MAY 9, 2012 11:47am ET

Stage 2 Crunch Time Comes for CMS

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Industry stakeholders have filed comment letters on the proposed Stage 2 electronic health records meaningful use criteria, and now the Centers for Medicare and Medicaid Services will start to digest it all.

Following established patterns, providers and vendors in unison sent an overriding message to CMS on requirements of the proposed rule: “Too much, too fast.” Consumer groups had a far different message: “Good start, but give us more.”

Providers and vendors want a 90- or 180-day reporting period for the first year of Stage 2 instead of a full year. They make compelling arguments. The College of Healthcare Information Management Executives contends that a 90-day period will ensure that more meaningful users under Stage 1 will become Stage 2 meaningful users, and isn’t more better?

But 21 consumer groups, in a joint comment letter, make an equally compelling argument for a full reporting year. “We respectfully remind CMS that the intent of the one-year delay in Stage 2 is to allow for a robust set of advancements, and therefore we do not agree with the proposal some have advocated to shortening the reporting period to only 90 days.”

Providers argue that the proposal to quickly enable patients to view, download or transmit their information via a portal is unrealistic. “The AHA believes that this objective is not feasible as proposed, raises significant security issues and goes well beyond current technical capacity,” according to the American Hospital Association. It then went further, asserting that the HHS Office for Civil Rights, not CMS, has jurisdiction to regulate how providers fulfill their HIPAA obligations to give patients access to their records.

Consumer groups, on the other hand, want stronger view/download/transmit criteria, which CMS proposed as within four business days once the information is available to a physician, and within 36 hours of hospital discharge. They call for patient access within 24 hours of an office visit or discharge. Consumer advocates also call for increased use of secure messaging between providers and payers AND demonstration that use of the data improves care and reduces health care disparities.

The Robert Wood Johnson Foundation also swung for the fences, asking regulators to raise the bar in terms of the number of patients that providers need to enable to view, download or transmit their data, and being sent a reminder for preventive or follow-up care. Providers would have more incentive to adopt patient-facing platforms that could increase engagement, and, “once an organization has the capacity to product patient reminders, expanding the degree to which they are used to 20 percent should not be unduly burdensome.”

In the end, providers and vendors will win more battles than consumers in the final rule, because they’re the ones that actually have to meet the requirements. And an “unsuccessful” Stage 2 doesn’t do anyone any good.

There was one important point that all stakeholders agree on: They want more progress from CMS in aligning meaningful use reporting requirements with quality measurement reporting programs, such as Physician Quality Reporting System, Medicare eRx, Medicare Shared Savings and NCQA’s Patient-Centered Medical Home Recognition Program.

My view is that meaningful use is a well-established program and it’s time for CMS to stop talking about the benefits of alignment and its goal to get there as soon as possible, and get there now. After all, the delay in starting Stage 2 gives CMS, just like everyone else, another year to get its ducks in a row.

That said, significant improvement of alignment is going to be a major challenge for CMS, which pretty much has promised to bring out a final Stage 2 rule within two or three months, even though it took about six months after the comment period was closed to finalize Stage 1. According to provider alliance Premier Inc., hospitals need a final rule no later than August to be ready in 2014.

So, let’s give a shout-out to the folks at CMS, who not only have to read and organize all the comments, coordinate rulemaking with the Office of the National Coordinator for HIT, make final decisions on dozens of issues, then summarize comments and justify the final requirements in the rule. Getting all that work done in three months would be impressive.

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