The healthcare industry hoped that the Centers for Medicare and Medicaid Services, which accounts for one-third of the nation’s health insurance and mostly controls the rest of the healthcare industry, would have some idea of how healthcare organizations live and die outside of the Washington Beltway.
Well, they die when CMS publishes 752 pages of rules addressing three meaningful use programs in a single document. Does the agency, which has regulated healthcare for decades, still not understand that small physician practices and hospitals simply can’t handle 752 pages of bureaucratic jargon? How can CMS be so deaf?
I’ve been reading CMS rules for more than two decades, and this was the toughest one to wade through. Stages 1, 2 and 3 were intertwined throughout, and confusion reigned. There is considerably more I don’t understand than do understand, and I really feel pity for those who have to implement this mess.
It did not have to be this way. For starters, the Stage 3 final rule did not have to be published at this time. Providers that are ready can start Stage 3 in 2017, but they will be a distinct minority, as most will wait until 2018, when participation is mandatory. With so many providers not yet having started Stage 2, can anyone expect that participation in Stage 3 will be robust?
A final rule covering Stage 3 simply did not have to be in this rule. It would have been appropriate and helpful for the industry if CMS had only included comprehensive guidance on its thoughts about Stage 3 to get more industry reaction.
But CMS rushed out Stage 3 when it did not have to. Ponder the fixes that CMS has made to Stage 2 before this rule, which already had been adjusted by the agency. By rushing out Stage 3, the agency has almost ensured it will need to make a series of incremental changes when Stage 3 participation starts to lag.
Also consider the message that CMS sent to Congress when Stage 3 was included in this rule. In the face of bipartisan congressional requests to delay finalizing Stage 3, releasing final rules now will likely further poison relations with the House and Senate.
The Obama Administration has never had good relations with Congress, but finalizing Stage 3 now was just dumb; by its action, CMS simply ignored House and Senate members of both parties. The administration was going to have a tough time getting any leftover initiatives through Congress anyway, but pushing through Stage 3 just about seals their fates. And remember, Congress has the power to amend or overturn meaningful use rules, and Senate health committee chair Lamar Alexander is threatening to do just that.
It sets up political theater, but not potential progress in how the nation keeps records, studies care delivery and treats its sick citizens.
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