Stage 2 electronic health record meaningful use requirements that at least five percent of patients conduct secure messaging with physicians, and view, download, or transmit their ambulatory and inpatient data came at the insistence of HHS Secretary Kathleen Sebelius. And those requirements might not be set in stone.

That’s the word from Travis Broome, a health insurance specialist at the Centers for Medicare and Medicaid Services, during a presentation of the Stage 2 rules at the MGMA Conference in San Antonio.  He devoted most of the presentation to rehashing the rules, but the tedium quickly dissipated during the question and answer period. It was dominated by concerns around requirements for patient access to a portal, government auditing of incentive payments, and the program’s longevity in face of recent Republican questions about its effectiveness.

The patient engagement provisions broke new ground in the EHR incentive program, because, unlike the other criteria, complying with them is not in direct control of a practice or hospital. Broome acknowledged the large amount of industry resistance to the idea during the rules formulation process, but said Sebelius insisted on some kind of requirement in principle. “We wanted to make the bar as low as possible, but uphold it principally,” he said, explaining the five percent threshold.

Practice administrators in the audience countered that while their groups offer patient portals, patients are not interested in using them. Broome replied that the groups would need to “push their use.” However, he added that if the requirement proves too onerous for the industry to meet, CMS would revisit it.

Answering a question about meaningful use payment audits, Broome acknowledged that the audits have begun. He declined to give many specifics other than saying that providers falling into certain “risk profiles” might be asked to justify their attestations. One practice, for example, attested to meaningful use and supplied identical statistics across multiple criteria, all but inviting suspicion. When challenged, that practice returned the money, Broome said.

But he assured the audience that the government was not conducting an all-out surveillance of meaningful use claims--merely asking for more supporting documentation in some cases. “It is unlikely somebody will show up at your door,” he said. Other than practices that had voluntarily returned their incentive payments--a number Broome did not divulge--no one to date has had to refund any incentive money.

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