Many stakeholders thought that bar should be high. But is it unrealistically high? That's the multibillion-dollar question being pondered as stakeholders prepare comments for federal officials to consider as they draft a final meaningful use rule. The proposed rule was issued in late 2009 and published on Jan. 13; the public comment period ends March 15.
Consider the analysis of Mary Carroll Ford, vice president and CIO at 851-bed Lakeland (Fla.) Regional Medical Center.
Ford contends that some of the 83 U.S. hospitals at Stage 6 of the HIMSS Analytics scale of EHR adoption-the second highest level-currently would not qualify for meaningfuluse incentive payments. "That's a disconnect."
University of Pittsburgh Medical Center is more than a decade into an e-records initiative. It expects to qualify for first-year incentives in 2011-but only after beefing up its functionality in such areas as personal health records and medication reconciliation, says William Fera, M.D., vice president of emerging technologies.
If the intent of meaningful use incentives is to encourage providers to adopt EHRs, Fera figured the rules initially would be a lot easier. "I cannot imagine a hospital system just starting to implement an EHR to reach this level by 2011."
There's always been a digital divide in health care. Many fear that if the final meaningful use rule mirrors what's been proposed, federal officials will inadvertently create an even larger chasm between the I.T. haves and have-nots.
"For a community hospital of our size, we have a lot of technology in place and are in pretty good shape," says Chuck Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind. "But I'm really worried about critical access hospitals and physician practices. Less than six percent of practices can meet meaningful use today. I'm not sure federal officials truly have thought out what the real cost will be."
Many hospitals, including Lakeland Regional, have been working the past year to get ready for meaningful use. CIO Ford, however, doesn't think her facility will qualify for incentives in 2011, the first year that providers can start getting payments.
That's okay, she notes, because the proposed rule enables hospitals and physicians that don't qualify until 2012 to still qualify for full incentive funding.
But with so much money on the line and so many facilities in need of a I.T. funding infusion, there's a temptation to do a rush job to earn that 2011 check, and sort things out later. But Lakeland isn't biting, Ford says. Going fast and getting sloppy isn't going to help Lakeland-or any organization-achieve meaningful use of an EHR, Ford contends.
"There's only so much change an organization can absorb at one time. I do not think we'll make it by 2011, but 2012 will be very realistic and we'll have a very solid implementation."
Providers are scrambling to get ready for what they believe meaningful use will mean. But the CMS proposed rule is tough to understand and interpret, leaving as many questions unanswered as answered. And as a proposed rule, everything in it is subject to change.
The final rule, expected in late spring or early summer, will be tough to understand and interpret. And 2011 is coming up fast with the fiscal year for hospitals starting in October and the calendar year for physicians in January.
Too Fuzzy
Here's the dilemma: Many stakeholders are highly impressed that federal regulators actually made a statutorily imposed deadline and got out most of the meaningful use rules in 2009.
Along with the CMS rule, the Office of the National Coordinator for Health Information Technology also published an interim final rule, with a comment period ending March 15, establishing standards, specifications and certification criteria for electronic health records systems. What's missing, and expected in late winter or spring, is a proposed or interim final rule to establish the actual EHR certification program.
So providers are busy preparing to implement or upgrade EHRs, and software vendors are trying to upgrade their EHR products. None of them are absolutely certain of the requirements they must meet and may not know for several more months.
Meanwhile, Medicare and the state Medicaid programs are gearing up to administer meaningful use incentive programs in 2011.
Under ARRA, providers will have to annually report specific measures to demonstrate that they are meeting meaningful use criteria. Medicare and Medicaid, however, won't be ready to electronically accept and assess measures until 2012 at the earliest.
Consequently, both Medicare and Medicaid will require in 2011 only attestation from hospitals and physicians that they are meeting the initial criteria to qualify for the incentive funding.
Attestation is the honor system, but backed by the threat of selected federal audits to ensure an organization that claims to meet the criteria actually does.
State Medicaid programs for 2011 have a much lower attestation bar for meeting incentive criteria-they want to see proof that an organization is adopting or upgrading EHRs.
Attestation to Medicare or Medicaid won't require the comprehensive data collection and reporting to demonstrate meaningful use that will be necessary in subsequent years. An organization, however, will need to collect enough documentation, including certain data measures, to pass an audit should one come.
Provider organizations are accustomed to grace periods with monolithic federal programs. Providers and insurers had grace periods for the HIPAA transactions standards and the new health information breach notification requirements. And enforcement of HIPAA privacy and security rules was notoriously lax for years because the government didn't fund the enforcement agency and follow up on complaints.
But the feds this time around likely will take a different tack with so many incentive dollars on the line.
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