The federal Centers for Medicare and Medicaid Services will not delay Stage 2 of the Meaningful Use EHR incentive program, but will offer leniency for healthcare providers claiming hardship exemptions from some of the requirements this year.
“We have decided to permit flexibility in how hardship exemptions are granted in the 2014 reporting year,” CMS Administrator Marilyn Tavenner said Thursday in a keynote address to the annual Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, Fla. However, she said CMS fully expects everyone to meet all Stage 2 requirements in 2015, when Medicare payment penalties for noncompliance will begin.
“Now is not the time for us to stop moving forward,” Tavenner said.
However, Tavenner did not offer any details from the stage. An e-mailed statement from CMS to reporters said the announcement was largely due to the slow pace of EHR vendors upgrading their products to 2014 certification standards, then getting those certified EHRs installed in healthcare facilities.
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“HHS is cognizant of the concerns expressed by stakeholders regarding availability of 2014 Edition Certified EHR Technology. Therefore HHS will implement a flexible hardship exception policy so those who legitimately tried to upgrade their EHR product to the 2014 Edition but may have not had time to implement the system would not be penalized in 2015,” the statement says.
At a press conference following the keynote session, national health IT coordinator Dr. Karen DeSalvo said that CMS will be providing more guidance “any day,” and recommended that interested parties subscribed to the CMS Office of e-Health Standards and Services’ listserv.
“What CMS is committed to doing is taking a look [at hardship requests] on a case-by-case basis,” DeSalvo said, which is what the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act requires. Those who do earn an exemption in 2014 are still eligible for Meaningful Use incentive payments going forward. “If you have a hardship exemption, you can get back on the train,” DeSalvo confirmed.
Immediate Twitter responses were skeptical.
If "hardship" doesn't extend to #MeaningfulUse attestation delays due to certified vendor resource/sw issues, expect lawsuits. #HIMSS14
— Mandi Bishop (@MandiBPro) February 27, 2014
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Could Ms. Tavanner have been any more vague about MU II deadline flexibility? #HIMSS14 pic.twitter.com/pd7URSr8gJ
— Eli Tarlow (@TarlowEli) February 27, 2014
What is the ICD-10 code for hand cramp related to hand-wringing while waiting for hardship exemption on MU Stage 2? @AMIApolicy #HIMSS14
— Ross D. Martin (@RossMartin) February 27, 2014
HIMSS President and CEO H. Stephen Lieber offered cautious praise to the news. “They recognize the challenges” of meeting Stage 2 requirements, he said. However, Lieber added, “Nobody needs to look at this as a free pass.”
Lieber said he expects CMS to release details and examples of what situations have earned hardship exemption in the next 30-90 days. At the moment, he said he has not heard much, even in private conversations with government insiders.
The College of Healthcare Information Management Executives (CHIME) was more concerned that this move might not be adequate.
“Such relief is vitally important for the future success of Meaningful Use, as ICD-10 deadlines and continued shifts in payment policies demand an ever-increasing amount of IT and workforce resources. If the expansion of the office’s EHR hardship exceptions provides the kind of relief the industry desperately needs, CHIME pledges to assist policymakers in every way possible,” the organization said in a statement attributed to President and CEO Russell Branzell and board chairman Randy McCleese.
However, CHIME said it was reserving the right to continue to push for additional time for providers to attest to Meaningful Use Stage 2. CHIME and 47 other organizations sent a letter to HHS Secretary Kathleen Sebelius last week urging an extension. HIMSS was not a signatory to the letter, which Lieber called “very vague.”
Tavenner also reiterated that the current deadline to switch to ICD-10 coding was firm. “I think folks understand there will be no more delays and the system will go live Oct. 1,” Tavenner said, noting that the deadline has been delayed several times already. She said CMS systems have been ready since October to accept Medicare claims coded in ICD-10.
