CMS Needs To Tighten Up Meaningful Use Procedures, OIG Says

Posted on December 4, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It looks like members of Congress aren’t the only ones finding fault with how CMS handles Meaningful Use incentives. In fact, HHS’s Office of the Inspector General has concluded that CMS needs to do more to verify that providers have indeed met MU standards both before and after payments get made.

As the OIG notes in its new report, CMS estimates that it will pay out $6.6 billion in incentives between 2011 and 2016. As things stand, the payments will be based on data self-reported by professionals and hospitals. To get a sense of how well this method is working, the OIG reviewed CMS’s incentive program oversight for 2011, as well as analyzing the self-reported data and auditing the agency’s planning docs, regs and guidance for the  program.

What did the OIG find?  Researchers concluded that CMS faces obstacles to overseeing the EMR incentive program which could end up with its paying providers and hospitals that haven’t fully met Meaningful Use requirements.

More specifically, the OIG concluded that CMS hasn’t put strong prepayment safeguards in place, nor has it good mechanisms for auditing incentive disbursements postpayment.  Moreover, ONC requirements for EMR reports might be getting in the way of more accurate incentive payment processes, the report said.

The OIG’s recommendations include having CMS get and review supporting documentation from selected hospitals and professionals before it cuts Meaningful Use checks, a step CMS rejects as imposing too big a burden on providers and slowing the payment process too much.  (For the sake of providers that need timely checks, let’s hope it stays that way.) The OIG also recommended that CMS  issue specific examples of documentation that can be used to support MU compliance.

Meanwhile, the OIG would like to see ONC  change certification requirements for EMRs to make it more likely that they can produce reports for yes/no Meaningful Use measures where possible. It would also like ONC to improve the certification process for EMR technology to make sure EMRs generate accurate reports.

For the most part, the  OIG’s recommendations seem reasonable, if not capable of being done overnight.  But I’ve got to agree that auditing incentive payments before issuing them would throw a serious kink into the process. Let’s hope the OIG and CMS compromise on something reasonable here.