CMS wants to loosen the reins on meaningful use

Changes would give providers an extra year to upgrade systems for Stage 2

Get our experts' take on the proposal.

CMS and the Office of the National Coordinator for Health IT (ONC) on Tuesday announced a proposed rule that would give providers an additional year to upgrade electronic health record (EHR) systems to meet reporting requirements for Stage 2 of the meaningful use program.

The meaningful use program was created by the 2009 federal economic stimulus package. Through the program, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

The agencies noted that the proposed timeline change comes 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.

CMS Administrator Marilyn Tavenner in a release said, "By extending Stage 2, we are being receptive to stakeholder feedback to ensure providers can continue to meet meaningful use and keep momentum moving forward."

Just four hospitals have achieved Stage 2 of meaningful use

Details of the proposed rule

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.

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The agencies noted that the proposed changes are "for 2014 only." In addition, the agencies noted that providers seeking to qualify for Medicaid meaningful use in 2014 "must adopt, implement or upgrade to 2014 Edition [certified EHR technology] only." They specify, “In order to avoid inadvertently incentivizing the purchase of an outdated product that cannot be used to demonstrate meaningful use in a subsequent year … A provider would not be able to qualify for a Medicaid incentive payment for 2014 for adopting, implementing, or upgrading to 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT”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.

The industry reacts

Tom Leary, vice president of government relations for the Healthcare Information and Management Systems Society, in a statement said the proposed rule "should go a long way toward relieving some of the time crunch eligible professionals and hospitals are experiencing, and help them continue the march toward meaningful use of EHRs and health care transformation."

College of Healthcare Information Management Executives President and CEO Russell Branzell in a release also praised the rule, saying, "If the government acts quickly to finalize the proposed rule, it will provide the flexibility needed for our members and their organizations to adequately optimize newly deployed technology and ensure success of the program."

However, both Leary and Branzell raised concerns about the timeline to finalize the change, noting that some hospitals might not have enough time to take advantage of the proposed flexibility.

According to Modern Healthcare, the current rule requires hospitals that were planning to advance to Stage 2 to begin their 90-day attestation periods for Stage 2 on the first day of the fiscal quarters, meaning hospitals have just one payment period to react to the rule change. Richard Schreiber, chief medical informatics officer at Holy Spirit Health System in Camp Hill, Pa., said the rule could be "too little too late," noting, "If it's going to be four to six month to final [regulations], three months brings us into the next quarter, and I've already had to make my decision" (Conn, Modern Healthcare, 5/20 [subscription required]; Goedert, Health Data Management, 5/20; Murphy, EHR Intelligence, 5/20; Sullivan, Healthcare IT News, 5/21; Gregg, Becker's Hospital Review, 5/20).

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The Advisory Board's take

Robin Raiford, Health Care IT Advisor, Health Care IT Advisor

This proposal is welcome news for providers who planned to submit a hardship exception application because they could not fully implement all of the functionality of 2014 Edition certified EHR technology, including development of new processes and workflows, testing, and end-user training.

However, this is not a blanket policy for all providers. These proposals only apply to those who can demonstrate that they are unable to fully implement 2014 Edition CEHRT.

Writing on the Daily Briefing blog, I've gone into further detail on the implications of CMS's proposed rule—see my additional analysis here.

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