- CMS granted some leeway Sunday for reporting data in connection with its numerous value-based payment programs, citing the coronavirus outbreak that threatens to overburden the U.S. healthcare system,
- The agency provided either deadline extensions for reporting data connected to the projects — which include the Medicare ACO program, Merit-based Incentive Payment System and the Hospital Readmissions Reduction Program — or waived them entirely for the fourth quarter of 2019. Financial penalties for failures to report were also waived, although upside incentive payments remain in place.
- CMS framed the rules relaxation as an exercise in cutting red tape, but the agency was aggressively lobbied by numerous provider organizations in the days before the decision was announced.
In an extraordinary time, CMS made the unusual move of granting leniency regarding the reporting of data connected to its 19 initiatives intended to improve quality of care throughout the entire Medicare system.
Virtually all of the initiatives require rigorous data collection by physicians, hospitals and other members of the provider community. That is often the source of frequent grumbling among those who had to pony up for EHR systems and other pricey items in order to comply or face lower Medicare payments.
CMS announced Sunday that it was extending 2019 data submission deadlines for ACOs participating in the Medicare Shared Savings Program from March 31 to April 30 of this year. Any providers who miss the deadline won't receive a financial penalty for failing to do so. It also granted the same leniency to participants in the Quality Payment Program and the affiliated MIPS. CMS added that it was reviewing 2020 reporting requirements as well.
CMS said it was also exempting reporting of fourth quarter 2019 data for 11 hospital-based quality programs and six post-acute programs, including the Hospital Readmissions Reduction Program, the Hospital Value-Based Purchasing Program and the Skilled Nursing Facility Quality Reporting Program. Submission of data is optional but will be counted if it is submitted.
For the hospital programs, data for the first half of 2020 will mostly not be counted. If data for the first quarter is provided by participants in the Hospital-Acquired Condition Reduction Program and the Hospital Value-Based Purchasing Program, it will be counted.
"In granting these exceptions and extensions, CMS is supporting clinicians fighting coronavirus on the front lines." CMS Administrator Seema Verma said in a statement.
CMS was lobbied by a variety of provider organizations prior to announcing the decision, including the National Association of ACOs (NAACOS), the American Medical Group Association, America's Physician Groups and the American Hospital Association.
America's Physician Groups and Premier sent a letter to congressional leaders and HHS Secretary Alex Azar early last week. "The unprecedented surge in demand and shortfall of products that we are expecting requires a major shift in focus for our organizations," the letter read in part. "While providers are actively working to confront head on the threat of the coronavirus, they are also concerned that that they will be face serious financial consequences under these programs as a result of factors not under their direct control."
A Wednesday letter signed by 10 different provider trade organizations, including NAACOS, AHA, MGMA and the American Academy of Family Physicians, among others, was addressed to the chair and ranking members of the House Energy and Commerce and Ways & Means committees.
"To enable these front line clinicians and care teams to continue to focus on providing high quality, coordinated care to patients, we urge you to preclude the financial impact or shared loss repayment for all ACOs and other value-based program participants based on costs accrued related to COVID-19 care and during this public health crisis," it read.
NAACOS CEO Clif Gaus said: "Some ACOs have spent years investing in the infrastructure and cultural changes needed to succeed in value-based care models. Just as we're starting to see serious, positive results, a catastrophic pandemic like this could wipe out years' worth of shared savings and threaten our decade-long movement to accountable care models."