Meaningful Use Stage 3 Not Set in Stone; Make Your Voice Heard

On Oct. 16, 2015, CMS published a long-awaited final rule that modifies the Electronic Health Record Incentive Program (aka meaningful use) requirements for 2015 through 2017 and establishes requirements for Stage 3, which starts in 2018. While CMS "finalizes" Stage 3 requirements within this final rule, the agency has signaled that these regulations are not set in stone. The public may submit feedback for the Stage 3 requirements until Dec. 15.

This public comment opportunity may be in response to the chorus of industry associations and lawmakers who recently have called for a delayed start to Stage 3. While CMS does not intend to propose stages beyond Stage 3, the program continues until at least 2024, as it is a component of the new Medicare payment methodology -- the Merit-based Incentive Payment System -- for eligible professionals. The meaningful use program appears to continue as-is for eligible hospitals. CMS encourages providers to comment on both Stage 3 requirements and the transition process to MIPS.    

Below are some key considerations of the "finalized" Stage 3 requirements and recommendations providers may wish to consider as they craft their public comments.

1. An aggressive 2015 Edition certified EHR technology upgrade schedule poses difficulties.

All providers must implement and use 2015 Edition certified EHR technology in 2018. The 24-month lead-time stated in this final rule may be insufficient as the new CEHRT upgrade lifecycle requires lengthy efforts of many stakeholders (i.e., Office of the National Coordinator for Health IT, testing and certification bodies, vendors and providers). Another challenge with this requirement is that providers must upgrade while in the midst of their year-long reporting period meaning they must maintain performance on meaningful use measures while undergoing an upgrade.

Recommendation: Providers may wish to request that CMS offer a 90-day reporting period for all providers in 2018 to allow providers optimal time to effectively and safely implement 2015 Edition CEHRT.

2. Possession of all functionality is mandatory despite Stage 3 measure "choice" and potentially costly to providers.

Some Stage 3 objectives require providers to possess CEHRT for all of the objective's measures even though they are required to only satisfy performance thresholds for some of the measures. This means that providers must possess the certified functionality to support all functions within the objective, even when they essentially will defer one of its measures.

Recommendation: Providers may wish to request that CMS reconsider this requirement as it may lead to higher costs and more complicated implementation plans.

3. Stage 3's API requirement is helpful for patients but potentially challenging for providers.

Stage 3 will require that providers enable certified application-program interface functionality for patients or authorized representatives to access their health information without limitation -- meaning providers may not prohibit patients from using any application that meets the technical specifications and security requirements of the API. The use of APIs may help patients have more control over access to their health information. However, providers should not underestimate the significant effort needed to scale infrastructure accordingly and address security implications. In addition, providers must educate patients about how to authenticate their access through the API, and maintain and share a list of available applications that leverage API functionality with patients. For example, providers may wish to seek clarification from CMS on the complex requirements, such as how they expect providers to maintain a list of all apps using the API and perform adequate patient education.

Recommendation: Many providers will applaud CMS' move to encourage innovation with the requirement to enable API functionality. As currently finalized, providers must educate patients about the availability of all applications that leverage API functionality. Providers may wish to request that CMS reduce the requirement to maintain a list of all applications and instead, for example, require only that providers maintain a list of the first five that are available in order to prevent the need to constantly monitor and update the list. Otherwise, providers may be challenged to maintain such a list if the applications that leverage the API grow quickly. Providers should seek to clarify all unclear API requirements in their public comments.

4. The electronic clinical quality measure reporting mandate begins in 2018 for all providers.

In 2018 and subsequent years, CMS will no longer accept electronic clinical quality measure data via attestation, with some limited exceptions. This mandate serves CMS' strategic goal to align quality reporting requirements across programs. In this final rule, CMS specifies eCQM reporting requirements for 2015 and 2016 and reserves subsequent year requirements in separate, future rulemaking (i.e., the Medicare Physician Fee Schedule and Inpatient Prospective Payment Systems rules). CMS has made electronic submission available for the past four years. However, most providers have chosen not to pursue this method because of many challenges, such as allocation of limited resources to other competing priorities, difficulties in data mapping, concerns about inaccurate quality data generated from CEHRT and other issues related to technology readiness.

Recommendation(s): Providers will find that the mandate to electronically report eCQMs in 2018 allows them to align CQM reporting requirements across multiple programs. While they should also applaud CMS on this effort, they should consider these two recommendations for public comment.

  • Provide applicable CQMs for electronic reporting. CMS is working toward identifying CQMs that are amenable to providers' specialty, setting and practice. Providers can play a major role in this effort and should recommend a set of measures that are meaningful to their scope of practice and relate to outcome improvement.
  • Allow multiple versions of electronic specifications. CMS requires that providers use the most up-to-date electronic specifications for electronic submission of eCQMs, and releases an annual update, typically about six months before the start of the program year. Depending on an annual policy on the data submission periods in the future rulemaking, providers may have insufficient time to ensure their vendor's ability to update and retest (not recertify) their products. They may also need to reconfigure their systems and implement new workflows to ensure accurate data capture and mapping. Providers may suggest CMS to allow use of the latest or the previous version of electronic specifications.  

5. The transition to Merit-Based Incentive Payment System for eligible professionals affects the future of meaningful use.

Apart from the Stage 3 policies, CMS is interested in learning from providers on how to operationalize the meaningful use program once it becomes a component of MIPS. Providers should pay close attention to MIPS as meaningful use contributes to one-fourth of the total MIPS performance score, which will be used to determine the payment adjustment for Medicare EPs. As a result, while the Medicare incentive payments will stop in 2016, providers may still have an opportunity to gain "incentives" via higher reimbursements based on MIPS performance scores.

Recommendation: Providers may wish to review this CMS Request for Information, consider challenges and benefits related to how they currently manage meaningful use and the other programs MIPS includes (e.g., Physician Quality Reporting System, Value-Based Payment Modifier). Comments were due to CMS by Nov. 17.

It is time to make your voice heard again. Sharing your thoughts on the Stage 3 requirements and how they will impact your organizations financially, legally and operationally is critical. Provide constructive feedback and comments by Dec. 15 at and help CMS as it uses meaningful use as one of the many vehicles in the transition to new value-based payment models.

Source: iHealthBeat, Thursday, November 19, 2015

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