AHA: Hurry up with EHR choice expansion

Hospital group also asks for MU simplification and flexibility, says to take heed of Stage 2 challenges so far
By Mike Miliard
11:07 AM

The American Hospital Association has called upon the Centers for Medicare & Medicaid Services and the Office of the National Coordinator to quickly finalize rules regarding the expansion of choice for certified electronic health records.

[See also: AHA says 'bar too high' for Stage 2]

"The flexibility offered in the proposed rule would support continued adoption of EHRs; without it, many providers are likely to conclude that they cannot meet meaningful use this year and abandon the program," wrote Linda Fishman, AHA's senior vice president of public policy analysis and development, in a June 17 letter to CMS Administrator Marilyn Tavenner and National Coordinator Karen DeSalvo, MD.

She added that, since hospitals have to decide their meaningful use strategy for fiscal year 2014 before the new rule is finalized, one that "narrows the proposed flexibility could unfairly cause significant financial and operational harm to hospitals.

[See also: AHA calls for Stage 2 reporting changes]

"We strongly urge you to finalize, as quickly as possible, the proposal to expand providers' choice of certified EHR technology to be used in 2014," Fishman wrote. "The proposed flexibility is much needed and would offer more choice in the specific meaningful use requirements they must meet in 2014 (Stage 1 or Stage 2). However, we are concerned that the extremely late release of the proposed rule will limit its benefit to hospitals."

The letter also urges CMS and ONC to clarify and simplify the rule's implementation, offer more flexibility in the reporting of clinical quality measures, shorten the MU reporting period for 2015 and take some lessons from the experiences of Stage 2 before finalizing the start date for Stage 3.

As for eCQMs, AHA makes the case that hospitals should have wider berth in the measures they choose to report, irrespective of the specific stage of MU.

"Specifically, hospitals using a combination of 2011 and 2014 Edition CEHRT should be able to report either set of eCQMs, regardless of the stage of meaningful use met," Fishman wrote.

Simplification of the rule would also be a boon, AHA argued, specifically were CMS to remove the proposed limitation on providers' ability to take advantage of this new flexibility.

"The proposed rule would limit the selection of an alternative approach to attesting in a manner consistent with the existing rules to hospitals that 'could not fully implement 2014 Edition CEHRT to meet meaningful use for the duration of an EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability,'" the letter argues. "AHA members have expressed considerable concern that this limitation creates uncertainty that could limit the benefit of the proposed flexibility."

AHA urged Tavenner and DeSalvo to understand that 2015 also will be a "transition year" for hospitals, and to adjust the reporting calendar accordingly.

"The proposed rule states that, beginning in FY/CY 2015, all eligible hospitals and professionals will be required to use 2014 Edition CEHRT to report meaningful use, consistent with current rules," Fishman wrote. "The reporting period would be 365 days for all providers, except the limited number in their first year of meaningful use, for whom the reporting period will be 90 days. Thus, the vast majority of hospitals will be expected to meet Stage 2 criteria in 2015, for 365 days.

"The AHA strongly recommends that CMS shorten the reporting period for 2015 to 90 days for all hospitals, CAHs and EPs," she added. "As acknowledged in the proposed rule, a central reason for the challenges being faced today is the requirement for a nation-wide, simultaneous upgrade to a new certification level for EHR technology. The flexibility in 2014 is helpful, but in reality provides only three months of additional time for providers to get up and running with Stage 2 requirements using the 2014 Edition technology."

Assuming a three-month reporting period, it takes 19 months to "efficiently and safely move from having the software to being able to attest to the next stage of meaningful use," the letter points out. "Most hospitals received their 2014 Edition CEHRT in spring or summer 2014 (with some still waiting), and will need until summer 2015 to complete their transition. We believe a 90-day reporting period would keep all providers moving forward to meet Stage 2, while giving them additional time to undertake the many workflow and other changes required by Stage 2."

Having seen the challenges that so many providers are having with regard to Stage 2, AHA implored CMS to learn from those experiences before finalizing the start date for Stage 3.

"The AHA believes it is too soon to finalize the start date of Stage 3 as FY 2017 for hospitals, as proposed," wrote Fishman. "Instead, CMS should specify that the 2014 Stage 1 and Stage 2 criteria will be effective until updated by future rulemaking."

As it stands, the proposed start of Stage 3 is Oct. 1, 2016, the first day of FY 2017, she points out.

"While hospitals may be ready for Stage 3 on that date, there is no evidence to support that assertion. To the contrary, experience to date suggests that rushing toward another aggressive deadline for Stage 3 could jeopardize program success.

"Furthermore, no one, including CMS and ONC, can judge readiness for providers to meet Stage 3 in the absence of the specific criteria that will be required. It would, therefore, be more appropriate to wait until the Stage 3 rules themselves are finalized to codify the start date in regulation."

The paltry numbers of Stage 2 success stories speak for themselves, Fishman argued.

"As of mid-May 2014, fewer than 10 hospitals and 50 EPs had attested to Stage 2," she wrote. "The limited success suggests that the aggressive timeline is not the only challenge."