Policy & Regulation News

2017 Patient Engagement Requirements for MACRA, Meaningful Use

Eligible hospitals should focus on patient engagement requirements for meaningful use, while clinicians should focus on MACRA provisions.

By Sara Heath

As 2017 approaches, healthcare professionals should prepare for new sets of reporting requirements, including patient engagement provisions under meaningful use for hospitals and MACRA for eligible clinicians.


With reimbursement rates hinging on successful participation in these programs, hospitals and clinicians alike would benefit from understanding the patient-centered requirements included in both programs.

In addition to meaningful use and MACRA, CMS has recently established an additional set of guidelines and programs to improve patient and family engagement. While these benchmarks may not influence federal incentive payments, they could be key for delivering high-quality, patient-centered healthcare.

Below, reviews the 2017 patient engagement requirements hospitals and clinicians should know.

Patient engagement and MIPS

READ MORE: CAHPS for MIPS Survey Vendor Applications Deadline Approaching

In October, 2016, CMS published the final MACRA implementation rule, which established the Quality Payment Program. Among other things, the nearly 2,400-page rule created a set of patient engagement requirements for eligible clinicians.

These requirements are a part of the Merit-Based Incentive Payment System (MIPS), one of two quality measurement legs of the Quality Payment Program. MIPS includes four quality improvement categories, and most of the patient engagement provisions are under the Advancing Care Information category.

“With these objectives we recognize that the Quality Payment Program provides new opportunities to improve care delivery by supporting and rewarding clinicians as they find new ways to engage patients, families and caregivers and to improve care coordination and population health management,” CMS said in an executive summary of the nearly 2,400-page rule.

Specifically, eligible clinicians will need to offer patients access to their health data and participate in care coordination with other providers. In the first reporting period, set to begin immediately following the New Year, eligible clinicians will be required to meet the following measures:

  • Allow one unique patient view, download, and transmit capabilities with their health data
  • Allow one unique patient access to their health data via an application programming interface (API)
  • Supply patient-specific educational materials to one unique patient
  • Extend one unique patient view, download, and transmit capabilities, with that patient then transmitting the data to a third-party provider
  • Send or answer at least one secure direct message with one unique patient
  • Collect patient-generated health data from one unique patient
  • Send or receive a summary of care from a third-party provider for one unique patient

2017 will be a transitional period for eligible clinicians, meaning those clinicians can report these measures for any consecutive 90-day period. Additionally, eligible clinicians may pick their own pace for reporting.

READ MORE: Physician Review Sites List Inconsistent Patient Satisfaction

To avoid a negative payment adjustment, clinicians may submit any data to CMS. This will result in a neutral payment adjustment, meaning clinicians will not lose out on payments, but they may not receive any incentive payments either.

For a modest positive payment adjustment, eligible clinicians may submit all requirements for a shortened reporting period.

Providers who submit all measures for the set reporting period will be eligible for a full positive payment adjustment.

Patient engagement and meaningful use

Going into 2017, eligible hospitals and critical access hospitals will still attest to meaningful use. Many of these providers will attest to Stage 2 Meaningful Use as that leg of the program winds down.

READ MORE: Patient Portal Use Growing as Engagement Efforts Take Priority

In 2017, all participants must attest a full calendar year reporting period, except for those participating in the program for the first time. First-time participants may report any consecutive 90-day period.

Under Stage 2 Meaningful Use, eligible hospitals and critical access hospitals will attest to nine objective measures, one of which being an overarching public health objective that includes four reporting measures.

Specific to patient engagement, EHs and CAHs will need to use certified EHR technology to produce patient-specific education materials for at least one patient. They will also need to offer patients the ability to view, download, and transmit their health data within 36 hours of hospital discharge.

In 2017, eligible hospitals and critical access hospitals have the option to begin reporting to Stage 3 Meaningful Use. Those selecting this option will only need to report for a 90-day period.

According to the Stage 3 Meaningful Use final rule, patient engagement requirements are combined into one overarching rule.

In the Stage 3 Patient Electronic Access Objective, we proposed to incorporate certain measures and objectives from Stage 2 into a single objective focused on providing patients with timely access to information related to their care. We also proposed to no longer require or allow paper-based methods to be included in the measures (80 FR 16753) and to expand the options through which providers may engage with patients under the EHR Incentive Programs. Specifically, we proposed an additional functionality, known as application programming interfaces (APIs), which would allow providers to enable new functionalities to support data access and patient exchange.

Other CMS patient engagement initiatives

While MIPS and meaningful use are the only reimbursement programs requiring patient engagement measures, CMS has recently put some other patient engagement projects into motion.

The agency recently implemented a strategy to improve patient and family engagement as a part of its goal to improve patient-centered healthcare, according to Kate Goodrich, MD, MS, Director of the CMS Center for Clinical Standards and Quality.

“We know that a key strategy to achieving better outcomes is to meaningfully engage patients as partners in decisions about their health care,” she explained in a blog post. “Therefore, one of the six goals outlined in this strategy is: Strengthen person and family engagement as partners in care.”

The Patient and Family Engagement strategy includes four central goals.

First, providers should engage patients and family members in the context of their own health by leveraging relationships with key community players. These community supports can help reinforce healthy living for patients.

Second, providers must identify patient engagement tools that coincide with family values. For example, providers can look into using a patient portal or mHealth wearable to help keep the patient engaged in their care.

Third, providers should foster a “culture of partnership” to make patients feel more comfortable collaborating with providers on their care.

Last, providers should create patient engagement measures to help guide practices in their initiatives.

In addition to the Patient and Family Engagement strategy, CMS has partnered with the Agency for Healthcare Research and Quality to launch two Medicare patient engagement models.

The first model, the Shared Decision Making Model, aims to foster better partnership in patient care and patient satisfaction.

According to a CMS fact sheet, this strategy includes “identifying SDM eligible beneficiaries, distributing the PDA to eligible beneficiaries, furnishing the SDM Service, and SDM tracking and reporting.”

The second model, the Direct Decision Support Model, will empower patients with the information necessary to engage in discussion with their providers about their health.

CMS will appoint Decision Support Organizations to disseminate information to eligible patients and arm them with the education necessary to better communicate with their providers.

“Providing information directly to patients about their health decisions acknowledges that patients make decisions about their medical conditions outside of, as well as inside, their doctor’s office,” said CMS Acting Principal Deputy Administrator Patrick Conway, MD, and AHRQ Director Andy B. Bindman, MD.

These efforts from CMS are a part of the agency’s efforts to promote patient-centered and value-based care. In requiring providers to offer patients access to their health data and incentivizing better engagement practices, the agency aims to improve the patient experience and drive positive care outcomes.

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