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Final MU 2 Rules Will Significantly Ratchet Up Vendor Costs

 |  By smace@healthleadersmedia.com  
   August 28, 2012

Five weeks ago I wrote that the then-imminent release of the Meaningful Use Stage 2 final rules did not mean vendors could turn a crank and produce software code that healthcare providers, would be able to seamlessly implement in order to meet deadlines looming in 2013 and 2014.

On Friday, during an online briefing about the just-released 2014 final rules, the squeeze on vendors seemed to tighten during an exchange with ONC federal policy division director Steve Posnack.

Someone asked him when certification of vendor code for Meaningful Use 2014-compliant software would begin.

"It's hard for me to give a definitive timeline," Posnack responded. "The test procedures have to be published for all the new certification criteria, and those are in the process of being finalized right now. Then they'll be subject to the period of public comment, so I think there is a window of variability in terms of when that would start.

"It's in everyone's interest to have it start as soon as possible," he continued," and that's what we're shooting for, because I think just like you saw with the final rule, there's intense commitment from everyone in the department to get these rules out as soon as possible, recognizing the timing concerns that commenters had expressed, and I think the same is going to be true with the test procedures and the other elements that still need to fall in place."

To me, this casts a lengthy shadow over all the other issues looming in the 474 pages issued by ONC and the other 672 pages issued by HHS. Providers are already seeing lengthy delays from vendors as they rush to implement EHR systems, according to Charles E. Christian, CIO of Good Samaritan Hospital in Vincennes, IN., who spoke at length of his concern at the American Hospital Leadership Summit in July.

Rewind back to the date that the final rules for Meaningful Use Stage 1 were released.  Now ask yourself this: How long did it take to get from the final rulemaking then and availability of software certified by CMS for Meaningful Use Stage 1? I wasn't monitoring the issue back in the summer of 2010, but I am guessing it was at least three months.

Given the number of new features in in this round for both Stage 1 and Stage 2 attesters, it could take as long or longer for certification of software this time.

The AHA shares my concerns. "there are many activities that need to happen before we will have certified products that can be purchased and installed by providers, hospitals, and physicians," says Chantal Worzala, AHA director of policy.

Each year, providers must confirm that their software is still in compliance with current Meaningful Use guidelines, and that's adding to the squeeze on providers to implement and vendors to facilitate those implementations.

In its comments to ONC this spring, AHA tried to allow any provider currently certifying at the 2011 Meaningful Use guidelines to stay on that release of software until it moved to the Stage 2 set of Meaningful Use functions.

But ONC refused to introduce this level of complexity into the regulations. While I can't blame ONC for trying to keep a complex set of regulations a little bit simpler, the result is that all providers have to get updated software from their vendors at once, whether they're in attesting at 2014-level Stage 1 or Stage 2.

"The notion that they're putting everybody into that upgrade cycle in the same year absolutely is problematic," Worzala says.

The question I can't get an answer for yet is this: were things just as bad for vendors when the 2011 rules were finalized? I'm sure someone reading this who's been following Meaningful Use longer than I can enlighten us in the comments below.

If that were the case, it could provide some inkling of how long the wait for certified code for the 2014 rules will be. Then again, the 2014 rules are a different beast than the 2011 rules, so as they say, your mileage may vary.

Vendors will shed light on all of this in the coming days and weeks. Along with that somber news may also come an unwanted, but basic economic effect of the law of supply and demand.

The AHA's letter of comment on the proposed rule in May reported that its members see "aggressive pricing of individual certified functionalities" by software vendors. "We expect that these distortions are exacerbated by limited vendor capacity to meet accelerated demand and workforce shortages."

We may be about to see that economic impact in spades. It remains to be seen whether the short time left to produce certified running code, and to help providers meet the 2014 deadlines for attestation makes that impact even worse.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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