From Measuring “Clicks” to Measuring Performance

By: Elizabeth N. Pitman, CHPC ( Beth ) with Waller Lansden Dortch & Davis, LLP


“For the times they are a-changin’” says Bob Dylan, and his advice, “then you better start swimmin’ or you’ll sink like a stone,” could easily apply to providers floating in CMS’s ebb and flow of reimbursement/incentive/penalty structures. Just when providers have become accustomed to the technology and workflows necessary for navigating the Meaningful Use EHR incentive program and other required CMS provider reporting, CMS announces change. In mid-January Andy Slavitt, CMS administrator, announced what sounded like the demise of the Meaningful Use Incentive Program only to clarify his statement the following week in the January 19th CMS blog with his co-administrator, Karen DeSalvo.

The CMS Administrators pointed out that Meaningful Use would continue into the unforeseeable future as a component of the composite provider performance score enacted in the new Medicare Merit-based Incentive Payment System (MIPS) under the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA), stating “While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next.”

Adele Allison (Director of Provider Innovation Strategies at Birmingham’s DST Health Solutions), a subject matter expert and national speaker on federal legislation and policymaking related to HIT, healthcare reform, and provider reimbursement models, agrees that Meaningful Use is here to stay: “Today, the majority of providers are used to reimbursement under a fee schedule. However, MACRA rapidly moves Medicare down the payment reform causeway and heralds the onset of acceptable new forms of reimbursement designed to draw a hardline on cost containment. This new payment era will result in differential payment based on quality and efficiency data; and, adoption and use of health IT - Meaningful Use - will be one of those measures. As of 2019, MACRA makes Meaningful Use permanent under MIPS as a component of a weighted performance measure for Medicare reimbursement. Other payers will follow this lead. Simply stated, meaningful use is now tied to provider long-term economic success.”

MIPS represents a shift from performance measurements based on the frequency of technology use to outcomes-based measurements demonstrated through use of technology in producing better patient outcomes, cost savings and a healthier patient population. Under MIPS, beginning in 2019, CMS will sunset the applicable payment adjustments under the CMS programs and replace adjustments with the MIPS 100 point weighted performance scale: clinical quality performance, 30%; resource utilization, 30%; meaningful use, 25%; and clinical practice improvement, 15%. MIPS is intended to be budget neutral, differentiating the poor performers from the best performers. The top 25% have the ability to receive a 10% performance bonus while the lower 25% will see like-minded reductions in reimbursements. The exact scoring standards are yet to be defined. Slavitt and DeSalvo said to expect regulations in spring 2016 guided by four principles: (1) rewarding providers based on patient outcomes achieved through technology, (2) flexibility in customizing HIT which fits the provider’s needs, (3) promoting technological innovation and (4) prioritizing interoperability. MACRA also establishes incentive payments for providers participating in Alternative Payment Models (APMs) such as bundled payments and accountable care organizations (ACOs) and we can expect that the quality measures will be comparable to those in MIPS.

So what does that mean for now? From 2016-2018, providers will continue to measure Meaningful Use, and other CMS quality measurement programs, under the current set of standards. Providers will have the opportunity to contribute to the structure of MIPS and time to prepare for MIPS. This transition phase should also enable HIT vendors and developers to shift their focus to technological innovation that meets the principles under MIPS as opposed to the checklist functionality under Meaningful Use compliance.

CMS’s Dec. 18, 2015 draft “Quality Measurement Development Plan” (MDP) lays out a strategy for meeting the 4-pronged scoring of MIPS through alignment of the CMS quality measurement programs of Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM) and the Meaningful Use incentive program. The MDP is open for public comment through March 2016, the final MDP is expected to be published in May 2016 and CMS expects to release the Final Rule for MIPS no later than November 1, 2016.

At present, MIPS applies solely to physician and non-physician providers. While CMS states that there will be a correlating program for hospitals, it has not yet been announced.