The health care industry is divided over a proposed rule released earlier this week by CMS and the Office of the National Coordinator for Health IT that would give providers an additional year to upgrade electronic health record systems to meet reporting requirements for Stage 2 of the Medicare meaningful use program, Modern Healthcare reports (Conn, Modern Healthcare, 5/21).   

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

Details of Proposed Rule

The agencies noted that the proposed timeline change came in response to stakeholder feedback about needing more flexibility. The proposed rule acknowledges 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.

The proposed rule would change:

• The meaningful use timeline;
• The definition of certified EHR technology; and
• Requirements for the reporting of clinical quality measures for 2014.

Specifically, the proposed rule would 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.

Providers would be able to attest to meaningful use under the 2013 reporting year definition and use the clinical quality measures from 2013.

In addition, providers scheduled to begin attesting to Stage 2 in 2014 who have run into vendor problems could use 2014 Edition certified EHR technology to meet the 2014 Stage 1 objectives.

The agencies noted that the proposed changes are "for 2014 only" and apply only for those providers in the Medicare incentive program. They noted that providers seeking to qualify for Medicaid meaningful use in 2014 "must adopt, implement or upgrade to 2014 Edition [certified EHR technology] only."

The proposed rule also would formalize the agencies' plan to extend Stage 2 through 2016 and push back of the start of Stage 3 until 2017 (iHealthBeat, 5/21).

Hospitals CIOs Express Mixed Reactions to Proposal

Many hospital CIOs expressed disappointment with the move, saying that it was confusing and many of its proposed changes may be too late, FierceEMR reports.

Todd Richardson, senior vice president and CIO at Wisconsin-based Aspirus health system, called the delay a shallow victory, noting, "If we look back in hindsight at all of the delays, one would think policymakers would begin grasping the concept that they are being too aggressive in setting deadlines, when they end up constantly pushing things off."

Similarly, Indranil Ganguly, vice president and CIO at New Jersey-based JFK Health System, said that while he "applaud[s] the fact that CMS is reacting to the calls for relief in this industry," it is "not clear yet on whether those of us who have been aggressive and diligent will see any meaningful relief."

Meanwhile, Edward Marx, senior vice president and CIO at Texas Health Resources, said that CMS and ONC's proposed rule gives his organization "a bit more time to implement and perfect" the "'technical' nuances" experienced during its current attestation period (Bowman, FierceEMR, 5/21).

Health Care Groups at Odds Over Proposed Rule

Similarly, health care industry groups and organizations have had mixed reactions to the proposed changes.

Rick Pollack, executive vice president of the American Hospital Association, said his organization "welcomes this proposed rule and the enhanced flexibility it would provide." He added that without such flexibility, "many, if not most, hospitals would not meet meaningful use in [fiscal year] 2014 and would be a setback to the movement toward widespread adoption of these new technologies" (Goedert, Health Data Management, 5/21).

Robert Tennant, senior policy analyst for the Medical Group Management Association, noted that reaction from MGMA members has been positive. Although he said the proposal is "not everything we were looking for, ... it was a good start and recognition that the program parameters were proving challenging for vendors and their customers."

Meanwhile, Robert Wah, president-elect of the American Medical Association Board of Trustees, raised some concerns about there being "no partial credit" and recommended that CMS relax its requirement that providers meet every criterion of the meaningful use program (Modern Healthcare, 5/21).

Steven Stack, immediate past president of the AMA Board of Trustees, said that while AMA "appreciates" the proposed changes, "our chief concern remains unaddressed, and we worry that current requirements will slow the adoption of technology that will help coordinate care and improve quality and that many physicians will drop out of the meaningful use program if the current all-or-nothing approach remains in place." He added, "To date approximately 20% of eligible professionals -- mostly doctors -- have dropped out of the program and we expect this number to grow unless more changes are made (AMA release, 5/21).

William Bria, president of the Association of Medical Directors of Information Systems, said he disagreed with the proposed delay, noting that "there are other ways to soften the blow" if providers do not meet the requirements, such as easing up on penalties. He added, "But going back to Stage 1, that's kind of wishy-washy; it just makes a political football out of this" (Modern Healthcare, 5/21).

Those sentiments were echoed by Debra Ness, president of the National Partnership for Women & Families, who characterized the rule as "disappointing." In a statement she said, "[O]nce again, patients and families will have to wait to realize many of the benefits of health IT," adding that the proposed rule means "delays in improving the quality of care and health outcomes." Ness said, "CMS should use the additional time associated with Stage 3 to revisit the recently withdrawn requirements to send patient reminders for preventive or follow-up care" (Pennic, HIT Consultant, 5/21).