Annals of Health Law
READY OR NOT
threat of financial penalties. Meanwhile, CMS is extending compelling
rewards in exchange for providers’ exceptional performance data. 161
Indeed, as providers’ VBP programs become more sophisticated, providers
will be required to submit all of their quality data through an EHR system.
As such, the OIG’s focus on fraud vulnerabilities in EHR use will
necessarily involve an examination of the integrity of the quality measures
data submission processes. Hospitals are wise to jump on board with EHR
implementation and VBP program participation, especially since
meaningful use of EHR is critical to the long-term success of VBP.
Currently, the required quality measures for the Hospital VBP program
do not perfectly align with the CQMs required under the EHR Incentive
Program. That is, while there is some overlap among the measures required
of the various P4P programs and the EHR Incentive Program, there are also
some variations across the programs. 162 The government recognizes that
these disparities can be problematic and burdensome. Using the same
specifications for similar MU and VBP measures would reduce confusion,
reduce the costs of developing measures, and potentially address the
limitations of CMS data collection methods. 163 The issue is ultimately
addressed by the Stage 2 Proposed Rule, which aligns Hospital VBP
measures with the EHR Incentive Program CQMs, as well as with other
existing quality programs. 164
161. See Hospital VBP Becomes Permanent Fixture in Healthcare Reimbursement,
supra Section IB.
162. Specifically, some of the clinical quality measures in the incentive program for the
MU of certified EHRs do not overlap or align with the Hospital IQR program and the VBP
Program. CMS has announced it is “actively planning to synchronize the various reporting
programs in order to ensure harmony among measures across various settings.” See Mary
Mosquera, For Hospitals, Value-based Purchasing Starts With Meaningful Use,
GOVHEALTHIT.COM (May 3, 2011), available at http://www.govhealthit.com/news/
hospitals-value-based-purchasing-starts-meaningful-use. CMS will work with the Office of
the National Coordinator for Health IT on operational issues involved when aligning VBP
and MU, including harmonizing the specifications of overlapping measures and considering
developing new policies to protect patient privacy when accessing electronic data. See id.
163. See Shay, supra note 4, at 1.
164. See MEDICARE AND MEDICAID EHR INCENTIVE PROGRAM STAGE 2 PROPOSED RULE
(2012), available at https://www.federalregister.gov/articles/2012/03/07/2012-4443/
medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage- 2.
Beginning in 2014, the twenty-four CQMs on which hospitals must report under the EHR
Incentive Program (Stage 2 MU) will match the Hospital VBP Program, the Joint
Commission quality measures, the Medicare Hospital IQR Program and the National
Quality Strategy. See Pawlak & Newman, supra note 151. For an in-depth discussion of
quality alignment issues, see Amy Thorpe & Adol Esquivel, Quality Reporting Alignment
12th Annual Conference and Exhibition, available at http://69.59.162.218/
HIMSS2012/Venetian%20Sands%20Expo%20Center/2.22.12_Wed/Marcello%204506/Wed
_0945/96_Amy_Thorpe_Marcello%204506/96ThorpeFINALrevc.pdf.
