Mostashari backs Stage 2 delay to 2014

By Mary Mosquera
10:07 AM

Farzad Mostashari, the national health IT coordinator, said that he agreed with the conclusions of the Health IT Policy Committee for delaying until 2014 the start of stage 2 of meaningful use, essentially signaling to the industry that federal policymakers will follow the advisory group’s recommendation.

He cited the committee’s reasoning that widespread deployment of the next set of electronic health record (EHR) functionality and updating systems in less than six months -- the time between the final rule that details the required measures and the start of stage 2 -- may be “infeasible, and therefore could have a detrimental effect on keeping providers on the meaningful use escalator.”

[See also: Mostashari to providers: MU is not about 'hoop jumping'.]

Providers who attest to meaningful use at the earliest possible time in 2011 should be rewarded, Mostashari said at the July 6 policy committee meeting. Delaying the onset of stage 2 may encourage more providers to attest in 2011.

“The last thing we want to do is provide a disincentive towards attesting for meaningful use in 2011. We recognize that not accepting your recommendation to delay the start of stage 2 could negatively impact provider participation rates in the EHR incentive program in 2011,” he added.

By giving providers and vendors additional time, requirements for stage 2 can be more rigorous than would otherwise be possible if stage 2 were to begin in 2013 as originally planned, Mostashari said.

“In consideration of these points and the concerns expressed by multiple stakeholders, we agree with the logic of delaying the start of stage 2 of meaningful use for a period of one year for those first attesting to meaningful use in 2011. We also agree that it makes sense to maintain the current expectations for those first attesting to meaningful use in 2012 so that all providers attesting to meaningful use in 2011 or 2012 would attest to stage 2 in 2014,” he said.

Mostashari has previously expressed support for the committee’s recommendations but not as clearly and forcefully.

The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) anticipate releasing their proposed rules on meaningful use of electronic health records (EHRs) and standards and certification criteria by the end of the year or early 2012, accepting public comments about it, and finalizing it next summer.

Paul Tang, committee vice chair and head of its meaningful use work group, which drafted the recommendations, said that he has heard from providers who are holding off from attesting for stage 1 in 2011 because they would be put in a difficult situation with little time to update systems once the stage 2 final rule was published.

[See also: Would meaningful use Stage 2 delay ignite ICD-10?.]

“Farzad [Mostashari] sent a very strong signal that the department understands. I think there is a pent up demand to attest, but they do not want to get into this ‘Catch-22’ predicament,” he said. Tang is also chief medical information officer at the Palo Alto Medical Foundation.

Indeed, Elizabeth Holland, CMS’ director of health IT initiatives group, told the committee that “our projections are higher than what we have experienced to date. As people continue to attest, we will look at the performance on attestation when we are formulating the regulation for stage 2 because we’re trying to get as many people on the bus as we can,” she said.

In its June report, CMS reported that 68,000 eligible physicians and hospitals have registered for the Medicare and Medicaid incentive programs and a total of $273 million have been issued in incentives.

Medicare EHR incentives have been paid to 560 physicians and hospitals. For the Medicaid program, 17 states are open for registration for the incentive program, and Medicaid incentives have been paid to 2,400 physicians and hospitals.