Delays Force Feds To Propose EHR Reporting Changes

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The Centers for Medicare and Medicaid Services (CMS) said it plans to allow eligible professionals to attest in 2012 that they have used their electronic health records to collect data on clinical quality measures as part of the CMS criteria for "Meaningful Use" of EHRs.

The 2010 Meaningful Use regulations required attestation only in 2011; after that, providers were to report the quality data by uploading it from their EHRs to a CMS-designated Web portal. In its new proposed rule on changes in physician reimbursement, CMS explained that it would allow attestation in 2012 because it's not yet ready to accept the data online.

At the same time, CMS announced the creation of a new pilot program to pave the way for online submission of quality data from EHRs. Because CMS wants to move toward a system in which physicians can report the same data for meaningful use and for CMS' Physicians Quality Reporting Initiative (PQRI), the program is called the Physicians Quality Reporting System-Medicare EHR Incentive Pilot.

Eligible professionals who join the pilot must also participate in PQRI, because they will be using the same infrastructure that CMS uses for the quality reporting incentive program. They will have to submit data on nine quality measures selected from the same menus required for Meaningful Use. By doing so, they will also satisfy the criteria for PQRI rewards.

Providers who choose to participate in this pilot, rather than attest, can either submit data through their software vendor--if CMS allows that vendor to reformat the data and send it to CMS--or submit the information directly from their EHR, if it is CMS-approved. CMS won't release its list of approved vendors until summer 2012, and it won't tell physicians whether their EHR is qualified until January of next year.

Pilot participants must submit the quality information for a full calendar year, even if they have not attested to Meaningful Use in a prior year. This will be a burden on physicians who have not previously registered for the EHR incentive program, because they would otherwise have to attest to Meaningful Use for only 90 days.

Moreover, their attestation to other elements of Meaningful Use will be "held" until their quality data is analyzed. Since they will be using the PQRI reporting mechanism, they will have to wait until all of the 2012 quality data is submitted to PQRI, which means that they won't receive their first EHR incentive payment until sometime after February 2013.

Why would any physician volunteer for this pilot, particularly in the first year of Meaningful Use? "I don't know why you would," said Bruce Merlin Fried, an attorney with SNR Denton in Washington, D.C., and an expert on health IT regulations. It would make far more sense, he said, for doctors to simply attest that they had gathered the requisite quality data.

Nevertheless, Fried said, CMS will probably garner enough participants to test its new quality reporting system. But the agency's inability to meet its own deadline for online reporting, he noted, raises questions about the prospects for collecting quality data from the new accountable care organizations (ACOs).

"There are 65 quality measures and they're supposed to be electronically submitted by ACOs. If this is a precursor to what we're going to confront [in that scenario], that's pretty worrisome," he said.

Up to now, CMS has provided three methods for submitting quality information to the PQRI program. A practice can either use special billing codes to describe care processes, or it can submit the data through specified electronic registries or EHRs.

The registry method, which is available only for certain measures, involves reporting through an electronic registry that may be set up and maintained by an academic institution, a commercial vendor, a medical society, or some other party. In some cases, physicians may have to enter some data manually.

CMS also accepts data from particular brands of EHRs on 20 PQRI measures. The approved products come from two dozen vendors, including Cerner, e-MDs, Epic, GE, Greenway, LSS, and Sage.

In a separate proposed rule, CMS encourages hospitals to participate in the electronic quality reporting pilot by submitting data from their outpatient departments online. Besides helping them meet the Meaningful Use criteria, CMS noted, the new reporting mechanism will lay the foundation for hospitals to submit electronically information required of them under the Hospital Inpatient Quality Reporting Program. Two percent of hospitals' Medicare reimbursement depends on the transmission of that data to CMS.

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