Newsletter - November 2016

CMS Releases Changes to the Medicare and Medicaid EHR Incentive Programs

November 06, 2016

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2017. This final rule with comment period includes a number of proposed changes that would affect the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The final rule will be published on November 14 and comments will be accepted until December 31.

The changes to the Medicare and Medicaid EHR Incentive Programs include:

  • For eligible hospitals, CAHs and dual-eligible hospitals attesting to CMS, eliminating the Clinical Decision Support (CDS) and Computerized Order Entry (CPOE) objectives and measures beginning in 2017, reducing a subset of thresholds for the remaining objectives and measures for Modified Stage 2 in 2017 and Stage 3 in 2017 and 2018, and adding new naming conventions to measures for Modified Stage 2 and Stage 3.
  • Allowing all returning participants in the EHR Incentive Programs to report on a 90-day EHR reporting period in 2016 and 2017. (Note: Medicaid/CHAMPS will begin accepting 90 day attestations for EPs previously set to report on a year-long reporting period once this Final Rule is effective on 1/1/17)
  • An application process for a one-time significant hardship exception to the Medicare EHR Incentive Program for certain eligible professionals in 2017 who are also transitioning to the Merit-based Incentive Payment System (MIPS).

For More Information Review the OPPS and ASC final rule and visit the CMS website.


CMS Finalizes the New Medicare Quality Payment Program

In October, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system.

The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.

Accompanying the October announcement, CMS also released the new Quality Payment Program website, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.

To see the press release and obtain more information about today’s announcement, including a fact sheet, please visit:

To learn more about the rule, visit:


CMS Launches New Online Tool to Make the Quality Payment Program Easier for Clinicians

In November, the Centers for Medicare & Medicaid Services (CMS) released a tool to share electronic data for the Medicare Quality Payment Program. This new release is the first in a series that will be part of CMS’s ongoing efforts to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients.

In October, CMS released the Quality Payment Program website, an interactive site to help clinicians understand the program and successfully participate. Today’s release, commonly referred to as an Application Program Interface (API), builds on that site by making it easier for other organizations to retrieve and maintain the Quality Payment Program’s measures and enable them to build applications for clinicians and their practices. The API, available at, will allow developers to write software using the information described on the Explore Measures section of Based on interviews with clinicians, CMS created the Explores Measures tool, which enables clinicians and practice managers to select measures that likely fit their practice, assemble them into a group, and print or save them for reference. Already, tens of thousands of people are using this tool.

Dr. Kate Goodrich, Director of the CMS Centers for Clinical Standards and Quality said the API, “…will continue CMS’s focus on user-driven design by providing developers and our partners the opportunity to turn our data into powerful applications. CMS is committed to collaborating with the organizations that doctors trust to make their lives easier, while supporting their efforts to improve the quality of care across America.”

“An important part of the Quality Payment Program is to make it easier and less expensive to participate, so clinicians may focus on seeing patients,” said Andy Slavitt, Acting Administrator of CMS. “This first release is a step in that process, both for physicians and the technologists who support them.”

Several groups have applauded the release of this information, including: the American Academy of Ophthalmology, the Network for Regional Healthcare Improvement (NHRI), American College of Radiology (ACR), American College of Physicians (ACP), National Rural Accountable Care Consortium, Great Lakes PTN, Pacific Business Group on Health, Compass PTN, TMF QIN-QIO, and the Mountain Pacific Quality Health Foundation.

“The American College of Physicians (ACP) supports the efforts of CMS to design and share publicly accessible interfaces that help simplify the process of physician participation in the Quality Payment Program. These efforts are aligned with ACP's ongoing efforts to help equip physicians with tools and support needed to transform from volume-based, to value-based, patient-centered care," said Nitin S. Damle, MD, MS, MACP, president, ACP.

“We applaud CMS for using innovations in technology to help clinicians select and report meaningful measures for the quality of care patients receive,” said Debra L. Ness, president of the National Partnership for Women & Families. “APIs hold a lot of promise for helping consumers access and use information in a more actionable and easy-to-understand way, which can lead to improved outcomes for both patients and health care providers.”

Through streamlined policy and improved technology and operations, the Quality Payment Program is modernizing Medicare to pay smarter for better care. The Quality Payment Program is designed to reduce reporting burden on clinicians so that they can focus on their patients, while also providing useful information to clinicians and other stakeholders, so that overall care quality improves. As the program and its supporting website mature, CMS will continue to release data and APIs to spur innovation and keep participants up-to-date.

To see the API Swagger documentation, please visit:


New Fact Sheets Now Available

A number of new Fact Sheets are now available on the Education page of the Quality Payment Program website.

APM-Related Fact Sheet:


MIPS-Related Fact Sheets:


Registries and Qualified Clinical Data Registries (QCDRs) Fact Sheets: