The Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health IT (ONC) released the final rule for Stage 2 Meaningful Use on Thursday, August 23, 2012. The final rule for Stage 2 Meaningful Use defines the requirements that both hospitals and eligible healthcare providers must meet in order to continue to qualify and receive payments under the Medicare and Medicaid electronic health records (EHR) incentive programs.
The Medicare and Medicaid EHR Incentive Programs are in place to promote and expand the meaningful use of certified EHR technology which is one important component of a broader national strategy to deploy health information technology infrastructures throughout the entire ambulatory and hospital healthcare system of the United States. This aggressive health IT strategy is critical to successfully reforming our healthcare system which will eventually lead to improving operational efficiency of medical organizations and patient care quality, safety, and outcomes.
Prior to the release of the final rule for Stage 2 Meaningful Use, CMS first posted its proposed rule for Stage 2 in the Federal Register on March 7, 2012. This action opened the sixty day public commentary period that allowed interested parties and individuals to submit comments, challenges, or concerns regarding any portion of the proposed rule. According to the Stage 2 final rule, approximately six thousand one hundred items of timely correspondence was received prior to the May 6, 2012 submission deadline. CMS and the ONC have included summaries of the timely public comments that were within scope of the Stage 2 proposed rule throughout the final rule document.
Key highlights of the final rule for Stage 2 Meaningful Use:
1. Stage 2 attestations start in 2014 – The meaningful use final rule for Stage 1 established an original timeline that would have required eligible providers enrolled in the Medicare EHR Incentive Program who attested to meeting meaningful use in 2011 to meet Stage 2 requirements in 2013. Now under the final rule for Stage 2, any eligible provider that attested to Stage 1 of meaningful use in 2011 will now attest to Stage 2 requirements starting in 2014. This significant change provides more flexibility and allows both eligible providers and certified EHR vendors more time to upgrade EHR systems to the 2014 edition. CMS and the ONC have also published the criteria in the final rule that EHR systems must meet in order to achieve or maintain their ONC-ATCB certification for Stage 2.
2. Changes to Stage 1 and introduction of new objectives and measures in Stage 2 – In the final rule for Stage 2, CMS and the ONC has maintained the same core-menu structure found in Stage 1. In Stage 2, there are a total of twenty measures that eligible providers must meet or qualify for exclusion to seventeen core objectives and three of six menu objectives. For eligible hospitals and critical access hospitals (CAHs), there are a total of nineteen measures they must meet or qualify for exclusion to sixteen core objectives and three of six menu objectives. The final rule has added the “outpatient lab reporting” to the menu for hospitals and CAHs and “recording clinical notes” as a menu item for both hospitals and eligible providers.
Also, the “exchange of key clinical information” core objective from Stage 1 has been replaced with the more robust “transitions of care” core objective in Stage 2, and the “provide patients with an electronic copy of their health information” objective from Stage 1 was eliminated in favor of the new “online, download, and transmit” core objective in Stage 2.
The final rule for Stage 2 also introduces two new core objectives. For eligible providers, the new core objective is “use secure electronic messaging to communicate with patients on relevant health information” and for hospitals and CAH’s, the new core objective is “automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).”
One significant policy change to Stage 1 effective as of 2014 is eligible providers, hospitals, and CAHs that meet an exclusion for a menu set objective does not count towards the number of menu set objectives that must be satisfied to meet meaningful use.
3. Streamlined Group Practice Reporting – The final rule will now allow group practices to batch and submit meaningful use attestation data, for all of their individual eligible providers, in one file.
4. Process for Medicare Payment Adjustments – The final rule has defined the process that will determine whether an eligible provider, hospital, or CAH will experience a Medicare payment adjustment. All future imposed Medicare payment adjustments will be determined by an EHR reporting period prior to the required statute taking effect in 2015. The final rule states that any Medicare eligible or hospital that demonstrates meaningful use in 2013 will not be imposed a payment adjustment in 2015. Furthermore, a Medicare provider that first demonstrates meaningful use in 2014 will not be imposed a payment reduction penalty as long as they successfully register for the EHR Incentive Program and attest to meaningful use by July 1, 2014 for eligible hospitals or October 1, 2014 for eligible providers.
In the final rule, CMS defines four specific categories of hardship exceptions for eligible providers to avoid a Medicare payment adjustment penalty and they are: New Eligible Providers, Infrastructure Barriers, Unforeseen Circumstances, and Specific Specialist/Provider Type that includes radiology, anesthesiology, and pathology.
For the most part, initial reactions by several healthcare associations regarding the final rule for Stage 2 Meaningful Use were quite favorable.
The Medical Group Management Association (MGMA) expressed that they were overall pleased with final rule specifically noting the change that allows groups to report batch information for certain measures that now removes the administrative burden on eligible professionals. They also expressed satisfaction with the threshold decrease of providing online access for the patient to get a hold of their medical records from the proposed ten percent down to five percent in the final rule. While the MGMA welcomed the decrease, they went on to express that this requirement continues to present a number of challenges to providers including the cost to integrate an online portal and the reliance on patients to use it.
The American Health Information Management Association (AHIMA) expressed that they were happy to see CMS acknowledge and continue to make efforts to align meaningful use quality reporting requirements with other quality reporting systems in order to reduce duplication and reporting challenges. The AHIMA also shared that this reporting alignment will drive efficiency and reduce cost over time. Both the MGMA and AHIMA were also glad to see that the Stage 2 Meaningful Use requirements will begin in 2014, as opposed to the proposed starting date of 2013.
On the other hand, the American Hospital Association (AHA) expressed concern about the timeline providers have to meet the Stage 2 requirements. The AHA believes that the final rule sets an unrealistic date by which hospitals must attest to initial meaningful use requirements to avoid financial penalties. They also went on record to say that the final rule makes the reporting of clinical quality measures more complicated and the addition of new meaningful use objectives has created new burdens for hospitals.
In conclusion, the journey to digitize the healthcare system of the U.S. requires all stakeholders to effectively managing change while navigating a very long and winding road. The fact is EHR adoption along with meeting all of the requirements for Stage 2 Meaningful Use is not going to be easy and not everyone will be in agreement with the final rule. However, the time will come when the efforts of today will lead to a more robust coordination of patient care, eliminate redundant screenings and tests, reduce medical errors, reduce healthcare costs, and foster improved patient engagement and outcomes in the near future.