EHR Incentive Program Updates Respond to Hospital Worries 

The Centers for Medicare and Medicaid Services (CMS) is using the rulemaking process to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. According to Patrick Conway, MD, the CMS deputy administrator for innovation and quality and CMS chief medical officer, these changes will reduce the reporting burden on providers, while supporting the long term goals of the program. So far, more than 400,000 eligible providers are considered by CMS to be meaningful users of EHRs.

Changes to the incentive program will include realigning hospital EHR reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 edition software into their workflows and to better align with other CMS quality programs; modifications to other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens; and shortening the EHR reporting period in 2015 to 90 days to accommodate these changes. CMS is “working on multiple tracks right now” to be responsive to hospital and other providers’ concerns, Conway said.

In a separate announcement, the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) released a plan to tackle interoperability of health IT software—an issue that has long been a major problem for providers attempting to securely exchange health information across platforms. In the plan, ONC lays out a strategy to create clear and enforceable interoperability standards, the lack of which has made most health information exchanges unworkable.

Big Boost in Demand Not Likely Under ACA

Even though some 11 million people have gained health insurance under the Affordable Care Act (ACA), this influx of newly insured is unlikely to overwhelm healthcare providers or significantly increase healthcare utilization, concludes a Commonwealth Fund issue brief. The authors project that primary care providers will see, on average, 1.34 additional office visits per week, or about a 3.8% increase in visits nationally. Hospital outpatient departments will see, on average, 1.2– 11.0 additional visits per week, or about 2.6% nationally.

The report predicts that emergency department visits will increase by 1.1 million, or 2.2%, with those gaining Medicaid coverage accounting for more than two-thirds of the increase. Overall, only 17 states are expected to experience increases in primary care visits that exceed 4%, and only seven states are expected to see increases of greater than 5%. The majority of states are also expected to experience increases in outpatient care utilization of 4% or less. 

ICD-10 Testing Going Well, CMS Says

As providers get ready for the October 1, 2015 deadline for using the ICD-10 claims coding system, CMS has released results from its end-to-end testing that ran from January 30, 2014 to February 3, 2015. Some 660 providers, clearinghouses, and billing agencies participated. During the test, CMS received 14,929 claims with an 81% acceptance rate. According to CMS, 13% of the rejections were due to non-ICD-10 related errors.

CMS Administrator Marilyn Tavenner emphasized that ICD-9 codes must be used for services provided before the October 1 deadline, and ICD-10 for services provided after October 1, a point that she said has caused confusion among providers. The rule applies no matter when a claim is submitted: claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.

During a February 11 hearing of the House Energy and Commerce Committee, the American Hospital Association submitted testimony that the association did not support any further delay and that more than 90% of hospitals surveyed by the association in January and February were either moderately confident or very confident in their ability to transition to ICD-10.