Mixed Industry Response to Stage 3 Meaningful Use Rule

The proposed Stage 3 Meaningful Use rule released March 20 received early mixed reviews from two stakeholder associations.

The rule, focusing on advanced use of electronic health records with fewer objectives, is meant to provide more flexibility and simplify requirements for providers, according to the Centers for Medicare and Medicaid Services. It specifies the criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet to qualify for Medicare and Medicaid EHR incentive payments and avoid financial penalties under Medicare for Stage 3 of the EHR Incentive Programs.

Also See: ONC Expanding HIT Certification Beyond Meaningful Use

The rule proposes changes to the reporting period, timelines, and structure of the program to provide a “flexible, clear framework to reduce provider burden, streamline reporting, and ensure future sustainability of the Medicare and Medicaid EHR Incentive Programs,” according to CMS.

Specifically, the rule would “continue to encourage electronic submission of clinical quality measure (CQM) data for all providers where feasible in 2017, propose to require the electronic submission of CQMs where feasible in 2018, and establish requirements to transition the program to a single stage for meaningful use.” In addition, the Stage 3 proposed rule “would also change the EHR reporting period so that all providers would report under a full calendar year timeline with a limited exception under the Medicaid EHR Incentive Program for providers demonstrating meaningful use for the first time.”

In a written statement, the College of Healthcare Information Management Executives said it is closely evaluating the CMS Meaningful Use rule. Based on an initial review, CHIME said the organization is “pleased” to see flexibility built into the Stage 3 proposed objectives.

CHIME highlights a proposal that providers beginning in 2018 would report on the same definition of meaningful use at the Stage 3 level regardless of their prior participation, with all participants in the EHR Incentive Programs moving to a single stage of meaningful use.

“We are still trying to understand the implications of moving all Medicare providers to a single definition of MU by 2018, but are encouraged by the potential for this policy to simplify and streamline the long-term viability of Meaningful Use,” states the organization.

However, with eligible hospitals and professionals continuing to struggle to attest to Stage 2 MU and with Stage 3 MU not slated to begin until 2017, it’s difficult for some providers to look beyond their current challenges with the program.

Not surprisingly, the American Hospital Association was quick to condemn the proposed rule which the organization says demonstrates that CMS “continues to create policies for the future without fixing the problems the program faces today,” according to a written AHA statement.

“In January, CMS promised to provide much-needed flexibility for the 2015 reporting year, which is almost half over,” states AHA. “Instead, CMS released Stage 3 rules that pile additional requirements onto providers.  It is difficult to understand the rush to raise the bar yet again, when only 35 percent of hospitals and a small fraction of physicians have met the Stage 2 requirements.”

A Jan. 29 blog from CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., indicated that the agency intends to issue a new rule this spring to shorten the Meaningful Use reporting period in 2015 from 365 days to 90 days for providers under the Medicare and Medicaid Electronic Health Record Incentive Programs.

AHA is urging CMS to release the 2015 flexibility rules immediately. Likewise, CHIME has urged CMS to quickly publish the proposed rule that Conway alluded to in his Jan. 29 blog post.

“We were encouraged by the signals to shorten the 2015 EHR reporting period from 365 to 90 days and make other program improvements through a follow-on rule,” CHIME says. “We call on CMS to propose policy changes to the ‘all-or-nothing’ construct, lengthen timing between required Stage upgrades, and consider much-needed revisions to the hardship exception categories. These changes will enable far better participation among providers, which will in turn, keep them on a path towards improved care through health IT.”

In a statement, the Department of Health and Human Services said the Stage 3 proposed rule’s scope is “generally limited to the requirements and criteria for meaningful use in 2017 and subsequent years,” but that “CMS is considering additional changes to meaningful use beginning in 2015 through separate rulemaking.”

The same day that CMS released its proposed rule for Stage 3 of the Meaningful Use program the Office of the National Coordinator for Health IT released a rule establishing new and voluntary 2015 Edition certification criteria for providers not eligible for the MU program.

The Stage 3 proposed rule is available here, and the 2015 Edition proposed rule may be viewed here. Both documents are open for public comment until May 29, 2015.

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