An announcement from CMS on Meaningful Use implementation deadline changes obscures the fact that the agency fully expects all Stage 2 start dates to remain unchanged.
For a few hours last Friday, healthcare providers thought they were going to get some relief from next year's Meaningful Use Stage 2 implementation deadlines. But what observers are calling a poorly worded announcement from CMS hid the fact that the agency fully expects all Stage 2 start dates to remain unchanged.
Instead, the CMS announcement proposes to push back start dates for Meaningful Use Stage 3, by adding a third year of Stage 2 for those providers who attested for Stage 1 in 2011 or 2012.
See Also: Meaningful Use Deadlines Delayed for 1 Year
Organizations which attested to Meaningful Use Stage 1 during the first year, 2011, and the second year, 2012, are still expected to attest to Meaningful Use Stage 2 during 2014. Those attesting to Stage 1 this year are still expected to attest to Stage 2 in 2015.
What CMS' proposal would mean is that start dates for Meaningful Use Stage 3 attestation would commence not in 2016, but in 2017 at the earliest.
Confusion sown by the Friday announcement even had HIMSS erroneously congratulating CMS for a Stage 2 delay that in fact was not in the cards. On Saturday morning, HIMSS put out a corrective statement expressing the same concern that CHIME had expressed the night before.
While CMS did not issue any clarification, officials from ONC as recently as last month stated there would be no changes in Stage 2 compliance deadlines, although those officials did say the decision was ultimately CMS's to make.
But last Friday's announcement threw the industry into confusion that lingered through the weekend.
"They could have easily said, this has no effect on the start date and implementation requirements for Stage 2 in 2014, which is what our concern is, but they didn't say that," says Russ Branzell, CEO of the College of Healthcare Information Management Executives (CHIME).
Instead, Branzell says, CMS is proposing the same sort of flexibility for Stage 3 that it provided for Stage 1, while denying any further flexibility on a Stage 2 start date.
"We still believe there is some opportunity for flexibility with them for the beginning of Stage 2," Branzell says. "It's just going to require some hard work."
Toward that end, Branzell will be in Washington D.C. Monday and Tuesday meeting with CMS, legislative, and administration officials to once again press providers' plea for relief from being required to comply with Meaningful Use Stage 2 in 2014.
With ICD-10-compliant technology and processes required to be paid for care reimbursement after October 1, 2014, providers may simply be unable to comply with Stage 2 requirements in 2014, "which is even a greater concern on our part," Branzell says.
"If we mess up Meaningful Use as an organization, just pick any organization out there, that hurts," Branzell says. "You [don't] get your reimbursement from the government. You mess up ICD-10, you don't get paid. If you don't get paid for a few months, with today's cash flows in a lot of these smaller organizations, [your] viability's at risk."
In the wording of its Friday announcement, CMS may have been trying to make it appear that it was trying to satisfy the needs of the provider community without really doing so, says Laura Kreofsky, principal advisor at Impact Advisors, a healthcare IT consulting firm.
Kreofsky referred back to HHS Secretary Kathleen Sebelius' December 2011 announcement delaying the start of Stage 2. "It was, in my opinion, a more clearly worded press release," she says.
"Whether it was intentional or not, the initial ripple was very easy to have misconstrued," Kreofsky says. "The message has got to be in the provider community: Nothing's changed around Stage 2, and that everybody needs to stay the course under their Stage 2 or Stage 1 work.
"CMS purported to do this to basically make sure we're all ready for Stage 3. It was more defensive on the part of CMS than responsive to the needs of the provider organizations and vendor community."
Friday's announcement also introduced another potential complication which could make the job of healthcare system CIOs even more complicated, Kreofsky said, referring to CMS's call for frequent updating of criteria under its HIT Certification Program.
According to CMS' announcement, "This approach is designed to provide public input on policy proposals, enable our certification processes to more quickly adapt to include newer industry standards that can lead to greater interoperability, and add more predictability for EHR technology developers. We also anticipate that this new approach would spread out over a longer time period the certification requirements to which EHR technology developers have previously had to react."
The first step under this new approach would be to publish a proposed rule for a 2015 Edition of certification criteria.
"We intend for the 2015 Edition certification criteria to improve on the 2014 Edition certification criteria in several ways," the CMS announcement states. "We expect the 2015 Edition would be responsive to stakeholder feedback; would address issues found in the 2014 Edition; and would reference updated standards and implementation guides that we expect would continue momentum toward greater interoperability.
CMS also stated that it expects to propose that the 2015 Edition would be voluntary in the sense that providers participating in the EHR Incentive Programs would not have to upgrade to 2015 Edition EHR technology, and no EHR technology developer who has certified its EHR technology to the 2014 Edition would need to recertify its products. CMS' intention would be for the 2014 Edition to remain the baseline certification criteria edition for meeting the Certified EHR Technology definition.
Kreofsky questions the need for the proposed voluntary 2015 Edition. "Why wouldn't you push people to use the 2015 Edition?" she asks. These criteria won't come soon enough to be of any use to software vendors struggling to meet the 2014 criteria, and will add another layer of complexity to existing healthcare IT challenges, she says.
"For an organization that upgrades their EHR in the middle of a reporting period, it's incredibly confusing just to manage and keep track of which edition of the criteria you're at, and to have them changing constantly isn't going to help providers and organizations," Kreofsky says.
She also notes that the period for public input into many of these proposed rules will hit next fall, at just the time when the pressure is on to comply with ICD-10 requirements and, for those who attested for Meaningful Use Stage 1 in 2011 or 2012, to migrate to Stage 2.
"It takes a considerable amount of time and energy to review and respond to proposed rules," Kreofsky says.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.