Winners, Losers in HHS Final Meaningful Use Rule

There were a number of changes from the proposed to the final version of HHS' meaningful use rule—requirements that will qualify hospitals and physician practices for federal reimbursements for electronic health records and other IT initiatives, many based on feedback in roughly 2,000 letters responding when the rule was first proposed in January.

The HHS meaningful use final regulations announced Tuesday specify what physicians and hospitals will have to do to receive a share of up to $27 billion in bonus Medicare payments for adoption of electronic health records over the next ten years. Eligible professionals can get up to $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

That big pile of money aside, as with all efforts that result from compromise, there are reasons to cheer and reasons to jeer. Here's how it breaks down for four groups of stakeholders.

Those 2,000 letter-writers

Much of the feedback on the proposed rules and the timeline for meeting them had a common theme—they were unreasonably ambitious, inflexible, and onerous. "We have tried to listen," National Coordinator for Health Information Technology David Blumenthal, MD, told those letter writers at a briefing today. "The first thing we've done is add flexibility and choice"

One example of how Blumenthal put those listening skills to work: The proposed rule initially called on eligible professionals to meet 25 EHR objectives and for hospitals to meet 23 in order to demonstrate meaningful use. Now those objectives are divided into mandatory core requirements plus an "ala carte" menu of 10 additional requirements. Providers can choose five to meet, deferring the rest to the second phase.

Another win: The proposed rule called for organizations to hand over patient records upon request and said 80% of the requests must be fulfilled electronically within 48 hours. Now organizations will be compliant if they provide electronic records within three days to 50% of those who request it.