Meaningful Use Proposed Rule Aims To Offer Relief, but Many Questions Remain

by Fred Bazzoli, iHealthBeat, Wednesday, July 2, 2014

A few weeks ago, the nation's health care organizations received the promise of some much-needed relief from the pressure of meeting looming deadlines for achieving Stage 2 of the meaningful use program. That came with the release of a proposed rule from CMS and the Office of the National Coordinator for Health IT intended to give providers more flexibility and time in achieving Stage 2 objectives.

Primarily, the adjustments in the program will enable providers to meet Stage 1 or Stage 2 meaningful use with any combination of certified electronic health record technology, regardless of which requirements the provider is scheduled to meet in 2014. The proposed rule would create new pathways for providers to meet meaningful use in 2014, rather than force them to file hardship exceptions and forgo incentives.

The proposed rule would give health care organizations and eligible professionals a greater chance to continue their participation in the meaningful use program in 2014. The rule also includes a provision that would formalize the federal agencies' intent to extend Stage 2 through 2016 and begin Stage 3 of the program in 2017.

"While the proposed changes are complex, the adjustments will ensure broad program participation and will enable providers to continue their meaningful use journey," said Jeffery Smith, senior director of federal affairs for the College of Healthcare Information Management Executives.

Federal moves to provide relief for providers appeared likely in April, when CMS released data indicating that only four hospitals and 50 eligible professionals had attested to achieving objectives for Stage 2 of meaningful use. Overall, only 225 eligible professionals and 30 hospitals had achieved either Stage 1 or Stage 2 of meaningful use in fiscal year 2014.

The proposed rule is a further acknowledgement by the federal government that the nation's health care industry is struggling to keep up with the pace of health IT implementation initially laid out through the meaningful use program. In February, CMS announced hardship exemptions for providers that are experiencing issues obtaining and installing EHR products that would enable them to achieve Stage 2 of the meaningful use program.

Timing Still a Key Issue

Despite the deadline relief implied in the proposed rule, several key questions remain on how quickly it can be moved through the regulatory system and the extent of its effect on providers.

Without additional provisions in the rule addressing timing issues, hospitals may not be able to take advantage of the flexibility proposed in the rule, Smith said. Typically, proposed rules have 60-day comment periods, after which a final rule is issued, including a date on which the new rule becomes effective. Smith noted that, under existing rules, hospitals that were planning to attest to Stage 2 objectives must begin their reporting period by July 1, and it appears likely that the rulemaking process will extend past that date.

"Given the late date of the announcement, it is imperative that CMS and ONC take tangible steps as quickly as possible to finalize this rule to ensure the maximum positive impact for eligible hospitals and critical access hospitals," Smith said.

"If the government acts quickly to finalize the proposed rule, it will provide the flexibility needed to adequately optimize newly deployed technology and ensure the success of the meaningful use program," said CHIME President and CEO Russell Branzell.

CIOs React to the Proposed Rule

The late date of release of the proposed rule is worrisome to Charles Christian, who said he was encouraged that federal agencies have reacted to the concerns they've heard from the industry.

"However, I'm still concerned that they do not fully grasp the processes that are required to make changes this late in the game," said Christian, CIO at St. Francis Hospital in Columbus, Ga. "It has never been a matter of just installing new software; there are critical processes that have to be taken into consideration, and these have connections to myriad other processes."

Still, the relief will be a godsend for thousands of providers, according to Pamela McNutt, senior vice president and CIO of Dallas-based Methodist Health System.

"I was pleased to see CMS provide relief beyond exemptions for those providers who cannot make their prescribed stage of meaningful use by July 1," McNutt said. "The proposed regulation allows providers to drop back to a previous stage of meaningful use or a previously certified edition to attest for CMS fiscal year 2014 and not lose their EHR incentive funding. This will help many providers stay in the EHR incentives game. "

However, Christian said he believes that it may not be easy for providers who have started the shift to 2014 certified software to revert back to a previous version to qualify for stimulus funds. "Our system vendors have made changes to the underlying database architecture to accommodate the new data collection and calculation requirements," he said. "Once these changes are made in the newest version of software, depending on how the changes were implemented, it is no easy task to just report out the data using the earlier methods."

Some Problems Aren't Solved by the Proposed Rule

Stephen Stewart, CIO at Henry County Health Center in Mount Pleasant, Iowa, also believes that the late change in the proposed rule may not favor all providers equally.

"The proposed rule provides relief for those providers whose EHR vendors were not prepared with 2014 code. As opposed to dealing with the hardship route, they now have another set of options. However, for those of us who attested in 2011 and have already received working 2014 code from our partners, little has changed," Stewart said. "I see the rule as very good for some, but for many, especially the early adapters, it does very little. [Meaningful use Stage 2] still requires some very heavy lifting, especially in areas of transitions of care and portal usage."

The new rule will require an unknown amount of documentation, and that concerns McNutt. "This is not a 'get out of jail free' card," she said. One must attest to and have a defendable position that delays in receiving certified software or other issues did not allow you to implement and incorporate the necessary software into your workflow in time to meet the deadlines. This should strike a bit of trepidation -- how much documentation or substantiation from your vendor will be necessary?"

Linda Reed, vice president and CIO at Morristown, N.J.-based Atlantic Health System, doesn't believe the proposed rule will provide enough relief for eligible hospitals because of the level of attestation requirements that organizations will still face.

"I've spoken to a few hospital CIOs, and many agree that the announcement means almost nothing, especially to eligible hospitals," she said. "Most of us have done our 2014 edition upgrades. The main issue is the confusion surrounding the use of Direct (a standards-based approach to exchange health information) for transitions of care and the ability to get adequate patient engagement for attestation. A better approach would have been to allow us to attest to the fact that we have the capabilities for this stage and then get to a certain percentage later."

The additional time will provide benefits to the nation because providers will have a better chance to actually derive benefits from the technology, which can be used to improve care delivery, said David Chou, CIO of University of Mississippi Medical Center in Jackson. "The additional time will allow certain providers and eligible professionals to complete the requirements outlined fully instead of the bare minimum to check the box," he said. "This allows some breathing room to maximize the use of technology in satisfying the requirements."

Source: iHealthBeat, Wednesday, July 2, 2014

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