Providers hard-pressed to meet MU timelines, rely on hardship exemptions

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The Centers for Medicare and Medicaid Services fails to take into account the time necessary for providers to comply with the burdensome requirements of the Meaningful Use program and as a result hospitals and physicians have either been subject to financial penalties or have needed hardship exemptions.

That’s the message delivered to members of Congress on Thursday by Cletis Earle, chairman-elect of the College of Healthcare Information Management Executives (CHIME) Board of Trustees, who testified before the House Energy and Commerce Subcommittee on Health.

According to Earle, the “escalated, staged approach” of CMS to Meaningful Use rulemaking does not leave adequate time for providers to “absorb the pace of change” required to meet the deadlines for these requirements.

CHIME and other stakeholder groups such as Health IT Now support H.R. 3120, co-sponsored by Rep. Michael Burgess (R-Texas) and Rep. Debbie Dingell (D-Mich.), which seeks to reduce the volume of future electronic health record-related significant hardship requests.

Also See: Bill suggests changes for Meaningful Use program

The bipartisan bill amends the HITECH Act in order to remove a requirement that requires the Secretary of the Department of Health and Human Services to continue to make Meaningful Use standards more stringent over time and allows HHS to be more deliberative in such evaluations.

“Rather than propose the elimination of the Meaningful Use program or insist that requirements remain stagnant in perpetuity,” H.R. 3120 “leaves it to the discretion of the Secretary to modify the requirements over time as deemed necessary in conjunction with the industry,” Earle told lawmakers.

“Now, more than eight years after passage of HITECH, we have the chance to make policy decisions apart from arbitrary deadlines and measures of the EHR Incentive Program,” he added. “The Meaningful Use program has been plagued by the check-the-box, one-size-fits-all approach.”

Health IT Now, a coalition of patient groups, provider organizations, employers and payers, also supports the bill, which the group says will allow the Trump administration to focus on interoperability and other HIT objectives that improve patient outcomes.

“In the Medicare Access and CHIP Reauthorization Act (MACRA), Congress declared it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by Dec. 31, 2018,” wrote HITN Executive Director Joel White in a July 11 letter to Burgess and Dingell. “If passed, CMS should fully use the flexibility provided by this legislation to hasten its work to reach this deadline and admirable goal.”

While EHRs have been widely adopted thanks to the MU program and have the potential to transform healthcare delivery, providers have not had the time necessary to optimize EHRs and realize the full potential of these digital tools, Earle contends.

“As we strive to meet CMS program deadlines, we aren’t able to pursue workflow enhancements with our EHRs or other health IT tools that would actually improve outcomes,” testified Earle, who is also chief information officer of Buffalo, N.Y.-based Kaleida Health. “Moreover, our EHR vendors are so focused on meeting the specification and certifications that they don’t have the bandwidth to work with us on functionalities that our clinicians actually request.”

In written testimony, Earle lamented the fact that 2018 marks the first year that hospitals are expected to comply with Stage 3 MU measures and objectives—a deadline that will be difficult for them to meet.

“To comply with Stage 3, hospitals will need 2015 Certified Electronic Health Record Technology (CEHRT),” he said. “Unfortunately, 2015 CEHRT is not widely available to our members today.”

Earle cited a CHIME survey conducted in April 2017 in which 81 percent of its surveyed members indicated that they have not yet received their 2015 CEHRT, while more than 70 percent said they did expect to receive their updated software by July 1, 2017. In addition, more than 70 percent of respondents reported that they will not be ready for the Jan. 1, 2018, compliance date.

“CHIME members are very apprehensive about the looming requirement that mandates use of 2015 Edition CEHRT starting Jan. 1, 2018,” he noted. “This issue, combined with the requirement that providers begin meeting Meaningful Use Stage 3, places many hospitals at significant risk of a penalty.”

In response, a CMS spokesperson acknowledged that there are challenges when implementing an EHR update. Recognizing that reality, the agency representative said its proposed Quality Payment Program rule would allow eligible clinicians to use EHR technology in 2018 that is certified to either the 2014 Edition or the 2015 Edition to provide clinicians an additional year to implement the 2015 Edition.

“We are also offering the opportunity to apply for hardship exceptions for the Advancing Care Information performance category of MIPS (this takes the place of the Medicare EHR Incentive Program) starting in 2017,” according to the CMS spokesperson. “Failure to report on Advancing Care Information performance category will not necessarily result in a downward payment adjustment, as that will depend on the combination of the reporting of Quality, Improvement Activities and Advancing Care Information performance categories.”

“Furthermore in 2017, a MIPS eligible clinician can use the test option and submit either 1 Quality measure or 1 Improvement Activity or the base score measures of the Advancing Care Information and avoid a downward payment adjustment in 2019,” they added.

Nonetheless, to get ready for Stage 3, Earle related that a CIO from a rural healthcare organization told him that he has been forced to re-evaluate the use of a successful post-operative telehealth program because his organization didn’t have “enough resources” to meet all IT demands.

“Meeting the requirements established in regulations that often consist of 1,000 or more pages places unreasonable demands on limited resources and finances,” Earle added. “The ability to shift away from that continual churn would be a welcome development for the provider community.”

As hospitals and physicians continue to struggle to meet MU timelines and requirements, increasingly relying hardship exemptions, he concluded that H.R. 3120 will “infuse necessary flexibility to make the Meaningful Use program meaningful again.”

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