It’s the unenviable duty of stakeholders to slog through the more than 1,100 pages of stage 2 meaningful use final rules set down by the Centers for Medicare and Medicaid Services and Office of National Coordinator for Health IT, but when I caught up with Jeff Smith, the assistant director of advocacy with the College of Healthcare Information Management Executives or CHIME, he had gleaned enough information from the weighty tome to make some preliminary assessments about three parts of the rules.
Under the Health Information Technology for Economic and Clinical Health or HITECH Act, physicians, health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt and meaningfully use certified electronic health record technology. Of the three stages of meaningful use, here are the first two, as listed on CMS’ website:
- Stage 1 sets the basic functionalities electronic health records must include, such as capturing data electronically and providing patients with electronic copies of health information.
- Stage 2 (which will begin as early as 2014) increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.
Here are some of the points for physicians and hospitals among the final rules they are required to meet to satisfy Stage 2 Meaning Use to qualify for incentives.
The Stage 2 final regulations make some concessions to providers, and their vendor partners, by allowing participants a 90-day reporting period to meet Meaningful Use in 2014. CHIME and other provider stakeholders advocated for a three month reporting period during the public comment stage, because CMS had proposed a 365-day reporting period for all periods after the first year of Stage 1.
The timing between the publication of a final rule and the launch of Stage 2 would only be 13 months under the proposed scenario, Smith said. “By giving providers the ability to only report 90 days in fiscal year and calendar year 2014, it affords some flexibility so venders can develop and providers can implement and test new technology and workflow processes,” he said.
Smith added that on the other hand, “the final Stage 2 regulation makes clear that this is a one-time window. The regulation says that those who would attest to Meaningful Use Stage 2 in the years beyond 2014 would have to report on data gathered during the full 365-day reporting period.”
Another issue related to timing are the reductions in reimbursement for not making it to Stage 1 Meaningful Use by 2015. Under language in HITECH and regulatory language for Stage 1, providers have until 2015 to prove they are “meaningful users” of EHRs. Proposed rules released last spring by CMS attempted to change that, instead of signaling that providers would be required to meet Stage 1 by the end of 2013 due to accounting and budgetary constraints. The final rules published Thursday make clear that payment adjustments will not happen to providers until later.
The final rules say that eligible providers and eligible hospitals can avoid downward payment adjustments in 2015 “if they are able to demonstrate meaningful use at least three months prior to the end of the calendar year for eligible professionals or EPs, or fiscal year (for eligible hospitals).” The proposed change last spring unsurprisingly sparked a lot of outrage, so pushing the deadline back up to 2014 seems like a compromise, but it’s a mealy-mouthed one. Although hospitals and physician groups need only demonstrate a 90-day reporting period, the change really only gives providers an extra nine months.
“To a large degree, the government believes it’s adopting regulations that are feasible for the provider community,” Smith said. “However, I would argue that from a provider perspective there is some concern that the provider viewpoint, the boots on the ground understanding of how this gets implemented at a higher level, is not well understood by everyone on the federal advisory committee.”
Still, Smith said that the final regulation represents a willingness by rulemakers to compromise on the side of what’s feasible while pushing the healthcare industry forward.
The final rules also soften requirements that put physicians on the hook for patients to view their health records online. Under the proposed rule released earlier this year, at least half of all patients have to be able to “view online, download or transmit” their personal health information. Doctors would also be required to prove that at least 10 percent of those patients actually viewed, downloaded or transmitted their information. Under the final rule, physicians are required to prove that 5 percent of their patients utilize the service.
Clinical quality measures
One section that Smith drew attention to are the clinical quality measures that will be used to determine reimbursement for hospitals and physician groups.
“Payment reform is moving forward and right now it’s very difficult for providers to produce consistent and accurate clinical quality measures, or CQMs. The proposed rule was fairly ambitious regarding CQMs and that will be a key area to look at ’ how much of the proposed rule remains in the final rule and how much did they soften it to achieve accuracy and compatability?”
Another potential issue is the provision that permits the “2011 Edition Certified EHR Technology” to be used until 2014. That means the stakeholders that invested in this technology will have to fork out more money to update it sooner rather than later.
In the coming months, organizations that are not successfully attesting will make their feelings known, especially rural and small hospitals and physician groups.
Smith acknowledged that despite the potential problems, the rules showed that the government had listened to many of the concerns voiced during the public comment period.
“They didn’t follow our recommendations to a T but they did heed some of our warnings.”