On Tuesday, October 6, 2015, CMS released the final rule for 2015. The final rule for 2015 also discusses Meaningful Use for years 2016 and 2017. The final rule for Meaningful Use Stage 3, which becomes mandatory in 2018, was also released.
The purpose of this update is to discuss what is required to meet the Meaningful Use requirements for 2015.
Please pay careful attention to the directions in this memo to understand what you must do to gain any remaining bonus payments and avoid the payment adjustments being imposed in 2017 based on this year’s performance.
Please read the Red Flag section carefully.
Facts
- CMS released the final rule after the first day of the last measurement period for this year and this level of tardiness is unprecedented.
- CMS does not share with EHR vendors the details of the final rule before it is published.
- EHR vendors can’t build functionality in advance of the rule because they don’t know what functionality is required.
- Most providers cannot meet all measures in advance of the final rule because they don’t have a full understanding of the required measures.
Measurement Period
The measurement period for this year is any 90-day period. Based on the way the rule is crafted, we anticipate that most of our users will need to attest to the final 90-day period. For any provider that is already enrolled on the MediTouch Meaningful Use interface for this year, we will automatically reenroll them for the final 90-day period of the year, which began on October 3, 2015.
Attestation Period
CMS won’t open the attestation portal until Jan 4, 2016, but you’ll have until February 29, 2016 to report.
Review the Measures
We suggest that you review the Meaningful Use 2015 Objectives and Measures now and then return to this document.
Red Flags
There are two obvious red flags:
- Health Information Exchange
- Public Health
Red Flag #1: Health Information Exchange (Only applies to Stage 2 Providers)
Objective: Health Information Exchange (previously this objective was: Summary of Care)
Measure: The EP that transitions or refers their patient to another setting of care or provider of care
(1) Uses CEHRT to create a summary of care record (CCDA); and
(2) Electronically transmits such summary to a receiving provider for more than 10 percent of transitions of care and referrals.
Part 2 of the Health Information Exchange measure is the requirement that is the Red Flag.
What this measure is really asking the provider to do is to:
Part 1 – Create a CCDA (summary of care document) at the time the provider is referring a patient for a consult or any transition of care. After the CCDA document is created, Part 2 of the measure requires that the CCDA is transmitted electronically via Direct Secure Messaging to the receiving party.
Help on how to use Direct Secure Messaging is available on our training site. Log into the application, go the help site and review the Direct Messaging help page.
The reason why using Direct Secure Messaging to transmit CCDA summary of care documents at a transition of care is considered a Red Flag is because some providers in your referral network may not have a Direct Secure Address. Over the past year, we have seen greater adoption of Direct by more and more EHRs. Remember, MediTouch was live on Direct since June of 2013. There never has been an easier time to comply, but compliance is dependent on adoption by your referral network.
What You Should Do
Make sure that enough of the providers that you transition care to, via the MediTouch Orders/New Consult module, have Direct Secure Messaging enabled. Having more providers that you transition care to contributing to your denominator for this measure will make meeting the 10% threshold for the numerator achievable.
About the Exclusion for the Health Information Exchange Measure:
There is an exclusion for this measure: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.
If you are a physician that makes less than 100 “referrals or transitions” in the measurement period, you can attest to this exclusion. It is far easier to meet this “less than 100 times” threshold in 2015 because the measurement period is just 90 days. Next year, the measurement period will be a full year, but the exclusion number will remain at 100.
None of the Providers I Transition Care to Have Direct Secure Messaging:
If you believe that none of the providers in your referral network have Direct Messaging, you can claim a hardship exemption some time in 2016. We advise to always try to comply and attest successfully. It will be up to you to prove that your referral network did not support the 10% threshold should CMS choose to audit your practice. The MediTouch team will not be able to provide documentation of this fact so please document carefully if you choose to claim a hardship exemption for this measure.
Red Flag #2: Public Health
Measure 1 – Immunization Registry Reporting:
The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit immunization data.
Measure 2 – Syndromic Surveillance Reporting:
The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit syndromic surveillance data.
Measure 3 – Specialized Registry Reporting
The EP, eligible hospital, or CAH is in active engagement to submit data to a specialized registry.
STAGE 2 PROVIDERS ARE REQUIRED TO REPORT 2 OF THE 3 MEASURES.
STAGE 1 PROVIDERS ARE REQUIRED TO REPORT 1 OF THE 3 MEASURES IN 2015 AND 2 OF THE 3 MEASURES IN 2016 AND 2017.
Definition of Active Engagement
Proposed Active Engagement Option 1 – Completed Registration to Submit Data: The EP, eligible hospital, or CAH registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP, eligible hospital, or CAH is awaiting an invitation from the PHA or CDR to begin testing and validation. This option allows providers to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process. Providers that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.
Proposed Active Engagement Option 2 – Testing and Validation: The EP, eligible hospital, or CAH is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.
Proposed Active Engagement Option 3 – Production: The EP, eligible hospital, or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.
Many Providers May Be Able to Claim an Exclusion for One or More Measures: read the Public Health Reporting Exclusions document.
The rule works in a round-robin fashion. If you meet the exclusion criteria from one Public Health Measure, you must report the other one or two depending on your stage. If you meet the exclusion criteria for two measures, you must report the remaining one. If you meet the exclusion criteria for all three measures, you need not report any.
Read This Carefully
Historically CMS was requiring active ongoing submission of data, now the Public Health Measures simply required “active engagement” within 60 days from the start of the measurement period. This means that if you can’t be excluded from the measure you must actively engage. Assuming you are a Stage 2 Provider that can’t use the exclusion criteria for more than one measure, you must report that you are actively engaged for the other two measures. Today, most providers are not actively engaged with two Public Health Registries. Some may be actively engaged with one, usually an Immunization Registry, but very few are engaged with two registries. If you are a Stage 2 provider, you must be actively engaged with two registries.
NO PROVIDER SHOULD FAIL MEANINGFUL USE BECAUSE OF THE PUBLIC HEALTH MEASURES.
What You Should Do
If you do not meet the definition of active engagement with two Public Health Registries today, you still have time to meet the definition of active engagement. You must actively engage within 60 days of the start of the last reporting period, which began on October 3, 2015.
REMEMBER ACTIVE ENGAGEMENT CAN BE AS SIMPLE AS COMPLETING REGISTRATION TO SUBMIT DATA AND RECEIVING AND SAVING THE ACKNOWLEDGMENT OF YOUR REGISTRATION.
Public Health Measure Next Steps:
- It is impossible for EHR vendors to connect to every Public Health Agency in every jurisdiction in the country.
- Most Local or even Statewide Public Health Agencies are not ready to connect to EHR vendors.
- Some Public Health Agencies do not support one or more of the registry types included in the Meaningful Use Public Health Objective.
- There are several national Specialty Registries that may satisfy the needs for most MediTouch providers.
MediTouch is in the process of exploring relationships with several national Specialty Registries. Our thesis is that by connecting to several national registries it will allow us to aggregate our providers to a limited amount of registries hence reducing your connection and maintenance costs of ongoing submission in the future. We will soon publish our preferred list of Specialty Registries in a communication such as this one to all of our users.
Takeaways
- Our team is confident that our providers can meet Meaningful Use for 2015, but it will require some extra attention from your team.
- We will automatically enroll any provider that had previously enrolled in Meaningful Use for 2015, regardless of stage in the last 90-day measurement period, October 3 – December 31, 2015.
- If you have not enrolled on our Meaningful Use enrollment interface this year, a new enrollment screen will be made available in the next few weeks and we will be able to calculate your data back to October 3, 2015.
- Pay careful attention to the Red Flags captioned above.
- We will update the Meaningful Use report card screen in the next few weeks to reflect the latest objectives and measures.
- Watch for further communications relating to Meaningful Use 2015. There will be several more.