Meaningful Use Problems Go Beyond Just Software, Say “Stage 2 Flexibility” Critics

Sept. 10, 2014
The final rule for meaningful use Stage 2 flexibility, released late on Friday by the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC), is not as popular as the government probably would have liked.

The final rule for meaningful use Stage 2 flexibility, released late on Friday by the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC), is not as popular as the government probably would have liked.

The rule does allow eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) to use 2011 Edition certified electronic health record (EHR) technology (CEHRT)  or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs. However, the government has received sharp criticism from industry associations that the flexibility offered in these modifications was not enough to save hospitals and providers from receiving penalties down the line.

Robert Tennant, senior policy advisor of the Medical Group Management Association (MGMA), says while his organization is grateful for the focus on the CEHRT software, most of MGMA’s recommendations, as well as the other comments CMS and ONC received, and many of the overall problems with meaningful use were ignored.

“They’ve decided to focus exclusively on the issue of the software not being ready. We believe the problems with Stage 2 go beyond the CEHRT. That’s certainly an issue and we’re pleased they’ve given EPs flexibility for 2014 but that doesn’t solve the many other issues with Stage 2, not least of all, some of the new requirements have proven to be extremely onerous and forced EPs to rely on the actions of third parties,” says Tennant, speaking exclusively to Healthcare Informatics.

“The software issues are a problem, this definitely helps. But they made it adamant in the final rule that any criticism to the measures themselves were out of scope. They dismissed all of the industry recommendations.”

Tennant is frustrated that CMS and ONC continue with an “all or nothing” approach. He says the fact that an EP or EH can be 99.9 percent of the way there and fail sends the wrong message to the industry. Specifically, he mentioned the challenging transitions of care measures, which recent research showed that only a small number of EPs and EHs were able to meet.

The MGMA’s policy head mentioned the reporting requirements, and the lack of flexibility offered by CMS and ONC, as another reason the modifications weren’t enough for providers and hospitals. CMS and ONC are still requiring hospitals to engage in a 365-day reporting period in second-year Stage 2 reporting in 2015, rather than an industry-proposed 90-day reporting period. This means they have less than one month to get certified electronic health record (EHR) software in place in time to begin the mandatory reporting, since the fiscal year begins on Oct. 1, 2014.  

Speaking on this matter to HCI, Russell P. Branzell, president and CEO of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), was none too pleased with ONC and CMS’ efforts. “For a program that we still believe is absolutely essential and absolutely important to gain momentum, we are absolutely shocked that no flexibility was given in this case, with regard to 2015. Their rationale was that they wanted to create more momentum. But this does the opposite,” Branzell said.

This sentiment was echoed by Chantal Worzala, director of policy at the American Hospital Association. In a statement, she said: "The American Hospital Association appreciates the flexibility offered by CMS. Unfortunately, this rule offers little relief because CMS did not grant a shorter reporting period for FY 2015, which begins on Oct. 1."

Anita Samarth, CEO of Clinovations Government Solutions, a Washington D.C.-based consulting firm, said in an email to HCI that while for many organizations this will be a blessing, the timing on these announcement was probably too late for many others.

“I really wish they had made this announcement earlier in the year. This really benefits organizations that had not planned to meet the Stage2/2014 requirements until 4th quarter – and even if that was your plan, you were likely already in the implementation phase.  This does allow some time to pause, ensure you're implementing it correctly, and most-of-all that the products are ready,” Samarth said.

Anita Samarth

According to Karen Chan, also of Clinovations, requiring year-long reporting periods in 2015 may affect providers who use the new option to attest to Stage 2 by achieving Stage 1 measures in 2014. "While initially it seems like these providers are catching a break, in their second year they will suddenly find themselves with little to no experience with Stage 2, while facing a year-long reporting period using Stage 2 requirements. This new option is quite the double-edged sword," Chan says.

Chan says that many providers starting their second year of Stage 2 will face the challenge of having less time to develop long-term strategies for achieving the more rigorous Stage 2 requirements.  "This is particularly challenging in the small practice setting where staff resources are limited. In an ideal world, there would be plenty of time for education, planning, strategizing, etc. before an organization tries to achieve Stage 2 over the course of an entire year. However, the reality is that many organizations simply haven’t been afforded the time to do this and will likely be forced to dive directly into a year-long reporting period, perhaps unprepared, and with very little room for error," she says.

Not everyone was completely displeased with the modifications. The EHR Association said they were pleased that CMS has released the Final Rule quickly, which it says minimizes confusion and delays for both EHR developers and providers. “We appreciate that many of our customers will have more flexibility in achieving meaningful use for 2014 given the timing issues created by the Stage 2/2014 regulatory and certification schedule,” Mark Segal, Ph.D., EHRA Chair and vice president of Government and Industry  Affairs at GE Healthcare IT, said in a statement.

But doom and gloom seemed to rein supreme. Over at MGMA, Tennant predicts that many EPs are going to start weighing the return on investment (ROI) of participating in the program against the downstream penalties. This is especially the case, he adds, with the ICD-10 transition and other regulatory demands being pushed upon them. “We need a little help from the government,” he concludes.

HCI will be gathering more reactions to this news as they come in.

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