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ADA formally comments on proposed CMS changes

September 11, 2018

By Jennifer Garvin

Washington — The ADA filed comments Sept. 6 on several parts of a proposed rule announcing changes to Medicare and Medicaid requirements as they relate to dentistry.

In a letter to the Centers for Medicare & Medicaid Services and U.S. Department of Health and Human Services, ADA President Joseph P. Crowley and Executive Director Kathleen T. O’Loughlin offered comments on the following areas:

• Requirements for Merit Based Incentive Payments System-eligible physicians to use electronic health records technology using 2015 criteria.

• Proposed measures to update the existing quality measure specifications for health care specialties, including dentistry.

• The Physician Self-Referral Law.

Regarding Certified Electronic Health Record Technology requirements, the ADA noted that in 2017 and 2018, eligible clinicians had the flexibility to use electronic health record technology that was certified by the 2014 or 2015 Edition certification criteria. In 2019, clinicians will be required to use the 2015 criteria exclusively, which is problematic for dentistry.

The ADA said it “appreciates CMS’s and other stakeholders’ concerns regarding the obsolescence of the 2014 Certification Criteria,” but is concerned that dentists will not have access to 2015 Certified Electronic Health Record Technology products, and will not be able to participate in the Promoting Interoperability Programs in 2019, and possibly 2020 and beyond.

The ADA concern is based on the observation that none of the 33 dentistry-oriented products on the Office of the National Coordinator for Health Information Technology’s Certified Health IT Products List are certified to 2015 Criteria.

Because the Association is not aware of any “dentistry-specific, ambulatory-only” electronic health record vendors that plan to seek 2015 certification, Drs. Crowley and O’Loughlin suggested that the agency “examine the gaps” between existing dental electronic health record implementations and 2015 certified products and devise reporting criteria utilizing the existing 2014 Edition technologies.

In regards to proposed measures to update the existing quality measure specifications for health care specialties, including dentistry, the ADA commented on two oral health specific measures included in the specialty measure sets:

• Quality ID-378, which concerns children aged 1-20 who have dental decay or cavities.

• Quality ID-379, which covers primary caries prevention intervention measures such as fluoride varnish for children as offered by primary care medical providers, including dentists 

The ADA pointed out that the first measure, No. 378, has not been risk adjusted and said that the value sets included in the measure are not valid. 

“There is a large body of evidence that various socio-demographic factors influence outcomes, and thus influence results on outcome performance measures,” wrote Drs. Crowley and O’Loughlin. 

For measure No. 379 they noted that it only tracks a single fluoride varnish applied during the measurement period which goes against evidence-based clinical recommendations that suggest topical fluoride should be applied at least every three to six months in children with an elevated risk for caries.

The ADA “strongly urged” CMS to consider incorporating additional measures — including sealants — into the dentistry specialty set which have been developed by the Dental Quality Alliance through support from the Office of National Coordinator for Health Information Technology and tested using the Measure Authoring Tool based on the Quality Data Model and value sets.

Regarding the Physician Self-Referral Law (Stark Law), the ADA said it supports CMS’ efforts to make the regulations more consistent with the Bipartisan Budget Act of 2018 and to help relieve some of the burden of the law’s compliance, and urges CMS to “adopt the proposed changes to provide more flexibility concerning what constitutes a ‘written’ arrangement, and to permit doctors and DHS entities more flexibility around obtaining signatures,” Drs. Crowley and O’Loughlin concluded.