Provider Organizations Unhappy with Proposed Health IT Rules

Hospital and provider groups are leveling criticism against the two long-awaited proposed regulations released last week by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Improvement Technology to fund expansion of health information technology.

Hospitals have "serious concerns that the new health information technology rules severely limit hospitals' ability to access federal financing for health information technology that is used to improve patient care," American Hospital Association (AHA) Executive Vice President Rick Pollack said in a statement.

While moving toward broader adoption of electronic health records (EHRs) is "an important goal and helping hospitals, doctors, nurses, and other caregivers is essential in getting us there," widespread efforts toward adoption "will be hindered unless key provisions in these rules are addressed," he said.

In particular, AHA said that while the proposed definition of "meaningful use"—which was brought forward under the stimulus legislation, the American Recovery and Reinvestment Act of 2009—is "a worthy goal," the term "should be a destination point, not a starting point," Pollack said. "Only hospitals that are considered 'meaningful users' of EHRs can receive much needed financial assistance."

The intent behind the legislation was to "recognize the important efforts hospitals and physicians have undertaken to improve care and to stimulate greater use of health information technology and EHRs," he said.

But the rules released last week create a definition of "meaningful use" that doesn’t recognize efforts by hospitals in using clinical systems to reduce medication errors, track quality and outcomes measures, and collect basic patient health information, he added. Instead, the AHA is proposing that hospitals and physicians be rewarded for progress that already has been made toward adopting EHRs.

Meanwhile, the Medical Group Management Association (MGMA) said that the proposed rules are "overly complex and that medical groups will confront significant challenges trying to meet the program requirements."

"The Medicare and Medicaid incentive programs must be designed to facilitate the rapid deployment of health information technology," said MGMA President and CEO William Jessee, MD. He added that "burdensome requirements and needlessly complex administration" will discourage physician participation in the program and the implementation of EHRs.

In particular, the rules include many requirements that will create barriers to physician efforts to achieve the designation of meaningful use, including:

• Meeting thresholds for some of the meaningful use criteria (i.e., computerized prescription order entry, electronic claim submission, and electronic insurance eligibility verification).
• Addressing "potentially difficult" meaningful use attestations after the first year.
• Meeting a requirement that physician offices provide patients and others with electronic copies of medical records.

While the CMS and ONC rules include "some flexibility," especially in the areas of escalating stages of meaningful use requirements and reasonable 90 day reporting windows, the government "should make additional changes to achieve widespread adoption by professionals in all types of clinical settings," Jessee said.

The American Medical Association (AMA) said it will carefully review the proposed rules on standards for EHR use and incentives and provide formal comments before the 60 day comment period ends.

AMA said it is looking at the importance of realistic timeframes for adoption and at the removal of “extraneous requirements that would delay successful adoption and reasonable reporting requirements," said AMA board member Steven Stack, MD. "We want physicians in all practice sizes and specialties to be able to take advantage of the stimulus incentives and adopt new technologies that can improve patient care and physician workflow."