D.C. Report: MU Workgroup Mulls Stage 2 Delay and its Implications

MU Workgroup Mulls Stage 2 Delay and its Implications. The Meaningful Use Workgroup met Thursday to further discuss issues related to Stage 2 timing and criteria. Of note is that the MU workgroup intends to present recommendations suggesting a one-year delay for meeting Stage 2 Meaningful Use requirements as its favored option. As reported in the May 13 Advocacy Corner, the MU Workgroup had identified three options (.ppt) for Stage 2 timing: (1) stay the course; (2) require a 90-day reporting period instead of one year for Stage 2 attestation; or (3) delay Stage 2 by one year. After presenting these options and incorporating feedback from recent Health IT Policy and Health IT Security Committee hearings, the MU Workgroup will submit a transmittal letter highlighting the benefits of option three.

In his opening remarks, MU workgroup chair Dr. Paul Tang said that the group must recognize that Meaningful Use is part of a larger effort and that it’s one of many levers. “In 2009 we didn’t have the benefit of the Affordable Care Act,” he said, which puts forth many initiatives that can encourage health IT and EHR adoption. The dynamic now shifts to two other areas—how will EPs and EHs who successfully attest in 2011 proceed given the reduced pressure to meet Stage 2 criteria and similarly how will the criteria for Stage 2 change, if at all, given the longer timeframe to prepare. Some workgroup members feared that Meaningful Use will stall given the added time—as such it was suggested that higher minimum thresholds be considered. But that sentiment was rebuffed by members representing providers and vendors (and the chair himself) who said that being in a hybrid situation of operating on both paper and electronically is a very painful place to be for a hospital. “By not changing the floor, you don’t stop progress,” Tang said. And others indicated that the purpose of giving providers more time was not to “double the ask,” but instead meant to allow the proper implementation of Stage 1 criteria. Moving forward, the workgroup will focus its criteria recommendations through the lens of a longer timeline, while making an effort to send industry stakeholders more clarity and “stronger signals” about where Stage 3 development needs to go. Still unknown is whether a final ruling for Stage 2 criteria will have menu and core options, similar to Stage 1, that allow providers to choose among the best-fitting performance criteria.

The next MU Workgroup meeting is scheduled for June 1, at which time members will revisit individual criterion, while also focusing some attention on the certification versus implementation gaps discovered during a recent hearing on Stage 1 attestation experiences.

Provider Directories, Certificate Interoperability to Get ‘Aggressive’ Examination through ONC Framework. The Office of the National Coordinator (ONC) for Health IT announced this week the creation of two initiatives focused on provider directories and certificate interoperability. The efforts will be spearheaded by volunteer health IT stakeholders using the Standards and Interoperability (S&I) Framework. According to ONC, “an S&I Framework Initiative focuses on a single challenge with a set of value-creating goals and outcomes that will enhance efficiency, quality and effectiveness of the delivery of healthcare, through the development of content, technical specifications, and reusable tools and services.” For the Provider Directories Initiative, ONC has suggested a “fast-track” approach that includes four phases of development and has completed deliverables for phase one by early July. Likewise, ONC expects to achieve similar results, using an “aggressive timeline” for the Certificate Interoperability Initiative. In less than five weeks of interviews and comments, ONC hopes to analyze issues related to complying with digital certificate requirements for exchanging data with federal agencies. Among those issues under consideration, the cost, complexity and feasibility of providers acquiring, managing and using digital certificates that are cross-certified with the Federal Bridge will be identified for a report to the HIT Standards Committee around mid-summer. For more on these and the three other S&I Framework Initiatives, please visit the S&I Framework Wiki.


Medicare Meaningful Use Incentive Payments See Light of Day; eRx Incentives to Be Revisited. In an announcement made last Thursday, the Centers for Medicare & Medicaid Services (CMS) said that $75 million in Electronic Health Records (EHR) Incentive Payments had been made to providers who signed up in the first two weeks of the program (attestation began April 18, 2011). According to CMS’s latest tabulations, $158.3 million has been awarded in 2011 to eligible professionals and eligible hospitals for demonstrating meaningful use of certified EHRs under Medicare and Medicaid incentive programs. And more than 42,600 EPs and EHs had registered for the program through April 30. Also announced by CMS Thursday was a notice of proposed rulemaking for the e-prescribing (eRx) Incentive Program that would “better align” the eRx and EHR incentive programs, as well as possibly expand the “significant hardship exemption categories.” CHIME’s Policy Steering Committee is currently debating the rule’s relevance for possible comment. For more on the proposed rule change, read this fact sheet.

ACO Rule and Multi-Campus Focus of Congressional Attention. Seven Republican Senators in a letter this week urged HHS Secretary Sebelius to withdraw the Accountable Care Organization rules based on concerns expressed by various leading healthcare institutions such as Intermountain, Cleveland Clinic, Mayo, and national organizations including CHIME. “Incentives and accountability are misaligned,” said the letter, [and] “Detailed requirements are complex and return on investment is uncertain.” Acknowledging that the model of an ACO still holds promise, the letter requested the Secretary to “re-engage with experienced stakeholders to craft a new rule that fulfills the promise of ACOs.” The group of Senators includes Tom Coburn (R-OK), Jon Kyl (R-AZ), Mike Crapo (R-ID), Mike Enzi (R-WY), John Cornyn (R-TX), Pat Roberts (R-KS), and Richard Burr (R-NC).

As authorized by the HITECH Act, meaningful use payments are based on provider number not physical campuses, which pose a problem for hospital systems with multiple hospital campuses under the same provider number. While making the investment for system-wide changes as envisioned by HITECH, these healthcare institutions will see a significant reduction in incentive payments. To remedy this problem, a bi-partisan group of House members (Burgess R-TX-26, Engel D-NY-17, Brady R-TX-8 and Rangel D-NY-15) have proposed the “Provide Fairness in Health IT Payments.” In a letter to other House members, they are seeking to expand the list of co-sponsors. Similar legislation was introduced in the 111th Congress but failed to gain traction. The obvious revenue impact is likely to impede action this year, as well given ongoing budgetary constraints.