Providers: Be prepared for 'EHR creep'

The Centers for Medicare & Medicaid Services' 2015 provider payment rules, many of which have been released this month, are receiving a lot of attention.

But I'm surprised that one of the most consistent themes throughout them--"EHR creep"--has received very little publicity.

Buried into a number of these rules is very similar language that CMS is "interested in understanding" the current state of electronic health record adoption within that provider community. What CMS is really doing is piggybacking onto these payment rules a clear message that these non-acute care providers--which are not part of the Meaningful Use incentive program--will soon also be expected to adopt EHRs and participate in data exchange. 

For instance, take a look at the language from the final hospice wage index and payment rate update for 2015, published Aug. 4 (page 139):

"HHS is committed to accelerating health information exchange through the use of electronic health records and other types of health information technology across the broader care continuum through a number of initiatives including: (1) alignment of incentives and payment adjustments to encourage provider adoption and optimization of HIT and HIE services through Medicare and Medicaid payment policies; (2) adoption of common standards and certification requirements for interoperable HIT; (3) support for privacy and security of patient information across all HIE-focused initiatives; and (4) governance of health information networks. These initiatives are designed to encourage HIE among all healthcare providers, including professionals and hospitals eligible for the Medicare and Medicaid EHR Incentive Programs and those who are not eligible for the EHR Incentive Programs, and are designed to improve care delivery and coordination across the entire care continuum. ...

"We believe that HIE and the use of certified EHRs by Hospice [and other types of providers that are ineligible for the Medicare and Medicaid EHR Incentive Programs] can effectively and efficiently help providers improve internal care delivery practices, support management of patient care across the continuum, and enable the reporting of electronically specified clinical quality measures."

The payment rule for skilled nursing facilities contains similar language.

But CMS went beyond that in its payment rule for inpatient rehabilitation facilities. It floated the feasibility of requiring eCQMs.

And for inpatient psychiatric facilities (IPFs), the agency went even further, adding the use of an EHR measure for the fiscal year 2016 payment determination and subsequent years, justifying the move this way:

"We believe that the use of certified EHRs by IPFs [and other providers ineligible for the Medicare and Medicaid EHR Incentive Programs] can effectively and efficiently help providers improve internal care delivery practices, support the exchange of important information across care partners and during transitions of care, and could enable the reporting of electronically specified clinical quality measures."

Sounds familiar, no?

Now, I'm in favor of the move to EHRs across the care continuum. But I can't help but be a bit cynical here.

These non-acute care providers were not included in the Meaningful Use program. They were not entitled to any incentives. So is CMS now considering offering them incentives, since the agency references incentives in the hospice and skilled nursing payment rules? Will the agency now provide governance of health information networks, also mentioned in these 2015 rules, even though the Office of the National Coordinator for Health IT shied away from doing that for the Meaningful Use program several years ago?  

Or this this merely a vehicle for CMS to quietly ratchet up EHR requirements to a broader range of providers by tweaking their payment rules?  

Additionally, is it being done, to some extent, to bolster the Meaningful Use program, because the hospitals and physicians who are part of that program are running into trouble meeting the interoperability provisions without these non-acute providers?

The U.S. Department of Health and Human Services has always used payment rules as an easy way to change requirements without having to promulgate separate regulations--just look at the Stark law. So the agency isn't necessarily doing anything surprising here. 

But providers, all of you: The Office of the National Coordinator for Health IT is no longer waving the flag and suggesting that you embrace EHRs and data exchange. EHRs and data exchange will be expected of you if you want to be paid.

CMS has put you on notice: EHR creep is inevitable. - Marla (@MarlaHirsch and @FierceHealthIT)

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