from 2017 and 2018 MU payment adjustments would eliminate reporting burdens for EPs with limited office time. CMS is requesting feedback on whether to set the “substantially all” ASC threshold at 75 percent or 90 percent of patient cases.

An Industry-wide Rally for Less Regulatory Burden

While the IPPS proposed rule’s impact on EPs is limited, the message it conveys is promising for physicians. CMS recognizes regulatory burdens to be a widespread problem. Offering more of a grace period and relaxed reporting requirements reduces the burden on everyone.

Equally notable is the open invitation to submit feedback on a gamut of issues related to regulatory overhaul. This includes an RFI on topics including but not limited to data sharing, payment system re-design, reporting elimination or streamlining, and how CMS issues regulations and policies. The RFI points to increased opportunities for provider influence and collaboration in assuaging regulation.

Providers interested in weighing in on the RFI have until June 13 to comment. Those commenting should encourage CMS to continue aligning quality reporting programs and further streamline the submission process. Essentially: Do more of what you’re doing right now.

As the industry inches towards a universal reporting program, it behooves both hospitals and physician practices to stay attuned to regulatory changes in inpatient and outpatient settings alike. Additional reporting program crossover is highly probable.

Kerri Wing, RN is director of clinical analytics at IHealth Innovations in Louisville, KY.


Jenn, Mr. H, Lorre

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