Health Data Management interviews with numerous stakeholders reveal a number of concerns with the final rule. But these stakeholders agree on one point-compliance with Stage 1 meaningful use criteria now is doable.
"It's a much more realistic set of expectations," declares Harris Stutman, M.D., executive director of clinical informatics and research at MemorialCare Health System in Fountain Valley, Calif. In his opinion, the difference between the proposed and final criteria show the feds took those public comments seriously and adapted the rule.
But not everyone wholeheartedly agrees. The American Hospital Association, for one, remains concerned that the requirements continue to be out of reach for many hospitals.
Among its issues are: the exclusion of individual hospitals in multi-campus settings from receiving incentive payments; the requirement for immediate use of computerized physician order entry software; and the limited capacity of vendors to ramp up EHR installations, which could result in some hospitals not having electronics records in time to receive maximum financial incentives.
In addition, achieving the government's definition of meaningful EHR use is only half the battle. "It's the reporting requirements and how they will be done that is the real challenge," says Debra Spindel, vice president of physician services at Nautilus Healthcare Management Group, a Newport Beach, Calif.-based management services organization that provides I.T. and other services to group practices and independent physicians associations.
Meeting the initial meaningful use objectives won't be hard for Nautilus, Spindel says. The biggest hurdle will be collecting the measures that demonstrate that an objective has been met, which is going to require another redesign in physician and staff workflow. To demonstrate that 50 percent of patients received a clinical summary of an office visit means creating fields within the EHR to document that activity. And that's just one piece of extra reporting that must be embedded within the electronic record to demonstrate MU compliance.
Additionally, while the final rule is supposed to answer all questions about meaningful use, some experts have unearthed sections where clarifications are necessary, and soon.
The e-prescribing requirement has been lowered to "more than" 40 percent of permissible prescriptions written by an eligible provider, and that's a good start, says Rob Tennant, senior policy advisor at the Medical Group Management Association in Englewood, Colo.
But what happens if an eligible provider only reaches 39.5 percent because an unknown software glitch prevented accurate counting, and the provider then fails to qualify for an incentive payment?
Let's say this provider uses the last 90-day reporting period in 2011 to collect measures and attest to having met meaningful use requirements. The provider won't hear back from the government until October 2012 that meaningful use was not achieved. That means the provider won't meet meaningful use criteria in 2011 or 2012 and may not have enough time to fix the software and get paid in 2013, Tennant fears. "If they've done it with all good intentions but there's a glitch, there should be a way for them to still qualify."
Along with needed clarifications, another concern is whether the federal government can make good on its pledge to start making the first meaningful use payments in May 2011. Hospitals and eligible professionals can register to participate in the meaningful use program beginning Jan. 1, 2011.
They can file their first attestations of meeting MU criteria starting in April and start getting incentive checks in May, according to the rule. So, federal officials expect to turn around attestation to payment in four to six weeks.
But expecting the government and industry to move quickly enough on setting up incentive programs, implementing EHRs, getting EHRs certified, documenting meaningful use, and sending out the first checks by May could be asking too much. There's lots of challenges ahead not just during next immediate months but in the years ahead, warns Justin Barnes, vice president of marketing, corporate development and government affairs at Greenway Medical Technologies, a Carrollton, Ga.-based physician software vendor.
"While the rules held intact that spirit of meaningful use and rightly shifts to threshold reductions, core and optional reporting objectives over time, and an overall leveling of objectives into the Stage 2 criteria, there is no denying the remaining complexity of managing some 1,100 pages of regulations and the burgeoning certification program still in need of certifying bodies and final test scripts," Barnes notes. "Also to be determined are the timeframes between future Stage 2 and beyond meaningful use additions, and the effects that will have on functionality upgrades as ICD coding, PQRI programs and the effects of health reform are taken into consideration."
The bottom line: It took federal officials 18 months of intense work to get a final blueprint of the initial meaningful use incentive and EHR certification programs following enactment of the HITECH Act. And now they're expecting to have the programs running on all cylinders within 10 months of the final rule. The consensus among those tasked with implementing the rule: get ready for a rough ride.
Basic provisions
The final rule has many changes, but the amount of available incentive money remains the same.
Eligible individual "professionals"-the term used in the rule-still can get up to $44,000 from Medicare, or $48,400 if serving in a health professional shortage area, or up to $63,750 from Medicaid. Under the proposed rule, they could not participate in both programs. The final rule enables eligible professionals to switch incentive programs one time.
Hospitals, which can participate in both incentive programs, will receive a base incentive of $2 million, with millions more available based on a formula that includes the number of annual discharges, among other criteria.
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