Providers knock final rule for Stage 2

HHS calls it 'flexible,' but critics say it puts program in jeopardy
By Bernie Monegain
12:24 PM
stressed doc

The Department of Health and Human Services published a final rule for Stage 2 meaningful use August 29 that offers hospitals and physicians flexibility for 2014. CHIME and professional organizations had asked for even more flexibility. "Millions of dollars will be lost due to misguided government timelines," said CHIME CEO Russell Branzell.

Branzell went on to state: "Now the very future of meaningful use is in question.

The new rule allows eligible providers to use the 2011 Edition of certified EHR technology or a combination of 2011 and 2014 Edition for the 2014 Medicare and Medicaid EHR Incentive Programs.

Come 2015, all eligible providers will be required to use the 2014 Edition of certified EHR technology.

By bending the rule a little, more providers would be able to participate and meet important meaningful use objectives such as drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures, HHS officials noted in a news release.

"We listened to stakeholder feedback," Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner said in a news release. "We were excited to see that there is overwhelming support for this change."

Branzell does not feel he and the 1,400 CIO members CHIME represents were heard.

Russell Branzell"CHIME is deeply disappointed in the decision made by CMS and ONC to require 365-days of EHR reporting in 2015. This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014," Branzell said in a press statement.

He explains: Roughly 50 percent of EHs and CAHs were scheduled to meet Stage 2 requirements this year and nearly 85 percent of EHs and CAHs will be required to meet Stage 2 requirements in 2015. Most hospitals who take advantage of new pathways made possible through this final rule will not be in a position to meet Stage 2 requirements beginning Oct. 1, 2014.

"This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines," he writes.

Branzell points out that nearly every stakeholder group echoed recommendations made by CHIME to give providers the option of reporting any three-month quarter of EHR reporting period in 2015.

"This sensible recommendation, if taken, would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar, without pushing them off the cliff; and it would have ensured the long-term vitality of the program itself. Now, the very future of meaningful use is in question.

Indeed, CMS heard from individual stakeholders and also from several healthcare provider organizations, such as HIMSS, CHIME and MGMA, prior to issuing the final rule.

'We could see, frankly, failure of the program'

MGMA executives, too, are concerned about the high hurdles MU has set to date.

"We've raised numerous concerns about where meaningful use is going," MGMA Policy Advisor Robert Tennant told Healthcare IT News, Aug. 28, the day before the final rule was published. "If significant changes are not coming in the program, I think the program risks a lot. We could see, frankly, failure of the program. And, nobody wants that. We want t to succeed, but we don't want practices to have these administrative and financial burdens trying to adhere to these more rigorous Stage 2 requirements.

"It would be a disaster," Tennant said, "if the number of EPs attesting does not substantially increase. Eighteen hundred have attested compared to 400,000 for Stage 1. So, there's something wrong going on – and not just the EPs, hospitals as well. Very few have been successful with Stage 2."

In an interview last July, former National Health Information Technology Coordinator David Blumenthal, MD, widely regarded as the architect of the meaningful use program, was optimistic about progress.

 "Well, I take a long view," Blumenthal told Healthcare IT News. "My belief is that the United States healthcare system was flawed in ways that prevented, or dis-incented the adoption of electronic health records, and that to accelerate that process required government intervention."

"The intervention was not perfect, Blumenthal acknowledged, "but it accomplished the basic goal of accelerating the adoption and use of electronic health records. It means that most Americans' health information is in digital form."

Branzell told Healthcare IT News earlier this year that CHIME surveyed CIOs from organizations that were early adopters of health IT. Of the 33 who said they would attest to achieving Stage 2 in January 2014, none did. Close to half of these said they would be delayed significantly, perhaps six months or more.

"It takes a while to get the software in," Branzell explained. "It takes a while to mature it. It takes a while to get the data flowing."

When Healthcare IT News Managing Editor Mike Miliard spoke with HIMSS Analytics Executive Vice President John Hoyt at the beginning of August, Hoyt was skeptical about whether many providers would be able to meet Stage 2 within the 2014 timeline.

"I would not expect a floodgate," Hoyt said.  "We should have had more momentum early on. That means there are clearly software and process issues. And it takes a long time to solve those. I think we're going to be looking at a significant deficit."

"These updates to the EHR Incentive Programs support HHS' commitment to implementing an effective health information technology infrastructure that elevates patient-centered care, improves health outcomes, and supports the providers that care for patients," CMS officials wrote in announcing the relaxed requirements for Stage 2.

The rule also finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012.