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Proposed MU Rules Draw Strong Reaction

 |  By Margaret@example.com  
   May 09, 2012

More than 270 interested parties filed public comments regarding the Meaningful Use Stage 2 proposed rules, but it is a few paragraphs in the 68-page comment letter from the American Hospital Association (AHA) that has drawn the attention and ire of patient and consumer advocate groups.

Citing HIPAA concerns, the AHA disagrees with the Centers for Medicare & Medicaid Services proposal "to provide patients with the ability to view, download, and transmit large volumes of protected health information via the Internet."

It also terms as "too aggressive" the proposal that electronic information about a hospital admission be available within 36 hours of discharge for at least 50% of the patients. In addition, the AHA questions the authority of CMS to require that 10 percent of all discharged patients view, download or transmit to a third party their information during the reporting period for meaningful use.

Public reaction to the AHA's comments was blunt:

  • Deven McGraw, a lawyer and director of the Health Privacy Project at the Center for Democracy and Technology, said in this blog post that "getting patients critical information about their hospital stay could have an impact on their ability to recover. Patients should expect hospitals to be their partners in healthcare—but in no partnership that I'm aware of does one side get to hoard all of the relevant information."
  • Daniel Z. Sands, MD, president of the Society for Participatory Medicine, which represents both clinicians and patients, made this press statement: "Patient engagement is the cornerstone of a successful, cost effective, and high-quality health care system. Those goals cannot be achieved unless we give patients access to their own health information and encourage them to use it."
  • Columnist e-Patient Dave at e-patients.net suggested that the AHA had declared war on patient empowerment.

The AHA hasn't released a response to the criticism, but a review of public comments on the MU Stage 2 proposal demonstrates that the AHA is not alone in challenging what many in the healthcare industry view as an ambitious program.

Among the common themes: hospital MU performance shouldn't be dependent upon actions not fully under hospital control, measures that require adherence from a party other than the physician should be eliminated, and all electronic health record (EHRs) should be certified to all core quality measures (CQM).

Here are some of the comments:
The College of Healthcare Information Management Executives (CHIME), which represents 1,400 healthcare CIOs: CHIME wants to require certification of EHR products to all CQMs needed to meet meaningful use in each setting. "Through our experiences with Stage 1, we found that although EHR products were able to automatically produce CQM reports, the data was inaccurate and largely incomparable across different providers."

In its 46-page comment letter CHIME requests that the time to make online access of hospital information available to the patient be extended from 36 hours to four business days. It also objects to the requirement that 10% of discharged patients be able to view or download their information online. This echoes a common sentiment from commenters stating that providers' performance on MU objectives shouldn't be dependent on what their patients do or choose not to do.

CHIME also asks CMS to follow the precedent set with Stage 1 to allow providers to demonstrate meaningful use of EHRs during a continuous 90-day reporting period. It would also

Premier Health Alliance, which represents more than 2,600 hospital members:
Premier supports the CMS decision to extend Stage 1 MU, but wants CMS to publish a final rule specifying Stage 2 requirements by August 2012 warning that failure to do so will "seriously compromise the ability of the healthcare community to meet Stage 2 requirements beginning in 2014." If the August deadline can't be met, Premier recommends that Stage 1 be continued for an additional year, and that Stage 2 begin in 2015.

Premier likes the proposal that hospitals report clinical quality measures from a menu of options but asks that the CQM be reduced to 15 instead of the proposed 24. "Our alliance members have encountered significant difficulties in complying with the 15-measure requirement in Stage 1, in some cases due to problems with the performance of certified EHR technology, and we believe it would be more prudent to retain a 15-measure reporting requirement for Stage 2 rather than overreach."

It would like to see timeline for online access be two business days rather than 36 hours after discharge. "A measure based on full days would be simpler than one based on hours post-discharge, since discharges can occur throughout the day, making for a potential compliance nightmare."

American Medical Association (AMA) and 98 state and specialty medical societies:
The AMA sides with the AHA in terms of meeting a requirement for online access to patient health information. The 10% requirement "unfairly predicates the physician's success for meeting the measure on patient compliance and should be eliminated."

For Stage 2, CMS proposes that 50% of all unique patients seen by the physician be provided online access to their health information within four business days after the information is available to the physician. The AMA would like the threshold requirement to be 20% not 50%. AMA contends that the four-day timeframe is "inconsistent with the HIPAA."

It notes that for Stage 2, CMS proposes that the reporting period be the entire calendar year. "The sheer volume of patient information that has to be made available within four business days for the entire calendar year would be extraordinary for most practices and their staff to manage."

The AMA opposes back-dating of the MU penalty program, or for that matter, any other quality or health IT penalty program, including e-prescribing and PQRS. "If Congress intended that these penalty programs be back-dated, the legislation would have stated so. CMS is essentially pushing up deadlines for participation by a full year or more due largely to its own data processing limitations." The AMA asks CMS to allow physicians to successfully meet Stage 2 MU measures for 90 consecutive days during the first six months of 2015 to avoid the 2015 penalty. It says the process should be extended to 2016 and 2017.

Physicians, University of Utah:
"Epic, Cerner, and all major vendors make it absolutely impossible for physicians to bring in outside tools to measure Patient-Reported Outcomes (PROs). This is a real problem… if we are ever going to be able to measure value. Meaningful use must require open access to all EHRs from the vendors. We need to be able to integrate outside tools such as the NIH PROMIS system in the flow of patient care using EHRs."

Cincinnati Children' Hospital Medical Center:
"While a number of pediatric measures were added this year, most of the new measures are only related to very specific specialties. Based on the measures presented, a large number of our providers would still have zero denominators when reporting for Stage 2. We are requesting additional pediatric measures be added as well as the exclusion for patients 18 years and older."

Pacific Orthotics & Prosthetics (California):
"This new look-back period would certainly be the last straw. I am a small business owner competing with corporations that have far more resources. If I have to worry for 10 years that someone may request money back, I will certainly close my shop. … Stop burdening a much-needed industry and look somewhere else for money. The orthotics and prosthetics industry should not be lumped in with the durable medical equipment industry.

Larry Preston, Professional Medical Consultants, Las Vegas
"Providing office visit summaries in 24 hours will actually harm the patient in the some cases, since we will not have time to include lab and other diagnostic tests that were ordered on that visit. The current requirement of 72 hours at least allows for those tests to be documented in the physician's notes prior to sending to the patient."

See Also:

Climbing the Meaningful Use Mountain

 

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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