1. Hess, Cathy Thomas BSN, RN, CWCN

Article Content

In the February 2019 Practice Points column, Merit-based Incentive Payment System 2019 Changes, we reviewed the final changes to the 2019 Quality Payment Program Final Rule1 under the Medicare Access and CHIP Reauthorization Act of 2015 released by the Centers for Medicare & Medicaid Services (CMS). In this column, we will focus on the Promoting Interoperability performance category. This information is not exhaustive, and it remains your responsibility to read and understand how these changes affect your practice needs. The CMS references are provided along the way for you to build your resource library.1,2


For Performance Year 2019, the 2015 Edition certified electronic health record technology (CEHRT) is required for participation in this performance category. Measures are no longer classified as base score or performance score measures. Participants must submit collected data for certain measures from each of the four objectives measures (unless an exclusion is claimed) for 90 or more continuous days during 2019 (see the Table). The scores for each of the individual measures will be added together to calculate the score of up to 100 possible points. If exclusions are claimed, the points for measures will be reallocated to other measures.


Additional Performance Improvement Requirements

In addition to submitting measures, clinicians must


* Submit a "yes" to the Prevention of Information Blocking Attestation.3 The CMS description: The Prevention of Information Blocking Attestation has three related statements that are based on section 106(b)(2) of the Medicare Access and CHIP Reauthorization Act about how healthcare providers implement and use CEHRT. When you attest to these three statements together, you are confirming that you have acted in good faith to support the appropriate exchange of electronic health information and not knowingly and have not willfully limited or restricted the compatibility or interoperability of the CEHRT.


* Submit a "yes" to the ONC Direct Review Attestation. The Office of the National Coordinator (ONC) has required surveillance of certified health information technology since 2011 and has recently expanded these programs through the Enhanced Oversight and Accountability final rule to include a stronger focus on ensuring that health information technology products and capabilities continue to perform as expected when they are implemented and used "in the field." The ONC direct review and ONC-Authorized Certification Bodies surveillance of health information technology provide confidence that technology meets federal standards and possesses the capabilities that healthcare providers need to improve patient care and meet program requirements.


* Submit a "yes" for the security risk analysis measure.4 Measure description: Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of electronic protected health information data created or maintained by CEHRT in accordance with requirements in 45 CFR 164.312(a)(2)(iv) and 45 CFR 164.306(d)(3); implement security updates as necessary and correctly identify security deficiencies as part of the Merit-based Incentive Payment System (MIPS)-eligible clinician's risk management process.



Review Hardship Exceptions

A clinician or group participating in MIPS may submit a Promoting Interoperability Hardship Exception Application, citing one of the following reasons for review and approval:


* MIPS-eligible clinician in a small practice


* MIPS-eligible clinician using decertified electronic health record technology


* Insufficient internet connectivity


* Extreme and uncontrollable circumstances


* Lack of control over the availability of CEHRT



For clinicians participating in MIPS, getting a hardship exception means that the Promoting Interoperability performance category receives 0 weight in calculating your final score, and the 25% is reallocated to the Quality performance category. There are some clinicians who will be automatically reweighted based on special status (eg, hospital-based clinicians) or their clinician type (eg, a physical therapist, occupational therapist, or clinical psychologist). These clinicians will not need to submit a Promoting Interoperability Hardship Exception Application. If you are submitting as part of a group, the whole group must qualify for some sort of hardship exception for the group to be reweighted.




1. Federal Register. A Rule by the Centers for Medicare & Medicaid Services on 11/23/2018. 2018. Last accessed February 20, 2019. [Context Link]


2. Quality Payment Program. Resource Library. Last accessed February 20, 2019. [Context Link]


3. Quality Payment Program. 2019 PI Information Blocking Factsheet. Updated December 31, 2018. Last accessed February 20, 2019. [Context Link]


4. Quality Payment Program. 2019 Promoting Interoperability Measure Specifications. Updated December 27, 2018. Last accessed February 20, 2019. [Context Link]