CMS announced in a final rule that providers and eligible professionals will receive an additional year to upgrade electronic health record systems to meet requirements for Stage 2 of the meaningful use program, Modern Healthcare reports (Tahir, Modern Healthcare, 8/29).

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

Background

The delay was originally proposed in May after just four hospitals had attested to Stage 2 (Viebeck, The Hill, 8/29).

When proposing the rule in May, CMS and the Office of the National Coordinator for Health IT noted that the timeline changes came in response to stakeholder feedback about needing more flexibility. The proposed rule acknowledged that many software vendors have had difficulty upgrading their EHR products, receiving certification and upgrading customers' systems in time to attest to the meaningful use program (iHealthBeat, 5/21).

According to Modern Healthcare, the final rule did not change any of the proposed rule's provisions (Modern Healthcare, 8/29).

Final Rule Details

The final rule, which is scheduled to be published in the Federal Register on Sept. 4, will provide additional flexibility by allowing eligible professionals, eligible hospitals and critical access hospitals to use the 2011 Edition certified EHR technology or a combination of 2011 and 2014 Edition certified EHR technology for the 2014 EHR reporting period (Bowman, FierceEMR, 8/29).

Providers will be able to attest to meaningful use under the 2013 reporting year definition and use the clinical quality measures from 2013 (Murphy, EHR Intelligence, 9/2).

Providers will not be penalized for failing to move to meaningful use Stage 2 during the 2014 reporting period (The Hill, 8/29).

The final rule noted that the proposed changes are just for 2014 and that all eligible providers will be required to use the 2014 Edition of certified EHR technology beginning in 2015 (Monegain, Healthcare IT News, 9/2).

Further, CMS in the final rule said that it would delay the start date for Stage 3 from Jan. 1, 2016, to Jan. 1, 2017, giving MU participants more time to meet Stage 2 requirements and begin working towards Stage 3 (Modern Healthcare, 8/29).

According to CMS, the delays will allow providers more latitude to participate in the program and meet certain objectives, such as:

• Checks for drug interactions and allergies;
• Electronic prescribing;
• Providing patients with clinical summaries; and
• Reporting public health data and quality measurements (Pedulli, Clinical Innovation & Technology, 8/29).

However, CMS in the final rule declined to offer a 90-day reporting period during any quarter for Stage 2 in 2015, which was urged by many stakeholders. Instead, the final rule includes a year-long reporting period for Stage 2 in 2015.

The rule stated, "Changes to the EHR reporting period would put the forward progress of the program at risk and cause further delay in implementing effective health IT infrastructure." It added, "In addition, further changes to the reporting period would create further misalignment with the CMS quality reporting programs ... which would increase the reporting burden on providers and negatively impact quality reporting data integrity" (Goedert, Health Data Management, 8/30).

Reaction

In a statement, CMS Administrator Marilyn Tavenner said the agency "listened to stakeholder feedback and provided ... flexibility" for providers who want to continue participating in the program. She added, "We were excited to see that there is overwhelming support for this change" (The Hill, 8/29).

However, a majority of providers who commented on the proposed regulations said the delays would be implemented too late to be taken into consideration for 2014 reporting requirements, according to Health Data Management.

The College of Healthcare Information Management Executives in response to the final rule said the group was "deeply disappointed" that providers would still be required to report for all 365 days of 2015, noting that the "provision has severely muted the positive impacts of this final rule" and "has all but ensured that industry struggles will continue well beyond 2014" (Health Data Management, 8/30).

American Hospital Association Director of Policy Chantal Worzala said AHA "appreciates the flexibility offered by CMS," but the "rule offers little relief because CMS did not grant a shorter reporting period for [fiscal year] 2015, which begins on Oct. 1."

Meanwhile, Athenahealth Vice President of Government Affairs Dan Haley said he was also disappointed with the changes, noting that delaying the requirements could make it harder for earlier adopters to comply with interoperability metrics because they will likely have fewer providers with which they can communicate. He said that CMS should also allow "some type of relief/exception for (interoperability) measure(s)," adding, "Repeated delays only push off the date when health care in this country is truly connected" (Modern Healthcare, 8/29).