The American Medical Association applauds CMS for allowing a hardship exemption for physicians who are unable to attest in 2015, but calls the final rule, as a whole, "deeply disappointing." The American College of Cardiology says that the program requirements "[remain] difficult to implement."
Despite pleas within the past week from more than 100 members of Congress and various healthcare stakeholders for stage 3 rules to be postponed, the Department of Health and Human Services, with the release Tuesday of twin rules totaling 1302 pages, signaled what it intends to publish in the Federal Register on October 16.
Many healthcare providers have yet to successfully achieve stage 2.
HHS says it is providing a simpler, more flexible set of stage 2 regulations for 2015 through 2017 as the meaningful use regulation era gives way to CMS's transition to value-based compensation.
"We have a shared goal of electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people," said Patrick Conway MD, CMS deputy administrator for innovation and quality and chief medical officer, in a statement.
ONC Unveils Final Interoperability Roadmap
"We eliminated unnecessary requirements, simplified and increased flexibility for those that remain, and focused on interoperability, information exchange, and patient engagement. By 2018, these rules move us beyond the staged approach of 'meaningful use' and focus on broader delivery system reform."
After CMS's March and April notice of proposed rule-making (NPRM) regarding stage 3 and adjustments to stage 2, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will sunset the meaningful use "payment adjustments," in essence, penalties for noncompliance, at the end of 2018. Instead, Congress has called for the establishment of a Merit-Based Incentive Payment System (MIPS), of which the meaningful use program will form one component.
Due to this interim Congressional action, CMS in its final stage 3 rule said it would allow for an additional 60-day comment period, starting upon enactment of the stage 3 rule, regarding the transition from meaningful use to MIPS. Afterward, CMS may modify its final rules and lay the groundwork for an NPRM in mid-2016 detailing the implementation of MIPS.
Industry Reaction
Initial reaction to the final rule was mixed. Providers applauded the relaxation of 2015 requirements, and some applauded the retirement of some process measures that currently must be satisfied in order for providers to successfully attest they have met meaningful use's requirements.
But concerns remain about the complexity of the existing program, issues such as lack of interoperability among EHRs, and what providers still say is too hasty a timetable for adoption of stage 3-certified EHR software.
"Today's release of the meaningful use rules is a mixed bag for hospitals and health systems and the patients they serve," said Rick Pollack, president and CEO of the American Hospital Association, in a statement.
"We are pleased that CMS released the long-awaited modifications rule, which will allow hospitals a 90-day reporting period in 2015 along with other flexibilities in response to AHA concerns. Hospitals will finally have the clarity they need to take steps to ensure they meet the revised requirements.
But Pollack went on to say that the final rule implementing Stage 3, which providers will be required to use beginning January 1, 2018, "is deeply disappointing. Despite the urging of hospitals, physicians, and Congress, the Stage 3 final rule includes many new and more challenging requirements. More than 60% of hospitals and about 90% of physicians have yet to attest to stage 2. The Stage 3 [implementation deadline] is too much too soon."
AHA urged HHS to delay the implementation of Stage 3 and focus instead on ensuring that providers could easily and efficiently share health information to support care delivery and new models of care.
"America's hospitals and health systems remain committed to successfully using electronic health records to improve health care for patients," Pollack said. "We appreciate the changes that CMS has made in response to our concerns and are pleased aspects of the rule are still under debate."
The American Medical Association applauded CMS for allowing a hardship exemption for physicians who are unable to attest in 2015.
"The AMA continues to believe that stage 3 requires significant changes to ensure successful participation, and improve the usability and interoperability of electronic health record systems," said AMA president Steven J. Stack, MD, in a statement.
"We urge CMS to use the additional public comment period provided for Stage 3 to further improve the program and consider changes related to the Medicare Access and CHIP Reauthorization Act, which was signed into law earlier this year. We also want to make sure that EHR vendors have the time they need to further test products for interoperability, usability, safety and security."
A meaningful use modification first introduced in the April NPRM, which had ignited strong opposition from some patients, will, in 2015 and 2016, require hospitals to demonstrate that only a single patient per hospital has viewed, downloaded, or transmitted his medical record, post-discharge. The current meaningful use rule, which required hospitals to demonstrate that 5% of patients used their EHRs in this manner, has been a source of frustration for hospitals.
Still "Difficult to Implement"
In the companion EHR certification rule, the Office of the National Coordinator for Health Information Technology finalized some rules which were applauded yesterday by Charles E. Christian, chairman of the board of trustees of the College of Healthcare Information Management Executives (CHIME).
"CHIME supports key provisions in the rule that should lead to greater transparency regarding vendor products; improved testing and surveillance of health IT, and an improved focus on user-centered design," Christian said in a statement released Tuesday.
The final rule's action to reduce what until now had been a multi-stage, multi-year set of implementation stages for providers to a single set of requirements is a concern of the American College of Cardiology.
"The American College of Cardiology has concerns about [Tuesday's] announcement by CMS to align all three stages of meaningful use, as this does not account for the reality of the situation faced by the medical community working every day to implement the meaningful use program and to improve care for their patients," said ACC President Kim Allan Williams Sr., MD, FACC in a statement.
"The ACC is a longtime supporter of electronic health records as a way to improve the quality of patient care," Williams said. "While we applaud CMS for finalizing programmatic changes to the 2015–2017 reporting years, that should ease the difficulties providers face when attempting to meet meaningful use requirements, the decision to combine meaningful use into one single stage and finalize the program requirements at this time remains difficult to implement. Many of the requirements for stage 2 proved unattainable."
According to Williams, large numbers of providers either haven't met the stage 2 requirements, or, after trying and failing, have given up. "That is why it is vital that CMS consider participation data from the current stage to see what is working and what isn't before outlining an upcoming stage," he said.
"We cannot establish a long-term health care program that does not take into account what we can feasibly attain in the short-term, transitional period. The ACC looks forward to continued work with CMS to establish how the meaningful use program will fit into the new Merit-Based Incentives Program (MIPS) slated for 2017."
Both the AMA and CHIME said they would continue to review the regulations and would have more comment in the coming days.
Vendors Respond
Some EHR vendors have also become disillusioned about meaningful use as the program has struggled.
"With each new delay, modification, and dilution of the MU program it becomes more and more tangential to the ongoing process of dragging health IT into the 21st century," said Dan Haley, general counsel of athenahealth, in an email to HealthLeaders.
"Happily, that work continues independent of federal efforts. Through private sector initiatives like CommonWell, Sequoia, and others, industry and our provider clients are on track to meet the objectives set forth in the ONC's recently-released 10-year plan well ahead of the government's schedule.
"While we appreciate ONC's and CMS's efforts to address the many concerns that providers have with the direction of the MU program, at this point it would be better for the government to declare victory on EHR adoption and step back."
CMS reviewed and considered more than 2,500 comments on the two proposed rules to create the final policies, the agency said.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.