Senator Alexander Throws Down Gauntlet on Stage 3 Rule Delay

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Senate Health Committee Chairman Lamar Alexander (R-Tenn.) on Thursday continued to threaten to use legislative powers to delay the release of the final rules for Stage 3 of the Meaningful Use electronic health records program until Jan. 1, 2017.

Alexander threw down the gauntlet on Stage 3 at a committee hearing on “Achieving the Promise of Health Information Technology,” which heard witness testimony from CMS Acting Principal Deputy Administrator Patrick Conway, M.D., and National Coordinator for Health IT Karen DeSalvo, M.D.

“We have an opportunity in the Congress to carefully review whatever decision the Administration makes about how we proceed,” Alexander told Conway and DeSalvo. “One way we can do that is through the innovation legislation we’re working on. Another way is through the congressional review process if we don’t like the rule. But, I hope one of the lessons from the Affordable Care Act is that it’s better to move ahead with a consensus.”

Nonetheless, he warned that if the Obama administration won’t act “administratively” to delay the final Stage 3 rule, lawmakers will step up and pass legislation “that the full Senate and full Congress will adopt next year.” To that end, Alexander mentioned that a “bipartisan group of 96 Republicans and 20 Democrats in the House of Representatives” sent a letter this week to the Department of Health and Human Services and Office of the Management and Budget urging them to “pause” the process of making the Stage 3 rule final.  

Also See: Alexander Pushes Legislation if CMS Won’t Delay Stage 3 on Its Own

The senator pointed out that only 12 percent of physicians and 40 percent of hospitals have complied with Stage 2, “so rushing out the Stage 3 rule seems premature.” Consequently, Alexander said that it makes sense to “move ahead on a schedule that adopts Stage 2 now and Stage 3 in a year” using the time period between the stages to “get doctors, hospitals, and vendors buying into what you’re doing and go out of office at the end of next year with a big success instead of a big problem.”

The big problem, he added, would be “if you prematurely announce a rule and you have a lot of people who don’t like it trying to repeal it from the day you do it.”

In his testimony, Conway said that CMS in March proposed that Stage 3 would be optional in 2017 to give Meaningful Use program participants and industry “more time to implement changes, update workflows and adopt new technology.” In addition, he told lawmakers that CMS proposed a Stage 3 rule “focused on an aligned set of only eight objectives and measures” for eligible professionals and hospitals, down from 20 in Stage 2.

“Why would you go ahead with your final stage—Stage 3—and then have to do what you did with Stage 2?” asked Alexander, with CMS spending the next two or three years changing the rule “because it’s not very good.” Instead, he asserted that “there is no reason not to take time to do it right.”

However, DeSalvo assured Alexander that “we do want to get this right.” She said “our track record reflects that we are willing to work with the private sector and we do understand firsthand what that’s like to be in the clinical environment and working with our electronic health records.”

Still, a showdown appears to be brewing between Alexander and the Obama administration on the finalization of the Stage 3 rule. “The wiser approach would be to adopt the Stage 2 rule now and spend the next 12 months getting the Meaningful Use 3 rule right,” the senator concluded.   

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