Providers hoping the new final rule making modifications to Stage 2 of the meaningful use program will open the door to getting exemptions from participating are in for disappointment.
Organizations that cannot meet a Stage 2 measure--with one exception--will not be able to get an exemption from that measure and attest. Details in the final rule have the effect of limiting providers more than the industry expected, says Jason Fortin, a senior advisor at health information technology implementation and consulting firm Impact Advisors.
The exception on meeting measures is available for providers who cannot meet the 10 percent threshold for transmitting a summary of care document, but only if the intermediary or the recipient of the transition or referral is experiencing delays in the ability to fully implement 2014 Edition certified electronic health records technology, according to the final rule.
In other cases, if a provider cant meet a measure that must be met to attest for Stage 2 compliance, they cant attest.
Providers hoping to get an exemption from attesting to Stage 2 at all in 2014 also face barriers. Providers can attest that they experienced delays in the ability to fully implement 2014 Edition CEHRT. But the reasons cannot result from internal issues, such as staff changes and turnover, waiting too long to engage a vendor, or refusing to purchase requisite software updates.
Exemptions from meeting Stage 2 in 2014 will be considered only for delays in availability being experienced by the vendor. Valid reasons include: if a provider is waiting for updates; the software has functionality or safety problems or does not yet contain all required components; or a vendor has identified an issue and is sending out patches.
So, although we cannot list every possible scenario, installed 2014 Edition CEHRT with delayed or missing software updates, or cases where the software itself renders a provider unable to reliably use the software would be permissible reasons to use the CEHRT options because such issues are considered to be a 2014 Edition CEHRT availability delay, according to the rule.
Providers attesting to an inability to meet one or more meaningful use measures should fully document the reasons why and be ready to defend the decision if audited, Fortin advises.
Fortin isnt sure why the government took such a hard line in the rule, particularly in not offering quarterly reporting periods in 2015. That gives hospitals only one month to get ready for a year of reporting in fiscal 2015. Im not sure how many problems can be solved in one month.
There is a feeling that something has to change--too many providers will struggle with meaningful use in 2015 just as they did this year, Fortin says. The government contends in the rule that further delays and easing of requirements would put the meaningful use program at risk, but Fortin believes the hard line being taken brings more risk.
The bottom line, he adds, is that this rule isnt about 2015, but is strongly focused on requirements for 2014. That said, it is almost impossible to predict what will happen next year--whether providers will drop the meaningful use program, take the financial penalties and focus resources elsewhere, or if the government will back down.
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