The Centers for Medicare and Medicaid Services on Tuesday released the final rule for Stage 3 of the electronic health records Meaningful Use program, garnering both praise and condemnation from stakeholders. But, with strong opposition to the regulations from some industry groups and lawmakers, as well as the opportunity for a 60-day public comment period, the rule may not stand in its current form.
Stage 3 is intended to be the final stage of the Meaningful Use program. Speaking at a press conference held late yesterday, Patrick Conway, M.D., CMS acting principal deputy administrator and chief medical officer, said thatproviders in the Meaningful Use program have the option of voluntarily participating in Stage 3 in 2017 with a 90-day reporting period, while participation becomes mandatory in 2018.
“By 2018, these rules put an end to stages of Meaningful Use so that the Electronic Health Record Incentive Program can become a part of the larger physician, clinician, and hospital quality and value programs over time,” said Conway. Specifically, he argued that the final regulations for Stage 3 “make significant changes in current requirements easing the reporting burden for providers, increasing simplicity and flexibility, supporting interoperability and information exchange, and improving patient outcomes.”
Conway pointed out that the final Stage 3 rule reduces the number of objectives for eligible professionals and hospitals from about 20 to just eight measures. These measures, he asserted, are flexible “so that providers may choose measures that are most relevant to their practice.”
The Healthcare Information and Management Systems Society supports 2018 as the start date for providers required to meet Stage 3 objectives and measures. “Consistently, HIMSS has called for at least 18 months between the publication of a new Meaningful Use rule and the start of a new stage’s reporting period—the 27 months provided in this final rule appears to address this issue,” said Carla Smith, executive vice president of HIMSS North America.
However, Senate Health Committee Chairman Lamar Alexander (R-Tenn.), who has been a strong critic of the Meaningful Use program and called for a delay in finalizing the Stage 3 rule,said that in “rushing its rule” the Obama administration “is doing a disservice to more than 500,000 doctors, thousands of hospitals, and millions of patients.”
Alexander noted that only 12 percent of doctors and fewer than 40 percent of hospitals are in compliance with Stage 2.“Instead of taking the time to get the Stage 3 rule right, they’ve rushed ahead with a rule against the advice of some of the nation’s leading medical institutions and physicians,” he charged. “Congress will carefully review this rule and has the option of fixing it through legislation or overturning it through the Congressional Review Act.”
Similarly, the American Medical Association—which has adamantly called for a delay of Stage 3—said in response to the release of the final rule that the physicians group “continues to believe that Stage 3 requires significant changes to ensure successful participation, and improve the usability and interoperability of electronic health record systems.”
Nonetheless, Conway at CMS argued that the Stage 3 rule is “focused on interoperability and information exchange so clinicians and patients have the information that they need to better coordinate care and improve health outcomes.” More than 60 percent of the rule’s measures require the exchange of health information, he said, compared to 33 percent in Stage 2.
Holding out hope that changes can still be made to the Meaningful Use program, AMA is urging CMS to use the additional public comment period provided for Stage 3 to further improve the program and consider changes related to the Medicare Access and CHIP Reauthorization Act, which was signed into law earlier this year.
Conway acknowledged that “there’s more work to do, which is especially true in the context of the passage of the SGR fix legislation that requires the establishment of a Merit-based Incentive Payment System.” Under MIPS, 25 percent of the score that determines a provider’s penalty or bonus payment will be based on participation in Meaningful Use and how well they comply with the regulations. Consequently, Conway said the final rule includes a 60-day comment period for certain provisions of the payment system that could affect Meaningful Use.
“We’re announcing an additional 60-day public comment period in particular to facilitate additional feedback about our vision for the EHR Incentive Program going forward and how it incorporates into broader system delivery reform efforts,” he said. “Although this is a different administrative mechanism than those who call for Stage 3 not to be finalized, we believe this mechanism will allow for significant engagement and get us to a similar place and outcome for our health system.”
Based on feedback from stakeholders during the 60-day comment period, Conway added that CMS intends to issue a notice of proposed rulemaking for MIPS in the late spring of 2016, with a final rule expected later in the fall. “We’re asking for public comment over the next 60 days,” he commented, “so that if additional improvements are needed for Stage 3 we can make those improvements next year.”
In response, the College of Healthcare Information Management Executives said it was “pleased” that CMS agreed to extend the comment period for Stage 3. “With regard to Stage 3, the extra comment period will enable providers, CMS and other stakeholders to ensure that the next stage of Meaningful Use advances interoperability and takes into account new payment models being advanced by Medicare,” said CHIME Board of Trustees Chair Charles Christian.
Likewise, AMA hopes “the decision by CMS to leave Stage 3 open to additional comment will allow for further improvements in the program and promote technological innovation that supports patient care,” according to AMA President Steven Stack, M.D. “We also want to make sure that EHR vendors have the time they need to further test products for interoperability, usability, safety and security.”
However, Conway said that yesterday’s release of the final Stage 3 rule by CMS is a “reflection of our effort to listen and understand physicians and other providers on the challenges they face making this technology work well for their individual practices and for their patients.” As evidence of this, he told reporters that CMS has “heard about the need for flexible exemptions for those providers who are attempting to report successfully and, for example, need to change electronic health record vendors— and we will provide that opportunity.”
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