The CMS has proposed an array of rule changes affecting physicians and their use of health information technology under various Medicare and Medicaid payment regimes, including delaying for at least a year a requirement for the direct, electronic reporting of physician quality data as part of the meaningful use requirements of the electronic health-record incentive payment program under the American Recovery and Reinvestment Act of 2009.

The 621-page proposed rule, released by the CMS this month, but not scheduled for official publication in the Federal Register until Wednesday, is open for public comment through August 30.

One key change in the rule is a proposal to continue to allow physicians and other eligible professionals (collectively referred to as EPs under the program) to qualify as having met a portion of their meaningful-use requirements for clinical quality measures by submitting attestations to the CMS.

In its final rule issued on meaningful use released in July 2010, the CMS allowed physicians and other EPs to report their clinical quality measures by attestation for 2011, the first year of the program, but had required EPs to report the quality measures as data to the CMS electronically in 2012.

However, according to the newly released proposed rule, the standards and technology chosen to perform that task is inappropriate for the task.

In their new proposal, the rule makers said, the CMS was expecting that “certified EHR technology will be required to calculate the clinical quality measure results and transmit under the Physician Quality Reporting Initiative (PQRI) Registry XML specification.”

But, according to the CMS, “Since the publication of the final rule, we have determined that it is not feasible to receive electronically the information necessary for clinical quality measure reporting based solely on the use of PQRI (Physician Quality Reporting Initiative) 2009 Registry XML Specification content exchange standards as is required for certified EHR technology. This is because the specification is tailored to the elements required for 2009 PQRI Registry submission, rather than constituting a more generic standard.”

As a result, the CMS rule makers “propose to modify the requirement that clinical quality measure reporting must be done electronically. Specifically, we propose that for the 2012 payment year, EPs may continue to report clinical quality measure results as calculated by certified EHR technology by attestation, as for the 2011 payment year.”

The rule makers, however, proposed offering a voluntary, “pilot mechanism” in 2012 for eligible professionals to electronically report their clinical quality measures. Participation in the Physician Quality Reporting System-Medicare EHR Incentive Pilot, as the combined program is to be called, would satisfy an EP's meaningful-use requirements under the EHR incentive payment program, the rule makers said.

EPs would be required under the pilot to report their clinical quality measures for a full year. By participating in the pilot, EPs will be eligible for Physician Quality Reporting System incentive payments and EHR incentive payments. Participants in the pilot also could submit data through certain CMS-approved EHR vendors, the rule makers said. A list of those qualified vendors is not expected to be available until the summer of 2012, they said.