MU Stage 2 Final Rule Elicits Few Cheers

The final rule for Meaningful Use Stage 2 released last week by the Department of Health and Human Services "looks a lot better than some people feared," says Jeffrey Smith, assistant director of advocacy for College of Healthcare Information Management Executives (CHIME), which represents 1,400 healthcare CIOs at hospitals and clinics.

The rule, which delays the onset of MU Stage 2 until 2014, specifies the criteria that eligible professionals, hospitals, and critical access hospitals (CAH) must meet to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. It also specifies the Medicare payment adjustments that will be made for failing to demonstrate meaningful use of certified EHR technology.

Although stakeholders are still parsing through the 672-page rule, it is already garnering support among groups associated with the IT side of the healthcare business. The reaction is more subdued, however, among provider groups.

While Premier Health Alliance sees opportunities with the release of the final rule; the American Hospital Association views it as "an obstacle" Among the sticking points: the reporting of clinical quality measures (CQMs).

The final rule for CQMs provides for a menu-based reporting system. Eligible professionals will submit nine CQMs from at least three of the National Quality Strategy (NQS) domains. Eligible hospitals and CAHs will submit 16 CQMs from at least three of the NQS domains.

AHA contends that the change complicates the reporting of CQMs compared to the MU Stage 1 requirements. Chantal Worzala, director of policy for the AHA, told HealthLeaders Media that for Stage 1, all hospitals reported on the same 15 quality measures and EHR vendors needed to be able to produce all of the hospital CQMs.

For Stage 2 she says there is a much broader pool of CQMs and EHR vendors can select the CQMs they want to produce. "It raises a very large question in our minds about whether or not this choice that CMS finalized, is a real choice. We do need to use certified EHR technology to report the measures, but if our vendor has not been certified against a particular measure, we can’t choose it. That’s a pretty complicated scenario," explains Worzala.

"If your vendor can choose which measures they care to be certified against, it’s not clear that you have a choice on which measures to report."

CHIME is more enthusiastic about the CQM changes.

Smith says that for CHIME members the CQMs for MU Stage 1 "were very problematic" with hospitals and physicians unable to able to report on CQMs important to them because CQMs "were dictated in the beginning based on what the vendor system could do."

The final rule for Stage 2 provides more flexibility in terms of CQM selection and reduces the reporting burden. "It is definitely a step in the right direction," he says.

There is concern among some stakeholders regarding the view-transmit-download provision, which requires that 5% of the unique patients seen by an eligible professional must actually electronically download or transmit their healthcare information.

"The basic concern is that providers will be on the hook for delivering something over which they have very little control," explains Smith. He says CHIME wanted providers to have the capability for view-transmit-download without the requirement that it be used by a certain number of patients.

The concerns extend to cost, the availability of software, and privacy rules, explains Susan Turney, MD, president and CEO of the Medical Group Management Association and the American College of Medical Practice Executives.

The pressure to meet fast-approaching deadlines in 2013 and 2014 presents a challenge to vendors. And because vendor capacity is low and demand is high, costs may rise.

Turney notes that incorporating portal functionality could be a challenge because it will not be available from all EHR vendors. Eligible professionals might need to contract with an outside vendor for portal functionality and absorb the additional cost of the portal and the necessary software.

"We are also concerned about the potential for data breaches," she explains. "While comprehensive portals are becoming more common with large healthcare institutions, smaller group practices typically do not have the infrastructure to maintain and support this type of portal. It will require practice workflow to be significantly modified."

Smith says that while he understands the government’s motivation in making the 5% rule, it is still a difficult goal to meet. "The government is pushing hard on patient engagement. They figure if providers have skin in the game to get their patient online to actually download their health records then they (providers) will be more proactive and push their patients to use the system."

Premier Health Alliance takes particular pride in its successful efforts to broaden and clarify certain provider definitions, says Randy Thomas, vice president of portfolio strategy and design for Premier. "We have focused on getting definitions clarified so providers can get their share of incentives."

For example, the expanded definition for eligible professional allows physicians who are employed by hospitals, but have invested their own funds in EHR, to now qualify for EHR incentive payments.

Smith anticipates that there will be further tweaks or clarifications for MU Stage 2. But he expects the process to be less intense that for Stage 1. "I think they have a better developed game plan this time. The structure of this final rule seems more mature in terms of points of clarification. I don’t think anything big will change unless there’s a huge uproar that is supported with data."