CMS holds off on health IT measure in final joint replacement payment model

The Centers for Medicare & Medicaid Services has issued its final rule implementing its new comprehensive care for joint replacement bundled payment initiative, but for now is not requiring a health IT performance measure.

The final rule, released Nov. 16, and slated to be published in the Federal Register Nov. 24, will test bundled payment and quality measures to hold hospitals accountable for hip and knee replacements from surgery through 90 days after a payment's discharge. It requires hospitals to work with physicians and post-acute care providers to coordinate care and reduce costs. The five-year model, which will begin April 1, 2016, will be instituted in 67 geographic areas, down from the 75 suggested in the proposed rule.

CMS notes that the use of health IT tools is a "critical component" of effective coordination across care settings and calls it "essential" in bundled payment models; it references the Office of the National Coordinator for Health IT's interoperability road map. The proposed rule, released in July, had invited comment regarding how to incorporate a performance measure for certified health IT in the 2017 performance year and asked, among other things, whether Meaningful Use attestation was the most appropriate quality measure for assessing hospital performance in this area.

CMS received a number of comments on this issue, including concerns about exchanging electronic information with post-acute care providers, many of whom have not implemented electronic health records since they're not participating in the Meaningful Use program.

Upon review of the comments, CMS has opted to "evaluate" the suggestions for future consideration.

"While we did not propose to include a measure of health IT utilization, we will consider these comments as we assess any future action for the model," the agency notes. "As future measures become available ... we will continue to explore whether there are opportunities to address this important aspect of care delivery for model participants. Should we decide to implement a measure of health IT utilization in the future, we will do so through notice-and-comment rulemaking."

CMS continues to use payment rules to encourage or require providers to adopt EHRs. The final payment rules for end stage renal disease and home health providers, both released earlier this month, encourage these providers to transition to electronic data exchange.

To learn more:
- read the announcement
- here's the rule

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