The federal government at the start of the Labor Day weekend finalized a rule to add flexibility to attesting for Medicare and Medicaid Stages 1 and 2 of meaningful use during 2014. But for many providers, the relief is too little too late.

The final rule, from the Centers for Medicare and Medicaid Services and Office of the National Coordinator for HIT and available here, extends Stage 2 through 2016 and starts Stage 3 in 2017 for providers who first attested to Stage 1 in 2011 or 2012.

It also offers a number of different options to attest during fiscal and calendar year 2014. This is necessitated because many providers and software vendors do not yet have the updated electronic health records software that was required in 2014. Consequently, providers can use the 2011 Edition of certified electronic health records technology, or a combination of 2011 and 2014 CEHRT to attest in 2014, but must use 2014 CEHRT in 2015. And in some cases, they can attest to Stage 2 using Stage 1 measures and objectives.

Providers scheduled to attest to Stage 1 in 2014 who could not fully implement 2014 CEHRT can use the 2011 CEHRT for 2013 objectives and measures; or use 2011 and 2014 CEHRT to do 2013 Stage 1 objectives and measures or 2014 Stage 1 objectives or measures. Those with 2014 CEHRT could attest to 2014 Stage 1 objectives and measures.

Providers scheduled to attest to Stage 2 in 2014 who could not fully implement 2014 CEHRT can use 2011 CEHRT for 2013 Stage 1 objectives and measures; or use 2011 and 2014 CEHRT with 2013 Stage 1 objectives and measures, 2014 Stage 1 objectives and measures, or Stage 2 objectives and measures. Providers with 2014 CEHRT can attest to Stage 2 using 2014 Stage 1 objectives and measures or Stage 2 objectives and measures.

This flexibility comes with a huge caveat. Virtually all providers or their trade associations commenting on the proposed rule urged CMS and ONC to offer a 90-day reporting period during any quarter for Stage 2 in 2015, saying the final rule would come too late to make reporting in 2014 practical for most organizations.

However, CMS and ONC in the final rule impose a year-long reporting period for Stage 2 in 2015. “Changes to the EHR reporting period would put the forward progress of the program at risk and cause further delay in implementing effective health IT infrastructure,” the agencies say in the rule. “In addition, further changes to the reporting period would create further misalignment with the CMS quality reporting programs like PQRS and IQR, which would increase the reporting burden on providers and negatively impact quality reporting data integrity.”

Within minutes of the final rule’s release, the College of Healthcare Information Management Executives issued a statement highly critical of the government’s actions:

“CHIME is deeply disappointed in the decision made by CMS and ONC to require 365 days of EHR reporting in 2015. This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014.

“Roughly 50% of eligible hospitals and critical access hospitals were scheduled to meet Stage 2 requirements this year and nearly 85% of EHs and CAHs will be required to meet Stage 2 requirements in 2015. Most hospitals who take advantage of new pathways made possible through this final rule will not be in a position to meet Stage 2 requirements beginning October 1, 2014. This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines.

“Nearly every stakeholder group echoed recommendations made by CHIME to give providers the option of reporting in any three-month quarter EHR reporting period in 2015. This sensible recommendation, if taken, would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar, without pushing them off the cliff; and it would have ensured the long-term viability of the program itself. Now, the very future of Meaningful Use is in question.”

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