MU 'Modified Stage 2' Gives CIOs Some Breathing Room

Relief is welcome, but the challenges that hospital physicians face in complying with MACRA starting in 2017 will be followed by increasing demands in subsequent years.

Hospital CIOs had something to celebrate last week: a relaxation of some reporting requirements for meaningful use stage 2.

It came as a result of the release last week of the final rule for CMS's 2017 Hospital Outpatient Prospective Payment System (OPPS).

CMS Finalizes 2017 Outpatient-Service Payment Rules

At the urging of the College of Information Management Executives (CHIME), CMS reduced reporting periods for 2016 and 2017 from one year to 90 days.

More importantly, the "Modified Stage 2" finalized by last week's rule removed 2017 reporting requirements in the categories of clinical decision support (CDS) and computerized physician order entry (CPOE). In addition, these requirements were also removed from meaningful use stage 3, which hospitals must still comply with in 2018 and beyond.

While the result of Tuesday's presidential and congressional elections could spell further change, even radical change, in the meaningful use program, it has already been replaced in 2017 with the advancing care information provisions of MACRA.

Tech Remedies for Regulatory Compliance

Nevertheless, at CHIME's annual meeting in Phoenix last week, officials were relieved that in the waning days of the Obama Administration, the meaningful use program, often credited with increasing the incidence of physician burnout, won't impose quite as much of a reporting burden in future years.

"That is fabulous for all of us," says Liz Johnson, chief information officer for acute care hospitals and applied clinical informatics at Tenet Health in Dallas. She briefed CHIME attendees.

"CHIME took a lead position reminding ONC and CMS over and over that we need time between attestation periods to do little things," such as making upgrades and stabilizing environments.

Johnson says CHIME members would like to see the 90-day reporting period become a permanent way of attesting to meaningful use, rather than the original CMS vision of 365-day attestation. "We can't seem to get there," she says. "We get [90 days] one year at a time. We got two years this time."

The CDS and CPOE requirements were removed because meaningful use participants are required to certify that they have an EHR certified by CMS and ONC. Every certified EHR has those components, "so they're no longer making us report them separately," Johnson says.

Tenet intends to continue to have its physicians use CPOE and to measure their use of it.

"We were not ever as concerned about how many medication orders you put in, as we were concerned about doctors using a tremendous tool to help deliver care in a safe way," she says. "We believe this is the right thing to do, and it's going to change outcomes if they use the order sets that have been developed by them."

With the CPOE reporting requirement removed from meaningful use, vendors may feel free to take away such reporting functions from the EHRs themselves, according to Johnson.

"So be careful," she says. "If you want to continue to report, and you're dependent on your vendor to do that, often they remove that functionality with new editions, and you no longer have that reporting functionality."

In such cases, providers have two choices: negotiate with their EHR vendors to keep doing that reporting, or create their own reporting, "but be prepared for that," Johnson says.

MACRA, the End of Meaningful Use, and Beyond

Of course, looming behind the good meaningful use news is the challenge that hospital physicians face in complying with MACRA starting in 2017, with increasing demands in subsequent years, not to mention the requirements of meaningful use stage 3, which take effect in 2018 and will require EHR software upgrades throughout 2017.

Regarding MACRA, "especially for the quality measures, the payment is not based on meeting a threshold like we're used to with meaningful use," says Mike Martz, vice president and chief integration officer of Ohio Valley Health Services and Education, addressing the same CHIME audience.

"This whole program is keyed around us as providers competing against each other, and how well we get paid depends how much better we are than you or how much better you are than us," says Martz.

"So it's important that all of us change our mentality that we've had with meaningful use of doing just enough, to now doing as much as we possibly can, as best as we can, because we can still do far better than we're doing with meaningful use and lose money. That is a culture change that we have to drive in organizations."