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Clinical Laboratories and Pathology Groups

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CMS Finalizes Rule Rebranding ‘Meaningful Use’ Program to ‘Promoting Interoperability’

Ongoing federal regulatory push for EHR interoperability requires medical laboratories and anatomic pathology groups to have strategies for ensuring seamless interfaces with providers and hospitals

What difference does a name make? Clinical laboratories and anatomic pathology groups soon may know the answer to that question following the renaming of the Centers for Medicare and Medicaid Services (CMS) “Meaningful Use” program to “Promoting Interoperability” (PI).

CMS first announced the rebranding in April as part of a proposed rule aimed at transforming the Meaningful Use aspect of the federal Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH has been Medicare’s roadmap to electronic health record (EHR) implementation and interoperability since it was enacted in 2009.

The final rule arrived on August 2, 2018, and it may impact how clinical laboratories interface with provider and hospital EHRs.

Removing Obstacles to Quality Patient Care

In the news release outlining the updates to Medicare payment policies and rates under the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System, CMS states the “overhaul” of the meaningful use program will:

  • Make the program more flexible and less burdensome;
  • Emphasize measures that require the exchange of health information between providers and patients; and,
  • Incentivize providers to make it easier for patients to obtain their medical records electronically.

“We’re excited to make these changes to ensure care will focus on the patient, not on needless paperwork,” CMS Administrator Seema Verma stated in the news release. “We’ve listened to patients and their doctors who urged us to remove the obstacles getting in the way of quality care and positive health outcomes. Today’s final rule reflects public feedback on CMS proposals issued in April and the agency’s patient-driven priorities of improving the quality and safety of care, advancing health information exchange and usability, and removing outdated or redundant regulation on healthcare providers to make way for innovation and greater value.” (Photo copyright: Centers for Medicare and Medicaid Services.)

According to a CMS fact sheet, key provisions of the overhaul include:

  • The rule finalized an EHR reporting period to a minimum of any continuous 90-day period in each of calendar years 2019 and 2020 for new and returning participants attesting to CMS or their State Medicaid agency;
  • For the Medicare Promoting Interoperability Program, the rule finalized a new performance-based scoring methodology consisting of a smaller set of objectives that CMS states will provide a more flexible, less-burdensome structure, allowing eligible hospitals and critical access hospitals (CAHs) to place their focus back on patients;
  • CMS finalized two new e-Prescribing measures related to e-prescribing of opioids (Schedule II controlled substances); and,
  • Beginning with an EHR reporting period in CY 2019, all eligible hospitals and CAHs under the Medicare and Medicaid PI programs will be required to use the 2015 Edition of Certified EHR Technology;
  • CMS finalized changes to measures, including removing certain measures CMS believes do not emphasize interoperability and the electronic exchange of health information.

According to CMS, about 3,300 acute care hospitals and 420 long-term care hospitals will be subject to the final rule, which takes effect October 1. Obviously, medical laboratories servicing these healthcare organizations will be similarly affected.

Rebranding More than a Name Change

Healthcare Informatics analyzed the 2,593-page final rule explaining that the “core emphasis” of the meaningful use overhaul is “on advancing health data exchange among providers.”

The initial proposal in April, according to Healthcare Informatics, invited stakeholder feedback through a request for information on the possibility of revising CMS’ “Conditions of Participation” for hospitals by requiring providers to electronically transfer medically necessary information following a patient discharge or transfer. The final rule, however, did not include that change.

Instead, the CMS Fact Sheet on the rule states the April request for information was “to obtain feedback on positive solutions to better achieve interoperability, or the sharing of healthcare data between providers, which will inform next steps in advancing this critical initiative.”

Rebranding meaningful use is CMS’s first step in implementing core pieces of the Administration’s MyHealthEData Initiative to strengthen interoperability. In remarks during the ONC Interoperability Forum in Washington, DC, CMS Administrator Seema Verma described the rebranding decision as “much more than a name change” and signaled future CMS actions.

“It is a change in direction for the programs—from programs that support the adoption of health IT, to programs that promote interoperability and patient access to data,” she explained. “To avoid payment reductions and gain incentives, doctors and hospitals will have to give patients electronic access to their health records. We are also considering whether CMS should require—as a condition of participation in the Medicare program—that providers share data with patients in a universal electronic format and hope to share more information on that soon.”

The recent changes follow passage of the Bipartisan Budget Act of 2018, which included a provision relaxing meaningful-use requirements. Though the legislation affects only hospitals and outpatient Medicaid providers, Robert Tennant, Director of Health Information Technology Policy for the Medical Group Management Association (MGMA), declared the revision a “huge win” for providers.

“I don’t think the government recognized how difficult it would be to move from stage 1 to stage 2 to stage 3 [meaningful use] requirements and the significant costs involved,” Tennant stated told Modern Healthcare. “We hope that it signals an interest in Congress in having the administration and HHS (Federal Health and Human Services) not make these quality reporting programs so onerous that it results in large swaths of providers not being successful.”

Clinical laboratories and anatomic pathology groups should be aware that interoperability between their laboratory information systems and the EHRs of providers and hospitals continues to be important. Although the term “Meaningful Use” is to be supplanted by “Promoting Interoperability,” the ability to move patient health information seamlessly among providers continues to be a major goal of this country’s healthcare system.

—Andrea Downing Peck

Related Information:

CMS Finalizes Changes to Empower Patients and Reduce Administrative Burden

In Proposed MU Rebranding Rule, CMS Raises the Interoperability Stakes

Fact Sheet: Fiscal Year (FY) 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule (CMS-1694-F)

H.R. 1892: Bipartisan Budget Act of 2018

Printable PDF: Final Rule (CMS-1694-F)

Speech: Remarks by Administrator Seema Verma at the ONC Interoperability Forum in Washington, DC

Congress Budget Deal Relaxes Meaningful-Use Requirements

CMS Proposes Changes to Empower Patients and Reduce Administrative Burden

CMS Proposes Meaningful Use Changes to Promote Interoperability



University of Michigan Study Links Value-Based Care Programs to Lower Readmission Rates and $32 Million in Medicare Savings in 2015; Clinical Laboratories Play Critical Role

Meaningful use, accountable care organizations, and bundled payment initiatives work best together to reduce readmissions, UM research suggests

Ever since the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmission Reduction Program (HRRP) in 2012, healthcare organizations all over America have sought to prevent unnecessary hospital readmissions within 30 days of discharge. For some clinical laboratories, this meant performing precise microbiology testing to ensure patients are discharged with prescriptions for oral antibiotics in-hand to combat possible infections. Now, a recent study reports that the effort could be paying off, and clinical laboratories played a critical role.

Research performed at the University of Michigan (UM) has linked lower readmission rates under the HRRP to voluntary value-based programs. The three value-based programs the UM researchers identified as contributing to the successful lowering of hospital readmission rates are:

The UM researchers published their findings in the Journal of the American Medical Association (JAMA) Internal Medicine. It could be the first study to demonstrate that synergistic value-based reward programs facilitate healthcare improvement and efficiency. As opposed to HRRP financial penalties alone that is, according to a UM news release.

Researchers Had No Expectations of Payment Reform Programs

Researchers at UM found that all three programs operating together in 2015 (the last year included in the longitudinal study) resulted in about 2,400 fewer readmissions and a $32-million savings to Medicare, the UM release noted.

The team analyzed data on patients treated at 2,877 hospitals from 2008 through 2015 for:

Their source of information was publicly available Hospital Compare readmission data.

“We had no real expectations that hospitals’ participation in voluntary reforms would be associated with additional reductions in readmissions. We thought that it was just as likely that hospital participation in meaningful use, accountable care organization programs, or the Bundled Payment for Care [Improvement] Initiative may be distracting to hospitals, limiting readmissions reduction,” stated Andrew Ryan, PhD, in ACEPNow, a publication of the American College of Emergency Physicians (ACEP) in Irving, Texas. Ryan is an Associate Professor, Health Management and Policy, at UM’s School of Public Health.

More Participation Leads to Greater Reduction in Readmissions

Nevertheless, the UM researchers linked more reductions in readmissions based on common diagnoses to value-based “reward-style” programs than to HRRP financial penalties. And the more value-based programs a provider implemented, the greater reduction in hospital readmission rates, the study found.

Nearly all hospitals studied were participating in at least one of the value-based programs by 2015, as compared to no program participants in 2010, when the Affordable Care Act was signed into law, noted a Healthcare Dive article.

illustrates the reduction in hospital readmissions starting in 2012

The chart above from the Kaiser Family Foundation (KFF) illustrates the reduction in hospital readmissions starting in 2012, which multiple studies have linked to the CMS Hospital Readmission Reduction Program (HRRP). The rates, according to the KFF, are risk adjusted to account for age and certain medical conditions. (Image copyright: Kaiser Family Foundation.

For 56 providers that were not participating in value-based care programs by 2015, researchers found the following readmission reductions also were associated with HRRP:

  • 3% drop in heart failure readmissions;
  • 76% drop in heart attack readmissions; and
  • 82% decline in pneumonia readmissions.

For the majority of providers, however, escalating value-based care program participation resulted in greater readmission rate reductions, the study noted.

Readmission Reductions for Heart Failure Patients

Noting the influence of value-based programs, HealthcareDIVE and FierceHealthcare reported the following results for the heart-failure patients studied:

  • ACOs result in 2.1% annual readmission reduction;
  • MU participation attributed to a 2.3% drop in annual readmission reduction;
  • Involvement in all three programs (ACOs, MU, and bundled payments) result in the largest annual readmission declines for hospitals of 2.9%.

Readmission Reductions for Heart Attack, Pneumonia Patients

For myocardial infarction patients, the study showed these effects from value-based programs on readmission declines:

  • 7% from ACO launch;
  • 5% associated with MU; and
  • 2% readmission reductions when all programs were in effect.

For pneumonia patients, the research suggested these changes in readmission declines were associated with value-based programs:

  • 4% from ACO launch;
  • 4% due to MU; and
  • 9% when all programs were in effect.

The researchers advise that providers, aiming for quality improvement and cost savings, should leverage as many of these programs as possible.

“There is a reason to believe these [value-based] programs are reinforcing the broader push to value-based care. Our findings show the importance of a multi-pronged Medicare strategy to improve quality and value,” noted Ryan in the UM news release.

Clinical Laboratories Play Key Role in Reducing Readmissions

Accurate medical laboratory testing plays a critical role in the success of these hospital readmission reduction programs. Thus, all pathologists and laboratory personnel should congratulate themselves for a job well done. And commit to continuing their outstanding performance.

—Donna Marie Pocius 

Related Information:

Association Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program

Voluntary Value-Based Health Programs Dramatically Reduce Hospital Readmissions

Value-Based Reforms Linked to Readmission Reductions

Hospitals Participating in Value-Based Programs Have Lower Readmission Rates

Study: Value-Based Care Programs Reduce Readmissions

Involving Patient’s Family in Discharge Process Linked to 25% Reduction in Hospital Readmissions

Integrating Caregivers at Discharge Significantly Cuts Patient Readmissions, Pitt Study Finds

Hospitals with Lowest 30-Day Readmission Rates Succeed at Reducing Rates by Improving Care Coordination and Monitoring of Patients After Discharge

National Clinical Laboratory Sales Excellence Award Winner, Mark Klisman, Helps Ease the Transition to Value-Based Healthcare for His Hospital Lab

Pathologists  and clinical laboratory managers may be overlooking ways that sales teams can add strategic value

As of January 1, 2018, the value of a top-performing clinical laboratory sales professional will increase because, on that date, labs will see a reduction in Medicare Part B clinical laboratory test prices as mandated by the Protecting Access to Medicare Act (PAMA) of 2014.

As these Medicare price cuts become effective, clinical laboratories and hospital lab outreach programs across the United States will need their lab sales representatives to bring in new client accounts that can generate additional revenue to offset the decrease in Medicare lab test reimbursements.

It was to recognize these laboratory sales professionals that The Dark Report organized the National Lab Sales Excellence Award in 2016. These new national sales awards were unveiled at the Executive War College (EWC) in New Orleans on April 26-27, 2016, and will return again at the 2017 EWC May 2-3. (more…)

Physician Practice Management Companies Stage a Comeback; Anatomic Pathology Groups Remain Skeptical

As reimbursement models shift, physician practice management companies (PPMCs) offer increased value and appeal for hospital-based physicians (HBPs)

Are physician practice management companies (PPMCs)—a hot trend during the 1990s—poised to make a comeback in this decade? Whether this healthcare business model can gain traction during the 2010s remains to be seen, but, of all physician specialties, pathologists are likely to be among the most skeptical, just as they were during the 1994-2000 heyday of PPMCs.

In the mid-1990s, such physician practice management companies as MedPartners, Phycor, and others raised billions of dollar to invest in both independent physician practices and hospital-based physician (HBP) groups. But not even 10 years later, competition for viable practices drove prices above sustainable levels and many PPMCs closed shop. (more…)

Medicare Program Officials Affirm Meaningful Use Stage Three to Continue Even As the Agency Moves to Implement MACRA’s Value-Based Payment Law

Clarification comes just a week after one CMS official had discussed the end of Meaningful Use at a conference in San Francisco

Talk about mixed messages! Is the federal Meaningful Use (MU) program about to end? Or is it going to continue and evolve in significant new ways?

Alert pathologists and clinical laboratory executives may have picked up on the conflicting statements about the future plans for Meaningful Use that have been made in recent weeks by certain officials from the Centers for Medicare and Medicaid Services (CMS).

Because thousands of hospitals and hundreds of thousands of physicians have made substantial capital investments in electronic health records to qualify for federal incentives, any major change to the Meaningful Use requirements will have broad consequences.

Medical laboratories have a big stake in this issue as well, since they must invest substantial money into creating the interfaces needed to connect their labs’ laboratory information systems (LIS) to the EHRs of client hospitals and physicians. (more…)