2017 Medicare Electronic Health Record (EHR) Incentive Program

FACT SHEET

FOR IMMEDIATE RELEASE
September 2, 2016

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

 

2017 Medicare Electronic Health Record (EHR) Incentive Program
Payment Adjustment for Hospitals

 

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress established payment adjustments under Medicare for eligible hospitals that are not meaningful users of Certified Electronic Health Record Technology (CEHRT). Eligible hospitals that do not successfully demonstrate meaningful use for an EHR reporting period associated with a payment adjustment year will receive reduced Medicare payments for that year.

 

The payment adjustments began on October 1, 2014 for eligible hospitals. Eligible hospitals that only participate in the Medicaid EHR Incentive Program and do not bill Medicare are not subject to these payment adjustments. Eligible hospitals that participate in both the Medicare and Medicaid EHR Incentive Programs are subject to the payment adjustments unless they successfully demonstrate meaningful use under one of these programs. Over 4,800 eligible hospitals may participate in the EHR Incentive Programs.

What is an eligible hospital?

How does a hospital demonstrate meaningful use in order to avoid a payment adjustment?

An eligible hospital demonstrates meaningful use by successfully attesting through either the CMS Medicare EHR Incentive Programs Attestation System (https://ehrincentives.cms.gov/hitech) or through its state’s Medicaid EHR Incentive Program attestation system.

How have hospitals received incentives payments? Are incentive payments still available? 

The Medicare Electronic Health Record (EHR) Incentive Program provides incentive payments for eligible acute care inpatient hospitals that are meaningful users of certified EHR technology. The tip sheet below discusses incentive payments in detail: https://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_TipSheet_MedicareHospitals.pdf. The Medicaid EHR Incentive Program is run by each state. The Medicaid Electronic Health Record (EHR) Incentive Program provides for incentive payments for eligible acute care hospitals and children’s hospitals. The tip sheet below discusses Medicaid incentive payments in detail: https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/mln_tipsheet_medicaidhospitals.pdf 

What is the FY 2017 EHR Eligible Hospital payment adjustment?

Eligible hospitals that are not meaningful EHR users are subject to a payment adjustment beginning on October 1, 2016. This payment adjustment is applied as a reduction to the applicable percentage increase to the Inpatient Prospective Payment System (IPPS) payment rate, thus reducing the update to the IPPS standardized amount for these hospitals.

 

Eligible hospitals receive the payment adjustment amount that is tied to a specific fiscal year (e.g., eligible hospitals that did not successfully demonstrate meaningful use for an applicable EHR reporting period in 2015 are receiving a reduction to the IPPS applicable percentage increase in FY 2017). The table below illustrates the application of the reduced update to the IPPS standardized amount.

Hospital Adjustment	2015 (2013 Reporting Period)	2016 (2014 Reporting Period)	2017+ (2015 Reporting Period)
% Decrease	25%	50%	75%

 

 

 

How many hospitals successfully demonstrated meaningful use for the 2017 payment adjustment year?

In total, 98% of eligible hospitals and CAHs across the country have successfully demonstrated meaningful use at either Stage 1 or Stage 2.

Is there an exceptions process for hospitals that did not demonstrate meaningful use?

Eligible hospitals may apply for hardship exceptions to avoid the payment adjustments described above. Applications must be submitted no later than April 1^st of the year before the applicable payment adjustment year.  The time period for hardship exceptions for the 2017 payment adjustment closed on April 1, 2016.

Hardship exceptions are granted on a case-by-case basis and only if CMS determines that requiring an eligible hospital to be a meaningful EHR user would result in a significant hardship. Information on how to apply for a hardship exception is posted on the CMS EHR Incentive Programs website (https://www.cms.gov/EHRIncentivePrograms).

Eligible hospitals can apply for hardship exceptions in the following categories:

·         Infrastructure — Eligible hospitals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).

·         New eligible hospitals — Eligible hospitals with new CMS Certification Numbers (CCNs) that do not have time to become meaningful EHR users can apply for an exception for one full cost reporting period.

·         Unforeseen Circumstances — Examples may include a natural disaster or other unforeseeable barrier.

·         2014 EHR Vendor Issues — An eligible hospital’s EHR vendor was unable to obtain 2014 certification or the hospital was unable to implement meaningful use due to 2014 EHR certification delays.

Additionally, due to the Patient Access and Medicare Protection Act (PAMPA), the new streamlined hardship applications reduce the amount of information that eligible hospitals, eligible professionals, and CAHs have to submit to apply for an exception for calendar year 2016. .

Does a hospital have to achieve meaningful use each year to avoid the payment adjustments or can it avoid the payment adjustments by achieving meaningful use only once?

Eligible hospitals must demonstrate meaningful use every payment year according to the timelines detailed above in order to avoid Medicare payment adjustments. For example, an eligible hospital that demonstrates meaningful use for the first time in 2013 will avoid the payment adjustment in FY 2015, but will need to demonstrate meaningful use again in 2015 in order to avoid the payment adjustment in FY 2017.

Where can I go for more information?
Medicare and Medicaid EHR Incentive Programs
https://www.cms.gov/EHRIncentivePrograms

2016 Medicare Open Enrollment Bootcamp is Here September 8, 2016             1:00 – 3:00 pm ET This webinar will provide updates on the following: 1-800-MEDICARE Call Center Medicare Plan Finder Fraud Awareness Open Enrollment Media Campaign Tips For Hosting a Successful Enrollment Event. All CMS partners and stakeholders who help people with Medicare make informed health care choices are welcome to attend. To register for this event, visit: https://goto.webcasts.com/starthere.jsp?ei=1114823. September is Prostate Cancer Awareness Month Prostate Cancer is the most common non-skin cancer and the second leading cause of cancer death among American men. The potential benefit of prostate cancer screening is finding cancer early, which may make treatment work better. Talk to your doctor before you decide to get tested or treated. To learn more about prostate cancer symptoms, risk factors and screening tests, visit cdc.gov/cancer/dcpc/resources/features/ProstateCancer/index.htm. Prostate cancer screening is a preventive screening that is covered by Medicare Part B. For more information, visit medicare.gov/coverage/prostate-cancer-screenings.html. Newly Posted Training Materials 2016 CMS NTP Resources PowerPoint and Workbook 2016 Medicare and Medicaid Fraud and Abuse Prevention PowerPoint and Workbook 2016 Medicare Advantage and Other Medicare Health Plans PowerPoint and Workbook 2016 Medicaid and the Children’s Health Insurance Program PowerPoint and Workbook 2016 Medicare for People with Disabilities PowerPoint and Workbook 2016 Medicare Prescription Drug Coverage PowerPoint and Workbook 2016 Medicare Preventive Services PowerPoint and Workbook New / Updated CMS Publications Medicare and Other Health Benefits: Your Guide to Who Pays First Get Covered: A one-page guide to the Health Insurance Marketplace No computer? You can still get Marketplace coverage The Health Insurance Marketplace: Know Your Rights Protect Yourself from Fraud

CMS awards consumer assistance funding to support 2017 Health Insurance Marketplace enrollment

CMS News

FOR IMMEDIATE RELEASE
September 6, 2016

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
 

CMS awards consumer assistance funding to support 2017 Health Insurance Marketplace enrollment 

With open enrollment for 2017 only a few weeks away, the Centers for Medicare & Medicaid Services (CMS), announced $63 million in Navigator grant awards to returning and new organizations.  These awards will support local in-person assistance to help consumers navigate, shop, and enroll in the wide variety of Marketplace coverage options. 

“We are committed to making sure consumers have all the resources they need to find the right plan when open enrollment begins on November 1,” said Kevin Counihan, CEO of the Health Insurance Marketplace.  “We know in-person assistance is critical to connecting individuals and families with quality, affordable health coverage that best meets their needs.”

Navigators are trained individuals and organizations who help consumers, small businesses, and employees as they look for health coverage options and financial assistance through the Marketplace.  Navigators can meet in person with consumers and help them understand the coverage options available to them as well as help them pick, apply for, and enroll in a plan of their choice. Consumers in Federally-facilitated Marketplaces, including State Partnership Marketplaces, can visit Find Local Help to find assistance in their area.

This year, 96 returning organizations and 2 new organizations in the state of Hawaii received a grant award.  This is the second year of a three-year funding cycle for the returning grantees that currently provide local in-person assistance.  The 2015 Navigator Funding Opportunity Announcement required applicants to submit a proposal covering the full 36-month project period.  Funding is released in 12 month increments as CMS continually assesses Navigator grantees’ performance for ongoing support. 

For a list of CMS Navigator awardees or more information about Navigators and other Marketplace resources, please visit: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Navigator-Grantee-Summaries-2016.pdf

Round One State Innovation Model Initiative Test Awards Show Some Promising Progress and Lessons Learned

CMS BLOG
http://blog.cms.gov/2016/09/07/round-one-state-innovation-model

September 7, 2016
Patrick Conway, M.D., CMS Principal Deputy Administrator and Chief Medical Officer

 

Round One State Innovation Model Initiative Test Awards Show Some Promising Progress and Lessons Learned

The State Innovation Models (SIM) Initiative began in April 2013, and has supported over 38 states, territories and the District of Columbia in two rounds of awards.  Today, we are releasing the second annual independent evaluation report for the Round 1 State Innovation Model Test Awards, including the first findings available for SIM after the baseline data summary.  This report shows both progress in states being catalysts for health care transformation and the value of CMS’ collaboration with states.

Overview of SIM

SIM states are testing strategies to transform health-care across their entire state, specifically to have a preponderance of payments to providers from all payers in the state be in value-based purchasing and/or alternative payment models.

In the SIM Initiative, CMS is testing models for how state governments can use their policy and regulatory levers to accelerate statewide health care system transformation from encounter-based service delivery to care coordination, and from volume-based to value-based payment.  Round 1 states are implementing statewide health care innovation plans that support health care transformation through a variety of methods, including:

• primary care practice transformation through patient-centered, coordinated care;
• integration of primary care with other health and social services, including behavioral health services and long-term services and supports;
• payment reforms that promote delivery system transformation and a variety of enabling strategies to facilitate and sustain an improved health system that puts the patient at the center of care delivery; and
• community-based population health and prevention. 

Central to enhanced care coordination, population health, behavioral and physical health integration, and alternative payment models is the use of health information technology (IT) and a robust data infrastructure.  The Round 1 Test states are strengthening these capacities through:

• engaging and supporting providers that have not typically been connected to health IT;
• requiring participating providers to report on data and/or implement health IT;
• making available patient-level health information to providers and systems to improve care coordination; and
• improving data analytics to support quality improvement and payment reform, and aligning metrics and data infrastructure across payers and initiatives.

Evaluation findings from Year 2 of SIM Round 1

In SIM Round 1, Model Test awards were made to six states: Arkansas, Massachusetts, Maine, Minnesota, Oregon, and Vermont. The SIM Initiative has made notable progress in accelerating health care transformation among the Round 1 Test states. Over time, many states have been able to increase the populations served by their SIM-supported models.

• Over 70% of eligible Medicaid primary care providers participate in Arkansas’ patient-centered medical home, which serves about 80% of their eligible Medicaid population.
• Alternative payment models supported by SIM funds in Minnesota and Vermont are reaching about 50% of each state’s total population, with Oregon and Vermont also reaching over 80% of their total Medicaid population.

The evaluation found that states have been successful in engaging a wide swath of the payer, provider, purchaser, and patient communities and building stakeholder consensus by balancing standardization and flexibility when expanding payment reforms statewide. States have leveraged multi-payer efforts to implement payment and delivery system reforms, engaged the provider community in SIM-related activities, and used a range of policy levers to effect change. Some of the most substantial changes to delivery systems and payment methods are in areas where public and private payers are working together to accelerate transformation. For example:

• In Arkansas, Arkansas Blue Cross Blue Shield, QualChoice and some large self-insured employer groups, including Walmart, participate in the SIM-supported patient-centered medical home and episode of care models.
• Vermont’s SIM Initiative focuses on supporting Accountable Care Organizations. Providers participating in both Medicaid and commercial ACOs now represent a significant majority of the state’s available primary care providers. ACOs offer services to nearly all residents statewide, and about half of eligible beneficiaries were participating as of late 2014.
• In Oregon, participation in the Coordinated Care Model under the SIM Initiative currently includes commercial insurance carriers contracting with the state to cover state employees and Medicaid beneficiaries.  

It remains too early to attribute specific quantitative results directly to the SIM Initiative. However, analyses based on Medicare and commercial populations show that states were making progress on health outcomes, such as declines in emergency room visits and inpatient readmissions through models pre-dating SIM and models upon which SIM efforts are expanding. Future evaluation reports will provide more detail on quantitative results and whether and how the SIM Initiative is affecting and accelerating trends in health outcomes and spending.

SIM Supports Health Care Transformation

The Affordable Care Act provides tools through the CMS Innovation Center, like the SIM Initiative, to move our health care system toward one that provides better care to patients, spends dollars more wisely, and results in healthier communities. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate patient care to improve quality.

In 2015, the Administration announced goals for Medicare to tie payment to quality or value. These goals are for 30 percent of Medicare fee-for-service payments to be made through alternative payment models by the end of 2016 (and 50 percent by 2018), and tying 85 percent of payments to quality or value by 2016 (90 percent by 2018). In early 2016, the Secretary announced that HHS had reached its goal of 30 percent of Medicare payments made through alternative payment models ahead of schedule. HHS is also working with private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models. Initiatives like SIM are an important part of states’ role in health care transformation and tying payments to quality or value. 

CMS supports states through SIM and other innovation efforts to move towards this vision of multi-payer delivery system reform across an entire state.  Health system transformation and improvement happens at the state and local level and CMS will continue to support states in their transformation journey to improve care for people across the nation.

Monthly Partner Update Webinar

Join us for the CMS National Training Program

Monthly Partner Update Webinar

September 6, 2016

2:30 – 3:30 pm ET

 

This webinar will feature a presentation on Identifying and Notifying Consumers Who Are Dually Enrolled in Federally Facilitated Marketplace Coverage with Financial Assistance and Minimum Essential Coverage (MEC) Medicare.

 

To Attend

Go to https://meetings.cms.gov.orion/joinmeeting.do?MTID=cffb7afdcb25992043d284c30744529a. Follow the prompts to dial in.

The IMPACT Act and Improving Care Coordination

Centers for Medicare & Medicaid Services Special Open Door Forum: The IMPACT Act and Improving Care Coordination Thursday, September 15, 2016 2:00 -3:00 pm Eastern Time Conference Call Only The purpose of this Special Open Door Forum (SODF) is to provide information and solicit feedback pertaining to the Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly referred to as the IMPACT Act). The IMPACT Act mandates the standardization of patient assessment data across post-acute care settings including Skilled Nursing Facilities, Home Health Agencies, Inpatient Rehabilitation Facilities, and Long Term Care Hospitals in order to improve quality of care and quality of life. This SODF will offer discussion on the goals of the IMPACT Act, the expected outcomes of the Act, and potential roles post-acute care providers can play in improving coordinated care. This SODF will serve as a platform to update providers, consumers, stakeholders, researchers, and advocates alike on the work around the IMPACT Act and to solicit input on the ways the IMPACT Act can help you improve care coordination. We invite questions, comments, and ideas from providers, patients, consumers, researchers, and advocates in advance or during the Forum. Please submit questions, comments, and ideas to: PACQualityInitiative@cms.hhs.gov. Click here for the presentation. We look forward to your participation. Special Open Door Participation Instructions: Participant Dial-In Number: 1-800-837-1935 Conference ID #: 74951666 Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help. A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp for downloading under downloads section as well as the IMPACT Act Downloads and Videos webpage.             For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/. Thank you for your interest in CMS Open Door Forums.

Physicians and health care providers continue to improve quality of care, lower costs

CMS News

FOR IMMEDIATE RELEASE
August 25, 2016

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
 

Physicians and health care providers continue to improve quality of care, lower costs
Affordable Care Act Accountable Care Organization initiatives put patients at the center of their care while generating more than $1.29 billion in total Medicare savings since 2012

The Centers for Medicare & Medicaid Services (CMS) today announced the 2015 performance year results for the Medicare Shared Savings Program and the Pioneer Accountable Care Organization Model that show physicians, hospitals, and health care providers participating in Accountable Care Organizations continue to make significant improvements in the quality of care for Medicare beneficiaries, while achieving cost savings. Collectively, Medicare Accountable Care Organizations have generated more than $1.29 billion in total Medicare savings since 2012.

“The coordinated, physician-led care provided by Accountable Care Organizations resulted in better care for over 7.7 million Medicare beneficiaries while also reducing costs,” said CMS Acting Administrator Andy Slavitt. “I congratulate these leaders and look forward to significant growth in the program in the coming year.”

In 2015, Medicare Accountable Care Organizations had combined total program savings of $466 million, which includes all Accountable Care Organizations’ experiences, for 392 Medicare Shared Savings Program participants and 12 Pioneer Accountable Care Organization Model participants. The results show that more Accountable Care Organizations shared savings in 2015 compared to 2014 and those with more experience tend to perform better over time. 

Today’s results from the Medicare Shared Savings Program and the Pioneer Accountable Care Organization Model show significant improvements in the quality of care providers are offering to an increasing number of Medicare beneficiaries. Accountable Care Organizations are judged on their performance, as well as their improvement, on an array of meaningful metrics that assess the care they deliver. Those metrics include how highly patients rated their doctor, how well clinicians communicated, whether patients are screened for high blood pressure, and their use of Electronic Health Records.

All 12 participants in the Pioneer Accountable Care Organization Model improved their quality scores from 2012 to 2015 by more than 21 percentage points. Overall quality scores for nine out of 12 Pioneer participants were more than 90 percent in 2015.

Accountable Care Organizations in the Medicare Shared Savings Program also continued to show improvement, with Accountable Care Organizations that reported in both 2014 and 2015 improving on 84 percent of the quality measures that were reported in both years. Additionally, comparing 2014 and 2015 results, average quality performance improved by more than 15 percent on key preventive care measures including screening for risk of future falls, depression screening and follow-up, blood pressure screening and follow-up, and providing pneumonia vaccinations.

By meeting quality performance standards and their savings threshold, 125 Accountable Care Organizations qualified for shared savings payments. Since the passage of the Affordable Care Act, more than 470 Medicare Accountable Care Organizations – serving nearly 8.9 million Medicare beneficiaries – have been established through the Medicare Shared Savings Program, the Pioneer Accountable Care Organization Model, the Next Generation Accountable Care Organization Model, and the Comprehensive End-Stage Renal Disease Care Model.

“Accountable Care Organization initiatives in Medicare continue to grow and achieve positive results in providing better care and health outcomes while spending taxpayer dollars more wisely,” said Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer. “CMS continues to work and partner with providers across the country to improve the way health care is delivered in the United States.”

Accountable Care Organizations were created to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes. They are groups of doctors, hospitals, and other health care providers who voluntarily come together to develop and execute a plan for a patient’s care and share information, putting the patient at the center of the health care delivery system. In addition, under the proposed Quality Payment Program, health care providers that sufficiently participate in advanced tracks of Medicare Accountable Care Organizations may qualify for exemption from payment adjustments under the Merit-based Incentive Payment System, as well as the additional incentive payments available beginning in 2019 for participation in Advanced Alternative Payment Models.

The Affordable Care Act provides tools, such as Medicare Accountable Care Organizations, to move our health care system toward one  that provides patients with high-quality, cost-effective care. Today’s announcement is part of the Administration’s broader strategy to improve the health care system by paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality. These efforts support the Administration’s goal to have 50 percent of traditional Medicare payments flowing through alternative payment models by 2018 (already, 30 percent of Medicare payments go through alternative models).

For more detailed information on the quality and financial results, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-08-25.html

For additional information on the Medicare Shared Savings Program, please visit: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html 

For additional information on the Pioneer Accountable Care Organization Model, please visit: https://innovation.cms.gov/initiatives/Pioneer-ACO-Model/